title: Therapeutic radiotherapy for giant cell tumor of the spine: a systemic review.
abstract: BACKGROUND
  Giant cell tumor of the bone (GCTB) is a benign but locally aggressive tumor. Giant cell tumor of the spine (GCTS) accounts for 3-6 % of GCTB. Surgery remains the treatment of choice. For those not suitable for surgery, therapeutic radiotherapy (RT) is one classic modality. Although there are several articles on therapeutic RT for GCTS therapy, few systemic reviews have been performed on effects of therapeutic RT on GCTS.
  
  
  METHODS
  We searched EMBASE and Medline databases for papers reporting therapeutic radiotherapy for GCTS patients not suitable for surgical resection. The inclusion criteria and prognosis indicators have been defined prior to data extraction. Information of the included patients has been discreetly recorded. We analyzed the prognosis of therapeutic RT and multiple data concerning the GCTS patients. The indicators for prognosis were computed by SPSS software. The local control (LC) and overall survival (OS) rate was estimated by the Kaplan-Meier method. p values ≤0.5 were considered statistically significant.
  
  
  RESULTS
  We included 13 studies comprising 42 patients who received therapeutic radiotherapy with doses ranging from 21 to 80 Gy. The results suggested a response rate of 100 %, OS of 97.6 %, 1-year local control rate (LC) of 85.4 %, 2-year LC rate of 80.2 %, and overall LC of 79 %. No patient reported malignant transformation albeit four had post-RT neurological complications. Four had distant metastasis of the tumor. Patients with previously repeated recurrence had worse prognosis after RT (p = 0.028). No association between dosage and prognosis was found.
  
  
  CONCLUSIONS
  Therapeutic RT could provide a satisfactory prognosis for GCTS patients according to this study, and can be an alternative treatment modality for GCTS patients not suitable for surgery.
authors.affiliation: Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Huabin
authors.initials: H
authors.lastname: Yin
authors.forename: Quan
authors.initials: Q
authors.lastname: Huang
authors.forename: Tielong
authors.initials: T
authors.lastname: Liu
authors.forename: Xinghai
authors.initials: X
authors.lastname: Yang
authors.forename: Haifeng
authors.initials: H
authors.lastname: Wei
authors.forename: Jianru
authors.initials: J
authors.lastname: Xiao
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003131:Combined Modality Therapy; D018212:Giant Cell Tumor of Bone / Q000532:radiotherapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011879:Radiotherapy Dosage; D013125:Spinal Neoplasms / Q000532:radiotherapy; D016019:Survival Analysis