J Korean Neurosurg Soc.  2015 Sep;58(3):248-253. 10.3340/jkns.2015.58.3.248.

Clinical Outcome of Treatment for Patients with Giant Cell Tumor in Spine

• Kim SC
• Cho W
• Chang UK
• Youn SM

• KMID: 2191376
• DOI: http://doi.org/10.3340/jkns.2015.58.3.248

Abstract

OBJECTIVE
The treatment of giant cell tumor (GCT) is mainly performed surgically. However, GCT in spine seems difficult to treat because of the limited surgical accessibility and proximity. In this report, we analyzed the outcome of GCT treatment in spine.
METHODS
Between 2000 and 2012, 19 patients received treatment for GCT in spine. Median age at their first diagnosis was 31 years, 10 patients were male, and 9 female. Fourteen tumors were located in the sacrum, 1 in cervical, 1 in thoracic and 3 in lumbar spine. As primary treatment, gross total removal (GTR) was done in 6 patients, and subtotal removal (STR) in 13 patients. Radiation therapy (RT) as an adjuvant therapy was performed in 2 cases in GTR group and 10 cases in STR group.
RESULTS
During the follow-up, 7 patients had local recurrence (36.8%). The average period until recurrence after primary treatment was 14 months. No recurrence was detected in GTR group. Recurrence was noted in 7 out of 13 patients who underwent STR. These differences were statistically significant (p=0.024). A median of recurrence free period (RFP) was 84 months. Also average RFP of the RT group was 112 months, and non-RT group was 65 months. These differences were statistically significant (p=0.041).
CONCLUSION
Treatment of choice for GCT in spine is a complete removal of tumor without neurological deficits. In case of incomplete removal, radiation therapy may be a useful adjuvant treatment modality.

Keyword

Giant cell tumor; Recurrence; Radiotherapy

MeSH Terms

Diagnosis
Female
Follow-Up Studies
Giant Cell Tumors*
Giant Cells*
Humans
Male
Radiotherapy
Recurrence
Sacrum
Spine*

Figure

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  Fig. 1 Recurrence free period of patients with giant cell tumor. Median value of recurrence free period is 84 months.

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  Fig. 2 Average value of recurrecnce free period is 112 months in radiation therapy group and 65 months in non-radiation therapy group (p=0.041).

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  Fig. 3 A : Preoperative magnetic resonance (MR) image. Heterogeneously enhancing huge mass showed in sacrum and presacral area. Involvement of sacral foramen and right sacroiliac joint. B : Postoperative computed tomography scan. Remained bony destruction of sacrum with low attenuating and globular enhancing lesion. C : MR image when recurrence. Increased extent of heterogeneously enhancing lesion in remained sacrum and presacral mass. Enhancing mass progressed to the left side in paraspinal muscle and sacroiliac joint. D : Last follow-up MR image. No displaying signs of recurrence 94 months after the reoperation.

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  Fig. 4 A : Preoperative MR image. Heterogeneously enhancing mass involving in sacrum, sacral canal, right sacroiliac joint and pelvic cavity. B : Postoperative MR image. Remaining enhancing lesion in sacrum and right sacroiliac joint. C : Cyberknife® radiosurgery (marginal dose 3000 cGy) was performed. D : Last follow-up MR image. No change in enhancing lesion for 68 months.

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