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Recurrent Spinal Giant Cell Tumors: A Study of Risk Factors and Recurrence Patterns.

Patil S, Shah KC, Bhojraj SY, Nene AM - Asian Spine J (2016)

Bottom Line: However, resection is associated with morbidity and mortality.Recurrent GCTs are challenging entities.Intralesional surgery could be a safer and effective modality in managing recurrences.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, Wockhardt Hospital, Mumbai, India.

ABSTRACT

Study design: Retrospective study.

Purpose: To highlight risk factors, recurrence patterns and multimodal treatment in management of recurrent giant cell tumors (GCTs).

Overview of literature: GCTs of the spine are rare and challenging entities. Recurrences are very common and warrant complex management to prevent multiple recurrences. Gross total resection is preferred over subtotal procedures to prevent recurrences. However, resection is associated with morbidity and mortality. Proper understanding of risk factors and a high index of suspicion helps to spot recurrences early and aids in subsequent management.

Methods: Ten patients (six females, four males) with recurrent GCTs underwent 17 interventions. There were six lesions in the thoracic spine, two in the cervical spine and two in the lumbar spine. Recurrences were managed with preoperative digital subtraction embolization, intralesional curettage and postoperative radiotherapy.

Results: The average age at intervention was 31.3 years. The average duration of recurrence in patients following index surgery in a tertiary care hospital and surgery elsewhere was 7.3 years and was 40 months, respectively. The minimum recurrence-free interval after the last recurrent surgery was 10 years.

Conclusions: Our study reports the largest recurrence-free interval for GCTs. Recurrent GCTs are challenging entities. Understanding of risk factors and meticulous planning is required to prevent recurrences. Intralesional surgery could be a safer and effective modality in managing recurrences.

No MeSH data available.


Related in: MedlinePlus

Case 5 with single recurrence. (A) Sagittal magnetic resonance image (MRI) showing pathological fracture at L2. (B) Axial MRI showing lesion. (C) Coronal MRI showing lesion. (D) Immediate postoperative radiograph (posterior decompression with Hartshill stabilization with anterior bone grafting). (E, F) Computed tomography images show recurrence after 8 years. (G) Radiograph at the 10-year follow-up after second recurrence surgery showing sclerosed bone and no recurrence.
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Figure 2: Case 5 with single recurrence. (A) Sagittal magnetic resonance image (MRI) showing pathological fracture at L2. (B) Axial MRI showing lesion. (C) Coronal MRI showing lesion. (D) Immediate postoperative radiograph (posterior decompression with Hartshill stabilization with anterior bone grafting). (E, F) Computed tomography images show recurrence after 8 years. (G) Radiograph at the 10-year follow-up after second recurrence surgery showing sclerosed bone and no recurrence.

Mentions: The average age of the patients at time of index surgery was 31.3 years (range, 25–40 years). The average recurrence free interval (six recurrences) in patients operated on in our tertiary care hospital was 7.3 years (range, 5–9 years) compared to patients who had their primary surgery elsewhere (40 months; range, 3–96 months). The minimum postoperative follow-up period after the last revision surgery was 10 years, which represents the longest recurrence-free interval yet reported. All four patients with neurologic deficits improved to Frankel grade E in the immediate postoperative period. Patients with preoperative neurologic deficit of more than Frankel grade C took more than 3 months to improve to Frankel grade E. Postoperative radiotherapy was given in all patients. The patients who were operated elsewhere and presented to us with recurrence had not received radiotherapy after their index surgeries. There were no major complications. Two patients had superficial wound infections that healed uneventfully. There were no malignant transformations. However, there were recurrences (Table 1). Cases of double and single recurrence are presented in Figs. 1 and 2, respectively.


Recurrent Spinal Giant Cell Tumors: A Study of Risk Factors and Recurrence Patterns.

Patil S, Shah KC, Bhojraj SY, Nene AM - Asian Spine J (2016)

Case 5 with single recurrence. (A) Sagittal magnetic resonance image (MRI) showing pathological fracture at L2. (B) Axial MRI showing lesion. (C) Coronal MRI showing lesion. (D) Immediate postoperative radiograph (posterior decompression with Hartshill stabilization with anterior bone grafting). (E, F) Computed tomography images show recurrence after 8 years. (G) Radiograph at the 10-year follow-up after second recurrence surgery showing sclerosed bone and no recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764524&req=5

Figure 2: Case 5 with single recurrence. (A) Sagittal magnetic resonance image (MRI) showing pathological fracture at L2. (B) Axial MRI showing lesion. (C) Coronal MRI showing lesion. (D) Immediate postoperative radiograph (posterior decompression with Hartshill stabilization with anterior bone grafting). (E, F) Computed tomography images show recurrence after 8 years. (G) Radiograph at the 10-year follow-up after second recurrence surgery showing sclerosed bone and no recurrence.
Mentions: The average age of the patients at time of index surgery was 31.3 years (range, 25–40 years). The average recurrence free interval (six recurrences) in patients operated on in our tertiary care hospital was 7.3 years (range, 5–9 years) compared to patients who had their primary surgery elsewhere (40 months; range, 3–96 months). The minimum postoperative follow-up period after the last revision surgery was 10 years, which represents the longest recurrence-free interval yet reported. All four patients with neurologic deficits improved to Frankel grade E in the immediate postoperative period. Patients with preoperative neurologic deficit of more than Frankel grade C took more than 3 months to improve to Frankel grade E. Postoperative radiotherapy was given in all patients. The patients who were operated elsewhere and presented to us with recurrence had not received radiotherapy after their index surgeries. There were no major complications. Two patients had superficial wound infections that healed uneventfully. There were no malignant transformations. However, there were recurrences (Table 1). Cases of double and single recurrence are presented in Figs. 1 and 2, respectively.

Bottom Line: However, resection is associated with morbidity and mortality.Recurrent GCTs are challenging entities.Intralesional surgery could be a safer and effective modality in managing recurrences.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, Wockhardt Hospital, Mumbai, India.

ABSTRACT

Study design: Retrospective study.

Purpose: To highlight risk factors, recurrence patterns and multimodal treatment in management of recurrent giant cell tumors (GCTs).

Overview of literature: GCTs of the spine are rare and challenging entities. Recurrences are very common and warrant complex management to prevent multiple recurrences. Gross total resection is preferred over subtotal procedures to prevent recurrences. However, resection is associated with morbidity and mortality. Proper understanding of risk factors and a high index of suspicion helps to spot recurrences early and aids in subsequent management.

Methods: Ten patients (six females, four males) with recurrent GCTs underwent 17 interventions. There were six lesions in the thoracic spine, two in the cervical spine and two in the lumbar spine. Recurrences were managed with preoperative digital subtraction embolization, intralesional curettage and postoperative radiotherapy.

Results: The average age at intervention was 31.3 years. The average duration of recurrence in patients following index surgery in a tertiary care hospital and surgery elsewhere was 7.3 years and was 40 months, respectively. The minimum recurrence-free interval after the last recurrent surgery was 10 years.

Conclusions: Our study reports the largest recurrence-free interval for GCTs. Recurrent GCTs are challenging entities. Understanding of risk factors and meticulous planning is required to prevent recurrences. Intralesional surgery could be a safer and effective modality in managing recurrences.

No MeSH data available.


Related in: MedlinePlus