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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 2 with single recurrence. (A) Computed tomography (CT) image showing recurrence with well placed previous implants. (B) Radiograph at 10 years showing no recurrence. (C) CT image at 10 years showing no recurrence.
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Figure 3: Case 2 with single recurrence. (A) Computed tomography (CT) image showing recurrence with well placed previous implants. (B) Radiograph at 10 years showing no recurrence. (C) CT image at 10 years showing no recurrence.

Mentions: Compared to an autograft, the acrylic cement and metal cage is the preferred modality for anterior column reconstruction, as it provides immediate stability. The frequently used postoperative radiotherapy in GCTs often hampers the strength of autograft construct. GCT can recur in the grafted bone, which is very difficult to diagnose when compared to acrylic cement/metal cage [1314]. GCT recurrence typically presents on radiographs as a thin, hypointense line separating the tumor from acrylic cement/metal cage [15]. In our series, metal cage impregnated with acrylic bone cement was used in the majority of our patients. Fig. 3 shows use of cement following intralesional curettage in case 2.


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 2 with single recurrence. (A) Computed tomography (CT) image showing recurrence with well placed previous implants. (B) Radiograph at 10 years showing no recurrence. (C) CT image at 10 years showing no recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Case 2 with single recurrence. (A) Computed tomography (CT) image showing recurrence with well placed previous implants. (B) Radiograph at 10 years showing no recurrence. (C) CT image at 10 years showing no recurrence.
Mentions: Compared to an autograft, the acrylic cement and metal cage is the preferred modality for anterior column reconstruction, as it provides immediate stability. The frequently used postoperative radiotherapy in GCTs often hampers the strength of autograft construct. GCT can recur in the grafted bone, which is very difficult to diagnose when compared to acrylic cement/metal cage [1314]. GCT recurrence typically presents on radiographs as a thin, hypointense line separating the tumor from acrylic cement/metal cage [15]. In our series, metal cage impregnated with acrylic bone cement was used in the majority of our patients. Fig. 3 shows use of cement following intralesional curettage in case 2.

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