Giant cell tumor of the lumbar spine: operative management via spondylectomy and short-segment, 3-column reconstruction with pedicle recreation

Samartzis, Dino; Foster, William C.; Padgett, Diana M.; Shen, Francis H.

doi:10.1016/j.surneu.2007.01.038

Cited by 21 publications

(16 citation statements)

References 16 publications

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“…Due to the high complication rate in recurrent giant cell tumors of the spine, a marginal or even wide primary surgery according to Enneking (Enneking et al 1980) may be justiWed for this localization (Chen et al 2004;Gille et al 2005;Gruber et al 1999;Ozaki et al 2002). Some authors recommend spondylectomy as an aggressive operative treatment to prevent local recurrences (Kawahara et al 1998;Samartzis et al 2008) especially because of the diYculty to use conventional treatment options with curettage and cementing in these localizations (Matsumoto et al 2007). According to Fiedler (Fidler 2001) the en bloc approach is the safest technique.…”

Section: Discussionmentioning

confidence: 99%

Treatment options for recurrent giant cell tumors of bone

Balke

Ahrens

Streitbuerger

et al. 2008

J Cancer Res Clin Oncol

100

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Section: Discussionmentioning

confidence: 99%

Treatment options for recurrent giant cell tumors of bone

Balke

Ahrens

Streitbuerger

et al. 2008

J Cancer Res Clin Oncol

100

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“…Recognition of the aggressive tumors is critical because they require complex surgical treatment to minimize the chances of local recurrence. [2][3][4]11,15,17 Surgical en bloc reabbreviatioNS ASIA = American Spinal Injury Association; GCT = giant cell tumor; RANKL = receptor activator of nuclear factor kappa B ligand; WBB = WeinsteinBoriani-Biagini. obJect Giant cell tumors (GCTs) of the spine are rare and complex to treat.…”

mentioning

confidence: 99%

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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“…14 Both chordomas and GCTs in the spine can compress nerve root or spinal cord, and cause pain, weakness, or even paraplegia. 15 …”

Section: Discussionmentioning

confidence: 99%

Morphological and dynamic contrast enhanced MR imaging features for the differentiation of chordoma and giant cell tumors in the Axial Skeleton

Xing

et al. 2016

Magnetic Resonance Imaging

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Purpose: To characterize the morphological and dynamic-contrast-enhanced (DCE) MRI features of chordoma and giant cell tumor (GCT) of bone occurring in the axial skeleton. Materials and Methods: A total of 13 patients with chordoma and 26 patients with GCT who received conventional T1, T2, and DCE-MRI on 3 Tesla MR scanners were retrospectively identified and analyzed. Two radiologists evaluated morphological features independently, including the lesion location, expansile bone changes, vertebral compression, presence of paraspinal soft tissue mass, fibrous septa, and the signal intensity on T1WI and T2WI. The inter-observer agreement was evaluated by kappa test. The DCE kinetics was measured to obtain the initial area under curve (IAUC) and the wash-out slope; also the two-compartmental pharmacokinetic model was applied to obtain Ktrans and kep. The diagnostic accuracy was evaluated by CHAID decision tree and ROC analysis. Results: Chordomas were more likely to show soft tissue mass than GCTs (13/13 = 100% versus 15/26 = 58%; P = 0.007), as well as fibrous septa (9/13 = 69% versus 0; P<0.001). In decision tree analysis, presence of fibrous septa and lesion location yield 31/39 = 79% accuracy. The DCE-MRI pharmacokinetic parameters Ktrans and kep of GCTs were significantly higher than those of chordomas, 0.136 0.65 versus 0.0660.04 (1/min) for Ktrans, 0.6260.22 versus 0.176 0.12 (1/min) for kep, P<0.001 for both. If using kep = 0.43/min as the cut-off value, it achieved 100% sensitivity and 92% specificity to differentiate chordoma from GCT, with an overall accuracy of 37/39 = 95%. The IAUC was highly correlated with Ktrans (r = 0.94), and the slope was highly correlated with kep (r = 0.95). Conclusion: Several morphological features were significantly different between chordoma and GCT, but their diagnostic performance was inferior to that of DCE-MRI.

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Giant cell tumor of the lumbar spine: operative management via spondylectomy and short-segment, 3-column reconstruction with pedicle recreation

Cited by 21 publications

References 16 publications

Treatment options for recurrent giant cell tumors of bone

Treatment options for recurrent giant cell tumors of bone

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

Morphological and dynamic contrast enhanced MR imaging features for the differentiation of chordoma and giant cell tumors in the Axial Skeleton

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