A Review of Endovascular Techniques as Therapy for Inoperable Giant Cell Bone Tumors of the Sacrum, Pelvis, and Spine

Giant cell tumor (GCT) of bone is a benign but locally aggressive neoplasm. Lesions in the sacrum, pelvis, and spine present surgical challenges due to complex anatomy. Selective arterial embolization (SAE) is a minimally invasive treatment option for inoperable GCTs. A narrative review of PubMed and Embase (1976–2024) identified studies that included patients with biopsy-proven GCTs of the sacrum, pelvis, or spine treated with SAE. Inclusion required non-surgical candidacy, treatment with SAE alone, or SAE with denosumab and/or radiotherapy. Studies involving GCTs of the extremities, surgical resection, or preoperative embolization were excluded. Outcomes that were assessed included clinical and radiographic response, recurrence, and complications. Among 70 patients, SAE alone showed 86% (25/29) clinical and 79% (23/29) radiographic response rates. SAE with radiotherapy showed a higher clinical and radiographic response than SAE with denosumab (83% clinical and 65% radiographic versus 39% clinical and 50% radiographic). Recurrence and metastasis varied across groups. SAE is an effective therapy for inoperable GCTs of the axial skeleton. Further studies are needed to optimize treatment protocols.