Luksanapruksa Panya, Buchowski Jacob M, Singhatanadgige Weerasak, Rose Peter C, Bumpass David B
Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkoknoi, Bangkok 10700, Thailand.
Department of Orthopaedic Surgery, Washington University in St. Louis, 425 South Euclid Ave., St. Louis, MO 63110, USA.
Spine J. 2016 Feb;16(2):259-69. doi: 10.1016/j.spinee.2015.10.045. Epub 2015 Oct 30.
Spinal giant cell tumors (SGCT) remain challenging tumors to treat. Although advancements in surgical techniques and adjuvant therapies have provided new options for treatment, evidence-based algorithms are lacking.
This study aims to review the peer-reviewed literature that addresses current treatment options and management of SGCT, to produce an evidence-based treatment algorithm.
STUDY DESIGN/SETTING: A systematic review was performed.
Articles published between January 1, 1970 and March 31, 2015 were selected from PubMed and EMBASE searches using keywords "giant cell tumor" AND "spine" AND "treatment." Relevant articles were selected by the authors and reviewed.
A total of 515 studies were identified, of which 81 studies were included. Complete surgical resections of SCGT resulted in the lowest recurrence rates. However, morbidity of en bloc resections is high and in some cases, surgery is not possible. Intralesional resection can be coupled with adjuvant therapies, but evidence-based algorithms for use of adjuvants remain elusive. Several recent advancements in adjuvant therapy may hold promise for decreasing SGCT recurrence, specifically stereotactic radiotherapy, selective arterial embolization, and medical therapy using denosumab and interferon.
Complete surgical resection of SGCT should be the goal when possible, particularly if neurologic impairment is present. Denosumab holds promise as an adjuvant and perhaps stand-alone therapy for SGCT. Spinal giant cell tumors should be approached as a case-by-case problem, as each presents unique challenges. Collaboration of spine surgeons, radiation oncologists, and medical oncologists is the best practice for treating these difficult tumors.
脊柱巨细胞瘤（SGCT）仍是具有挑战性的难治性肿瘤。尽管手术技术和辅助治疗的进展为治疗提供了新的选择，但缺乏基于证据的治疗方案。
本研究旨在回顾经同行评审的关于SGCT当前治疗选择和管理的文献，以制定基于证据的治疗方案。
研究设计/场所：进行了一项系统综述。
从PubMed和EMBASE数据库中检索1970年1月1日至2015年3月31日发表的文章，关键词为“巨细胞瘤”、“脊柱”和“治疗”。作者筛选并审阅了相关文章。
共检索到515项研究，其中81项被纳入。SGCT的完整手术切除复发率最低。然而，整块切除的并发症发生率很高，在某些情况下无法进行手术。病灶内切除可联合辅助治疗，但基于证据的辅助治疗方案仍不明确。辅助治疗的一些最新进展可能有望降低SGCT的复发率，特别是立体定向放射治疗、选择性动脉栓塞以及使用地诺单抗和干扰素的药物治疗。
只要可能，SGCT的完整手术切除应作为目标，特别是在存在神经功能损害的情况下。地诺单抗有望作为SGCT的辅助治疗甚至单一治疗方法。脊柱巨细胞瘤应根据具体情况进行处理，因为每个病例都有独特的挑战。脊柱外科医生、放射肿瘤学家和医学肿瘤学家的合作是治疗这些难治性肿瘤的最佳方法。
