title: Recurrent Spinal Giant Cell Tumors: A Study of Risk Factors and Recurrence Patterns.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To highlight risk factors, recurrence patterns and multimodal treatment in management of recurrent giant cell tumors (GCTs).
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Spine Surgery, Wockhardt Hospital, Mumbai, India.
authors.forename: Sanganagouda
authors.initials: S
authors.lastname: Patil
authors.affiliation: Department of Spine Surgery, Wockhardt Hospital, Mumbai, India.
authors.forename: Kunal Chandrakant
authors.initials: KC
authors.lastname: Shah
authors.affiliation: Department of Spine Surgery, Wockhardt Hospital, Mumbai, India.
authors.forename: Shekhar Yeshwant
authors.initials: SY
authors.lastname: Bhojraj
authors.affiliation: Department of Spine Surgery, Wockhardt Hospital, Mumbai, India.
authors.forename: Abhay Madhusudhan
authors.initials: AM
authors.lastname: Nene
keywords: Giant cell tumor; Intralesional curettage; Radiotherapy; Recurrence; Risk factor