An Assessment of the Reliability of the Enneking and Weinstein-Boriani-Biagini Classifications for Staging of Primary Spinal Tumors by the Spine Oncology Study Group

Chan, Peter; Boriani, Stefano; Fourney, Daryl R.; Biagini, R.; Dekutoski, Mark B.; Fehlings, Michael G.; Ryken, Timothy C.; Gokaslan, Ziya L.; Vrionis, Frank D.; Harrop, James S.; Schmidt, Meic H.; Vialle, Luis Roberto Gomes; Gerszten, Peter C.; Rhines, Laurence D.; Ondra, Stephen L.; Pratt, Stuart R.; Fisher, Charles G.

doi:10.1097/brs.0b013e3181971283

Cited by 106 publications

(68 citation statements)

References 29 publications

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“…En bloc resection with wide margins is the recommended surgical treatment for Enneking Stage III tumors. 2,5,7,9 There is significant morbidity associated with this surgery evident in both the current and previous series. 2 In this study, denosumab was given preoperatively with the aim of shrinking and calcifying the tumor, thereby improving the ease and safety of surgery.…”

Section: Discussionmentioning

confidence: 86%

Giant cell tumors of the spine: has denosumab changed the treatment paradigm?

Goldschlager

Dea²,

Boyd³

et al. 2015

SPI

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OBJECT Giant cell tumors (GCTs) of the spine are rare and complex to treat. They have a propensity for local recurrence and the potential to metastasize. Treatment is currently surgical and presents unique challenges due to the proximity of neural structures and the need for reconstruction. Denosumab has been shown in clinical trials to be an effective treatment for GCT, but has not yet been studied specifically in GCT of the spine or as a surgical adjunct. To the authors' knowledge this is the first such reported series. METHODS A multicenter, prospective series of 5 patients with GCT of the spine treated with denosumab were included. Patient demographic data, oncological history, neurological status, tumor staging, treatment details and adverse events, surgical procedure, complications, radiological and histological responses, and patient outcome were analyzed. RESULTS All patients were women, with a mean age of 38 years, and presented with pain; 2 patients had additional neurological signs and symptoms. The mean duration of symptoms was 62 weeks. No patient had a prior tumor or metastatic disease at presentation. All patients had Enneking Stage III tumors and were treated with monthly cycles of 120 mg of denosumab, with initial additional loading doses on Days 8 and 15. Patients were given daily supplements of calcium (500 mg) and vitamin D (400 IU). There were no denosumab-related adverse events. All patients had a radiological response to denosumab. One patient failed to have a histological response to denosumab, with > 90% of tumor cells found to be viable on histological investigation. CONCLUSIONS This study reports the early experience of using denosumab in the treatment of spinal GCT. The results demonstrate a clinically beneficial radiological response and an impressive histological response in most but not all patients. Further experience with denosumab and longer patient follow-up is required. Denosumab has the potential to change the treatment paradigm for spinal GCT.

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Section: Discussionmentioning

confidence: 86%

Giant cell tumors of the spine: has denosumab changed the treatment paradigm?

Goldschlager

Dea²,

Boyd³

et al. 2015

SPI

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“…The cases were staged according to the Enneking system: st.2 for active lesions and st.3 for benign aggressive lesions [12]. This staging system has recently been submitted to a intra and interobserver reliability study which confirmed its validity [13].…”

Section: Methodsmentioning

confidence: 99%

Staging and treatment of osteoblastoma in the mobile spine: a review of 51 cases

et al. 2012

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“…Use of this system along with the Weinstein-Boriani-Biagini (WBB) classification has been studied for spinal tumors and appears to be safe and feasible and to improve disease control and survival, although both systems show only moderate interobserver reliability and additional studies are warranted [1]. Classification is considered safe when prognostication outlined in the classification system corresponds and correlates with outcomes in clinical practice.…”

Section: Limitationsmentioning

confidence: 99%