Multiprofessional management of giant cell tumors in the cervical spine: a systematic review

Michael Müther, Michael Schwake, Eric Suero Molina, Juliane Schroeteler, Walter Stummer, Mark Klingenhöfer, Christian Ewelt
World Neurosurgery 2021 April 12

BACKGROUND: Giant cell tumors of the bone (GCTB) are rare bone tumors, especially in the cervical spine. Generally considered benign, local aggressiveness and metastatic growth have been described. Surgical concepts for GCTB are challenged by complex neurovascular anatomy. Specific clinical management guidelines are non-existent. This systematic review aims to compile existing evidence on the treatment of GCTB of the cervical spine.

METHODS: Four electronic databases were searched: Medline, Embase, Web of Science and Cochrane Library. All clinical studies reporting treatment of GCTB in the human cervical spine in English language were found eligible for review.

RESULTS: Seven studies were included in the synthesis including a total number of 54 patients. Of those patients, 46 (85%) were treated for naive non-recurrent GCTB. Only one study is considered a cohort study, all other studies were case reports. Generally, intralesional procedures were performed in 13 (24%) cases. Subtotal resections were reported for 11 (20%) patients. Twenty-eight (52%) patients were surgically treated with piecemeal resection, en-bloc resection or spondylectomy. Thirty-six (67%) patients underwent adjuvant radiotherapy. A combination of radiotherapy and chemotherapy was reported in two (4%) cases. Bisphosphonates were prescribed for 9 (17%) patients. Inconsistent reporting of outcome data did not allow for comparative analyses.

CONCLUSIONS: Best available evidence suggests that the most aggressive surgical approach should be the main goal of any GCTB surgery. No specific adjuvant or neo-adjuvant treatment can be recommended as superior due to a lack of comparative data. Therapeutic approaches need to be planned thoroughly on an individual basis.

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