BACKGROUND: Giant cell tumor (GCT) of the bone has historically been regarded as an extremely unpredictable bone tumor. The anatomical characteristics of spinal GCT still present challenges to surgeons. Controversy remains regarding the proper treatment of patients with grade III tumors. METHODS: Eleven patients with grade III GCT of the thoracolumbar spine were treated between 1992 and 2002 at a medical center by the authors. Three patients were initially treated at other institutions. Adjuvant radiotherapy was employed for local recurrence in these three patients. The other eight patients were initially treated with marginal excision. The site, size, and extent of each lesion dictated the surgical approach. RESULTS: Five patients had tumor recurrence. One patient, who received radiotherapy, had local relapse with malignant transformation and finally died due to disease-related complications. One patient had a recurrent tumor with multiple metastases throughout the lung. Neurological status, measured using the American Spinal Injury Association scale, of one patient was worse after undergoing the procedure than preoperatively and three patients showed improvement. The other seven patients were classified as with the same grade postoperatively. CONCLUSION: Wide excision of GCT of the thoracolumbar spine is difficult and there is a risk of neurological deficit and spinal instability. Meticulous marginal excision with associated reconstruction may obtain good local control and preserve functional spine. Early detection of recurrent GCT during intensive follow-up can allow for treatment using en bloc excision which has achieved favorable prognoses.
BACKGROUND:Giant cell tumor (GCT) of the bone has historically been regarded as an extremely unpredictable bone tumor. The anatomical characteristics of spinal GCT still present challenges to surgeons. Controversy remains regarding the proper treatment of patients with grade III tumors. METHODS: Eleven patients with grade III GCT of the thoracolumbar spine were treated between 1992 and 2002 at a medical center by the authors. Three patients were initially treated at other institutions. Adjuvant radiotherapy was employed for local recurrence in these three patients. The other eight patients were initially treated with marginal excision. The site, size, and extent of each lesion dictated the surgical approach. RESULTS: Five patients had tumor recurrence. One patient, who received radiotherapy, had local relapse with malignant transformation and finally died due to disease-related complications. One patient had a recurrent tumor with multiple metastases throughout the lung. Neurological status, measured using the American Spinal Injury Association scale, of one patient was worse after undergoing the procedure than preoperatively and three patients showed improvement. The other seven patients were classified as with the same grade postoperatively. CONCLUSION: Wide excision of GCT of the thoracolumbar spine is difficult and there is a risk of neurological deficit and spinal instability. Meticulous marginal excision with associated reconstruction may obtain good local control and preserve functional spine. Early detection of recurrent GCT during intensive follow-up can allow for treatment using en bloc excision which has achieved favorable prognoses.