Surgical Treatment And Risk Factors For Recurrence Of Giant Cell Tumor Of Spine

Part â… Surgical Treatment of Giant Cell Tumors of the SpineCombined with Preoperative Transarterial EmbolizationObjective: To investigate the efficacy of surgical excision with preoperativetransarterial embolization for the giant cell tumor of spine.Methods: Between June1995and August2011,28patients with giant cell tumor ofthe spine were interviewed retrospectively. There were12males and16females with theaverage age of29.6years (range:11~58years).15cases were located in the sacrum and13in the mobile spine (8thoracic and5lumbar). Most patients presented with pain at the siteof tumor involvement before surgery.17patients existed neurologic deficit, and8caseshad bowel and/or bladder dysfunction. All the patients were operated1to2days aftertranscatheter arterial embolization. The intraoperative blood loss and transfusion werereviewed. The local recurrence, complications, follow-up status and functional outcomewere observed.Results: There were no symptomatic complications associated with embolization, andall the patients were treated with intralesional excision after preoperative transarterialembolization. There were no perioperative deaths. The average intraoperative blood losswas1528.6mL (range:400~5800mL), and the average transfusion volume was1514.3mL(range:400~6000mL). The anterior approach was used for8cases, posterior approach wasused for18cases, and combined anterior and posterior approach was used for2cases.There were14(50%) patients underwent reconstruction, and6(21.4%) patients weretreated postoperatively with adjuvant radiation therapy. The average follow-up was86.5months (range:16-193months). Eight (28.6%) patients developed recurrence and two(7.1%) patients died. Eight (28.6%) patients experienced complications perioperatively orduring the follow-up, six (21.4%) patients had wound complications, one patientexperienced cerebrospinal fluid leakage and one thoracic patient developed kyphosis. The14patients who underwent reconstruction did not experience hardware failure requiring surgical revision. Twenty-four (85.7%) patients retained normal neurologic function, whilethe function of the sphincter muscles were impaired in only4sacral GCT patients.Conclusion: Preoperative embolization can significantly decrease intraoperativeblood loss, and facilitate the maximal removal of the tumor. It is a safe and effectivetechnique for excising giant cell tumors of the spine. Intralesional excision withpreoperative embolization may be a feasible choice for GCT of the spine. Part â…¡Analysis of Risk Factors for Recurrence of Giant CellTumor of SpineObjective: To investigate the factors related to the local recurrence-free survival time(LRFS) after surgical treatment of giant cell tumor of the spine, in order to providetheoretic foundation for an improvement of LRFS.Methods: We retrospectively reviewed28consecutive patients with GCT of thesacrum and mobile spine who underwent initial surgical excision combined withpreoperative embolization between June,1995and August,2011. Data regarding age,gender, tumor location, tumor size, tumor extension, radiation therapy, and localrecurrences were reviewed. The expression of IMP3and IGF2was detected byimmunohistichemical staining. Local recurrence-free survival time was calculatedaccording to the Kaplan-Meier method and statistical analysis was performed usingLog-Rank test.Results: All the patients underwent intralesional resection. The average duration offollow-up was86.5months (range,16~193months).8(28.6%) patients developed localrecurrence. The average recurrence time was35.6months (range,5-79months). LRFSwas found statistically longer in intracompartmental (T1) tumors as compared toextracompartmental (T2) tumors (median:73versus43months, P=0.025). LRFS was alsofound significantly longer in IMP3negative group than IMP3positive group (median:73versus43months, P=0.002), and in IGF2negative group than IGF2positive group(median:75versus46.5months, P=0.007). LRFS was not found significant difference forage, gender, tumor location, tumor size, and radiation therapy.Conclusion: Extracompartmental tumor, positive expression of IMP3, and positiveexpression of IGF2will probably lead to shorter LRFS. The choice of surgical treatment should be balanced between the complications and tumor recurrence. Intralesional excisionmay be a feasible choice for T1tumors of the spine, but for T2tumors, more aggressivetreatment may be required. Overexpression of IMP3and IGF2may be used as prognosticindications of the recurrence of GCT of the spine.