En Bloc Resection Versus Intralesional Surgery in the Treatment of Giant Cell Tumor of the Spine.
METHODS
Multicenter, ambispective observational study.


OBJECTIVE
The aim of this study was to quantify local recurrence (LR) and mortality rates after surgical treatment of spinal giant cell tumor and to determine whether en bloc resection with wide/marginal margins is associated with improved prognosis compared to an intralesional procedure.


BACKGROUND
Giant cell tumor (GCT) of the spine is a rare primary bone tumor known for its local aggressiveness. Optimal surgical treatment remains to be determined.


METHODS
The AOSpine Knowledge Forum Tumor developed a comprehensive multicenter database including demographics, presentation, diagnosis, treatment, mortality, and recurrence rate data for GCT of the spine. Patients were analyzed based on surgical margins, including Enneking appropriateness.


RESULTS
Between 1991 and 2011, 82 patients underwent surgery for spinal GCT. According to the Enneking classification, 59 (74%) tumors were classified as S3-aggressive and 21 (26%) as S2-active. The surgical margins were wide/marginal in 27 (36%) patients and intralesional in 48 (64%) patients. Thirty-nine of 77 (51%) underwent Enneking appropriate (EA) treatment and 38 (49%) underwent Enneking inappropriate (EI) treatment. Eighteen (22%) patients experienced LR. LR occurred in 11 (29%) EI-treated patients and six (15%) EA-treated patients (P = 0.151). There was a significant difference between wide/marginal margins and intralesional margins for LR (P = 0.029). Seven (9%) patients died. LR is strongly associated with death (Relative Risk 8.9, P < 0.001). Six (16%) EI-treated patients and one (3%) EA-treated patients died (P = 0.056). With regards to surgical margins, all patients who died underwent intralesional resection (P = 0.096).


CONCLUSIONS
En bloc resection with wide/marginal margins should be performed when technically feasible because it is associated with decreased LR. Intralesional resection is associated with increased LR, and mortality correlates with LR.


METHODS
3.
Department of Orthopaedics, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada.
Raphaële
R
Charest-Morin
Department of Orthopaedics, Division of Spine, The University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
Charles G
CG
Fisher
National Center for Spinal Disorders, Budapest, Hungary.
Peter P
PP
Varga
Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.
Ziya L
ZL
Gokaslan
Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Laurence D
LD
Rhines
Oxford Spinal Unit, Oxford University Hospitals, Oxford, United Kingdom.
Jeremy J
JJ
Reynolds
The CORE Institute, Pheonix, AZ.
Mark B
MB
Dekutoski
Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham University Hospital, Nottingham.
Nasir A
NA
Quraishi
Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Mark H
MH
Bilsky
Department of Neurosurgery and Spinal Program, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
Michael G
MG
Fehlings
Department of Neurological Surgery, University of San Francisco California, San Francisco, CA.
Dean
D
Chou
Research Department, AOSpine International, Davos, Switzerland.
Niccole M
NM
Germscheid
Orthopaedic Oncology and Reconstruction of the Spine, Galeazzi Orthopaedic Institute, Milan, Italy.
Alessandro
A
Luzzati
Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna, Italy.
Stefano
S
Boriani
D005870:Giant Cell Tumors / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D013131:Spine / Q000601:surgery*