En bloc resection versus intralesional surgery in the treatment of giant cell tumor of the spine.
Spine (Phila Pa 1976). 2017 Jan 31;:
Authors: Charest-Morin R, Fisher CG, Varga PP, Gokaslan ZL, Rhines LD, Reynolds JJ, Dekutoski MB, Quraishi NA, Bilsky MH, Fehlings MG, Chou D, Germscheid NM, Luzzati A, Boriani S, AOSpine Knowledge Forum Tumor
STUDY DESIGN: Multicenter, ambispective observational study OBJECTIVE.: To quantify local recurrence 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 intra-lesional procedure.
SUMMARY OF BACKGROUND DATA: Giant cell tumor 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 giant cell tumor of the spine. Patients were analysed based on surgical margins, including Enneking appropriateness.
RESULTS: Between 1991 and 2011, 82 patients underwent surgery for spinal giant cell tumor. 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 intra-lesional in 48 (64%) patients. 39/77 (51%) underwent Enneking appropriate (EA) treatment and 38 (49%) underwent Enneking inappropriate (EI) treatment. Eighteen (22%) patients experienced local recurrence (LR). LR occurred in 11 (29%) EI-treated patients and 6 (15%) EA-treated patients (p = 0.151). There was a significant difference between wide/marginal margins and intra-lesional margins for LR (p = 0.029). Seven (9%) patients died. LR is strongly associated with death (RR 8.9, p < 0.001). Six (16%) EI-treated patients and one (3%) EA-treated patient died (p = 0.056). With regards to surgical margins, all patients who died underwent intra-lesional resection (p = 0.096).
CONCLUSION: En bloc resection with wide/marginal margins should be performed when technically feasible because it is associated with decreased LR. Intra-lesional resection is associated with increased LR, and mortality correlates with LR.
PMID: 28146024 [PubMed – as supplied by publisher]