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Giant Cell Tumor of the Mobile Spine: A Review of 49 Cases

Boriani, Stefano MD*; Bandiera, Stefano MD*; Casadei, Roberto MD; Boriani, Luca MD; Donthineni, Rakesh MD, MBA; Gasbarrini, Alessandro MD*; Pignotti, Elettra MSc§; Biagini, Roberto MD; Schwab, Joseph H. MD, MS

doi: 10.1097/BRS.0b013e3182233ccd
Clinical Case Series

Study Design. This is a retrospective review of 49 cases of giant cell tumor (GCT) of the mobile spine treated surgically.

Objective. Our goal was to determine which factors influenced local recurrence.

Summary of Background Data. GCT is a benign, locally aggressive tumor that rarely occurs in the spine. The management of local recurrence can be challenging.

Methods. We performed a retrospective analysis of GCTs of the mobile spine managed between 1970 and 2005. Median follow-up was 145 months with a minimum of 2 years or until death. We used the Kaplan-Meier method to test whether Enneking stage, surgery type, and surgical margin had statistically significant impact on local recurrence. The log rank test was used for comparison, and a P value of less than 0.05 was deemed significant.

Results. Of the 49 patients, 11 (22%) local recurrences occurred. The latest recurrence occurred at 60 months. Age less than 25 years was associated with a worse relapse-free survival (P = 0.03). En bloc resection was associated with better local control with Enneking stage III tumors (P = 0.01); however, intralesional resection provided adequate control of Enneking stage II tumors. There were 6 (12%) cases of metastasis, and 2 patients died from the progression of their disease. One patient died from the complications of the surgery.

Conclusion. En bloc resection should be considered for Enneking stage III GCTs of the mobile spine. The choice of en bloc resection must be balanced with the inherent risks of the procedure. Intralesional resection of Enneking stage II tumors provides adequate local control. Patients should be followed for at least 5 years because local relapse can occur late.

We retrospectively reviewed 49 cases of giant cell tumor of the mobile spine treated surgically. Enneking stage III tumors had higher rates of local recurrence. En bloc resection provided adequate local control for Enneking stage III tumors. Enneking stage II tumors were adequately controlled with intralesional curettage.

*Department of Spine Oncology, Rizzoli Institute, Bologna, Italy;

Department of Oncologic Surgery, Rizzoli Institute, Bologna, Italy;

Alta Bates Medical Center, Berkeley, CA;

§Statistical Analysis TF, Rizzoli Institute, Bologna, Italy;

Department of Orthopedic Oncology, IFO, Rome, Italy;

Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA.

Address correspondence and reprint requests to Joseph H. Schwab, MD, MS, Sections of Orthopedic Oncology and Spine Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; E-mail: jhschwab@partners.org

Acknowledgment date: October 11, 2010. Revision date: February 18, 2011. Acceptance date: April 4, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.