Giant Cell Tumors of the Axial Skeleton

Table 1

(a) Giant cell tumors of the mobile spine. (b) Giant cell tumors of the sacrum.

(a)

Number	Sex	Age	Site/neuro status	FU	Primary treatment	Rec.	Treatment rec.	Met.	Outcome
1	M	18 Y	Th6/OK	27 M	Ventral: intral. res., bone graft, ventral stabilization	8 M	Ventral: intral. res. Th6–Th7, bone graft		NED	Loss of sensory function and paresis at Th9 level, footdrop right
2	F	17 Y	Th12 / encasing of left nerve root with sensory disorders	98 M	dorsal: intral. curettage, dorsal instr. Th10 – L2, transection of nerve root Th12 + bone graft, bone cement				NED
3	F	23 Y	Th10/infiltration of spinal canal with initial paresthesias	83 M	Dorsoventral: intral. partial res. Th10, dorsal instr. Th9–11, bone graft	11 M	Dorsal: intral. partial res. Th9–Th11, decompression of spinal canal, extension of instrumentation Th8–Th12	13 M	SD	Recovery from paresthesias but local progress, destruction of Th7–Th9, encasing of aorta, displacement of cava and heart, pleural/pericardial effusion, bipulmonary met. treated by chemo; (4 cycles Ifosfamid, Cisplatin) and EBI 46 Gy over 1 M. last FU; constant unresectable met., decrease of local tumor, pregnant
4	F	26 Y	Th11/OK	24 M	Dorsoventral: intral. partial res. Th11, dorsal instr. Th10–Th12, bone graft (rib)	7 M/13 M	Ventral: intral. res., bone cement, laceration of aorta, severe bleeding		D	EBI started after rec., death due to pulmonary failure 13 days after last surgery
5	F	27 Y	L4/infiltration of right psoas/spinal canal, encasing right nerve root with sensory disorders	32 M	Dorsoventral: spondylectomy L4, intral. res. soft tissue component, dorsal instr. L3– L5, titanium cage interposition, bone graft			16 M	NED	Oral clodronate (800 mg 2/d), since resection of bipulmonary met., free of complaints
6	M	30 Y	L4/infiltration of right psoas muscle and spinal canal causing weakness of right quadriceps	45 M	Dorsoventral: intral. spondylectomy L4, intral. res. soft tissue component, dorsal instr. L3–L5, titanium cage interposition, bone graft	9 M	No surgery, serial SAE until complete devascularization 3 times (directly, 1 and 6 M later)		SD	Local rec. encasing aorta with loss of sensory function at L4 level, after serial SAE complete recovery of neurological functions, slight regression of tumor on MRI, since rec. daily oral pain medication and clodronate (800 mg 2/d), able to work full time in office

FU: followup, rec.: recurrence, met.: metastasis, M: male/months, F: female, Y: years, Th: thoracal spine, L: lumbar spine, intral.: intralesional, res.: resection, instr.: instrumentation, EBI: external beam irradiation, preop.: preoperative, SAE: selective arterial embolization, Gy: Gray, NED: no evidence of disease, SD: stable disease, D: dead due to disease.

(b)

Number	Sex	Age	Site /neuro status	FU	Primary treatment	Rec.	Treatment rec.	Outcome
7	F	25 Y	Sacrum/OK	133 M	Intral. curettage, bone cement	11 M	Resection of soft tissue recurrence	NED	Local infection after initial surgery cured by repeated curettage and cementation plus systemic antibiotics, subsequently irritation of left S1 nerve root causing claw toes
8	F	19 Y	Sacrum/OK	124 M	Intral. curettage, bone cement			NED	Local infection after initial surgery cured by repeated curettage and cementation plus systemic antibiotics, final FU free of complaints
9	M	20 Y	sacrum, affection of SI joint/OK	20 M	Intral. curettage, bone cement	12 M	Preop. SAE, partial intral. res.	PD	Local progress 6 M after rec. treated by SAE, another progress after again 6 M treated by EBI 30 Gy over 1 M without effect, at last FU free of pain but progress with incomplete paresis of left foot. Scheduled for denosumab treatment
10	F	20 Y	Sacrum, infiltration of spinal canal/no neurological deficits	62 M	Intral. curettage, bone cement			SD	Stable left-over tumor tissue after partial removal, oral clodronate (800 mg 2/d) over 1 Y, last FU free of complaints
11	F	61 Y	Sacrum/OK	24 M	Intral. curettage, laminectomy S1–S4, bone cement			NED	Conus/cauda syndrome since surgery
12	F	18 Y	Sacrum, crossing of midline/OK	49 M	Intral. partial res. mainly of soft tissue component, chemotherapy (CWS-96 study ifosfamid, vincristine, adriamycin), EBI 50 Gy over 1 M			SD	Free of complaints
13	M	24 Y	Sacrum/OK	88 M	Preop. SAE, ligation of left and right internal iliac vessels and median sacral artery, curettage, bone graft			NED	Local infection after initial surgery cured by repeated curettage and cementation plus systemic antibiotics, final FU free of complaints
14	F	32 Y	Sacrum, infiltration of ilium/OK	15 M	Preop. SAE, curettage, bone cement			NED	Free of complaints
15	M	20 Y	Sacrum, infiltration of spinal canal and spinal cord compression/no neurological deficits	28 M	Preop. SAE, intral. partial curettage, bone cement, EBI with a special particle accelerator at the DKFZ (“german cancer research center” in Heidelberg, Germany) 66 Gy over 1 M			SD	Free of complaints, regression of tumor on MRI
16	M	28 Y	Sacrum, stenosis of spinal canal/ conus/cauda syndrome	51 M	Preop. SAE, partial curettage, bone cement, EBI 60 Gy over 1 M			NED	Persistent rectum/bladder dysfunction, gluteal dysesthesia
17	F	28 Y	Sacrum large/OK	36 M	No surgery, EBI 50 Gy over 1 M	21 M	No surgery, EBI 50 Gy over 1 M	SD	Regression after first EBI but progress after 21 M again treated by EBI + systemic interferon alpha, ongoing oral clodronate (800 mg 2/d) intake since rec.
18	F	29 Y	Sacrum, large, crossing of midline/OK	24 M	No surgery, EBI 55 Gy over 1 M			SD	slight regression of tumor on CT, free of complaints
19	F	56 Y	Sacrum/pain both thighs and buttocks, paresthesias of anal/genital area, buttocks, foot soles, rectum/bladder dysfunction	17 M	No surgery, EBI 50 Gy over 1 M, SAE 3 M later			SD	Significant regression of symptoms since SAE but still paresthesias both foot soles and moderate bladder dysfunction, daily oral pain medication, oral clodronate (800 mg 2/d) since treatment

FU: followup, rec.: recurrence, M: male/months, F: female, Y: years, intral.: intralesional, res.: resection, EBI: external beam irradiation, preop.: preoperative, SAE: selective arterial embolization, Gy: Gray, NED: no evidence of disease, SD: stable disease.