title: Management of eosinophilic granuloma in pediatric patients: surgical intervention and surgery combined with postoperative radiotherapy and/or chemotherapy.
abstract: BACKGROUND
  Eosinophilic granuloma (EG) of spine in pediatric patients presents kinds of clinical manifestation and a difficult management scenario. The choice of treatment, issues of surgical intervention versus conservative treatment, combination therapy or single treatment, all these factors, including neurological deficits, spinal stability, long-term complications, and continued skeletal growth, must be considered.
  
  
  METHODS
  From 2008 to the 2015, 31 pediatric patients of spinal EG were retrospectively reviewed. They were 17 males and 14 females, with a mean age 8.89 ± 2.84 years old (range, 3.5-14 years old). All the cases were divided into two groups. Twenty-three cases (Group S) accepted surgical interventions and surgery combined with local low-dose radiotherapy and/or chemotherapy. Eight patients (Group C) accepted radiotherapy and/or chemotherapy. All the patients had imaging studies of the lesion including standard radiography, three-dimensional computed tomography (CT) scan, and magnetic resonance imaging (MRI) prior to and after treatment. Cases in group S underwent surgery-related treatment, which include six patients accepted surgery only, nine patients accepted postoperative low-dose radiotherapy, four patients accepted additional chemotherapy, and four patients accepted both. Cases in group C accepted radiotherapy and/or chemotherapy, which include five patients accepted radiotherapy, one patient accepted chemotherapy, and two patients accepted both radiotherapy and chemotherapy. Clinical symptoms, neurologic status, radiologic manifestations, treatment, outcome, and/or complications were recorded and analyzed.
  
  
  RESULTS
  All the 31 patients had pain relief (both in group S and group C) but the patients in group S obtained more prompt pain relief. All the patients in group S obtained local kyphosis correction, reconstruction of stability of spine, and recovery of neurological deficit after treatment. They have no surgery-related complications after treatment and in follow-up. Seventeen patients who received additional postoperative radiotherapy and/or chemotherapy also had good outcomes. There were no severe radiation and chemotherapy complications in procedure. The patients (group C) who accepted non-surgical treatment also have no severe complications, and a new femur lesion was found in one patient in follow-up.
  
  
  CONCLUSIONS
  Surgical intervention, including anterior and/or posterior approach with bone graft or surgery combined with postoperative low-dose radiotherapy and/or chemotherapy is a safe and effective way for treatment of the spinal EG. Compared with radiotherapy and/or chemotherapy, more prompt pain relief can be achieved via surgical intervention or surgery combined radiotherapy and/or chemotherapy.
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan Province, 410008, China.
authors.forename: Zhenhai
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan Province, 410008, China.
authors.forename: Hongqi
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan Province, 410008, China. guochaofeng2016@126.com.
authors.forename: Chaofeng
authors.initials: C
authors.lastname: Guo
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan Province, 410008, China.
authors.forename: Honggui
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan Province, 410008, China.
authors.forename: Longjie
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan Province, 410008, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods*; D004803:Eosinophilic Granuloma / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007738:Kyphosis; D008279:Magnetic Resonance Imaging; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011878:Radiotherapy; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Eosinophilic granuloma; Radiotherapy; Surgical intervention