title: Management of spinal giant cell tumors.
abstract: BACKGROUND
  Spinal giant cell tumors (SGCT) remain challenging tumors to treat. Although advancements in surgical techniques and adjuvant therapies have provided new options for treatment, evidence-based algorithms are lacking.
  
  
  OBJECTIVE
  This study aims to review the peer-reviewed literature that addresses current treatment options and management of SGCT, to produce an evidence-based treatment algorithm.
  
  
  METHODS
  A systematic review was performed.
  
  
  METHODS
  Articles published between January 1, 1970 and March 31, 2015 were selected from PubMed and EMBASE searches using keywords "giant cell tumor" AND "spine" AND "treatment." Relevant articles were selected by the authors and reviewed.
  
  
  RESULTS
  A total of 515 studies were identified, of which 81 studies were included. Complete surgical resections of SCGT resulted in the lowest recurrence rates. However, morbidity of en bloc resections is high and in some cases, surgery is not possible. Intralesional resection can be coupled with adjuvant therapies, but evidence-based algorithms for use of adjuvants remain elusive. Several recent advancements in adjuvant therapy may hold promise for decreasing SGCT recurrence, specifically stereotactic radiotherapy, selective arterial embolization, and medical therapy using denosumab and interferon.
  
  
  CONCLUSIONS
  Complete surgical resection of SGCT should be the goal when possible, particularly if neurologic impairment is present. Denosumab holds promise as an adjuvant and perhaps stand-alone therapy for SGCT. Spinal giant cell tumors should be approached as a case-by-case problem, as each presents unique challenges. Collaboration of spine surgeons, radiation oncologists, and medical oncologists is the best practice for treating these difficult tumors.
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkoknoi, Bangkok 10700, Thailand.
authors.forename: Panya
authors.initials: P
authors.lastname: Luksanapruksa
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St. Louis, 425 South Euclid Ave., St. Louis, MO 63110, USA. Electronic address: buchowskij@wustl.edu.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Chulalongkorn University; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
authors.forename: Weerasak
authors.initials: W
authors.lastname: Singhatanadgige
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Gonda 14S, Rochester, MN 55905, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rose
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St. Louis, 425 South Euclid Ave., St. Louis, MO 63110, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bumpass
mesh_terms: D005260:Female; D005870:Giant Cell Tumors / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000601:surgery*
keywords: Adjuvant therapy; Denosumab; Giant cell tumor; Mobile spine; Sacrum; Spine tumor