European Spine Journal

, Volume 25, Issue 12, pp 4033–4042 | Cite as

Treatment options and prognosis for repeatedly recurrent giant cell tumor of the spine

  • Yifei Ma
  • Jialin Li
  • Jun Pan
  • Wangjun Yan
  • Quan Huang
  • Tielong Liu
  • Xinghai Yang
  • Cheng Yang
  • Wei Xu
  • Haifeng WeiEmail author
  • Jianru XiaoEmail author
Original Article



Giant cell tumor of the spine has high rate of postoperative recurrence. There are not much published studies on repeatedly recurrent GCTS (RRGCTS). Also, there are controversies as to the prognostic factors and treatment options for RRGCTS.

Methods and materials

A retrospective survival analysis between 2000 and September 2014 was performed on the 74 times of in-hospital treatment of the 21 patients. Recurrence-free survival was defined as the time between the date of surgery and the date of recurrence. Factors with P values <0.05 in univariate analysis were subjected to multivariate analysis by means of proportional hazard analysis.


A total of 21 patients comprising ten males and 11 females with a mean age of 29.7 years (range 15–49) were included, with a total of 74 times of surgery performed. Eighteen patients had no evidence of disease. Univariate and multivariate analysis suggested that total spondylectomy and bisphosphonate therapy were independent prognostic factors for better RFS in RRGCTS patients.


Patients of RRGCTS are suitable for further surgical treatment with relatively good healing process and restoration of nervous function. Early diagnosis of recurrence may be associated with better prognosis. Total spondylectomy in combination with bisphosphonate therapy could reduce postoperative recurrence rate.


Repeatedly recurrent giant cell tumor of the spine (RRGCTS) Follow-up Recurrence Prognosis 



This study was supported by Shanghai youth science and technology talent sailing program (Grant 14YF1405900).

Compliance with ethical standards

Conflict of interest

The authors disclose no conflicts.


  1. 1.
    Unni KK (1996) Dahlin’s bone tumors: general aspects and data on 11,087 cases. Lippincott-Raven, New York. 5(1):234–254Google Scholar
  2. 2.
    Dahlin DC, Cupps RE, Johnson EW (1970) Giant cell tumor: a study of 195 cases. Cancer 25(4):1061–1070CrossRefPubMedGoogle Scholar
  3. 3.
    Marcove RC, Weiss LD, Vaghaiwalla MR (1978) Cryosurgery in the treatment of giant cell tumors of bone. Cancer 41(2):957–969CrossRefPubMedGoogle Scholar
  4. 4.
    O’Donnell RJ, Springfield DS, Motwani HK (1994) Recurrence of giant cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg 76(A):1827–1833CrossRefPubMedGoogle Scholar
  5. 5.
    Sanjay BK, Sim FH, Unni KK, McLeod RA, Klassen RA (1993) Giant-cell tumours of the spine. J Bone Joint Surg Br 75(5):148–154PubMedGoogle Scholar
  6. 6.
    Wei Xu, Li Xiang, Huang Wending (2013) Factors affecting prognosis of patients with giant cell tumors of the mobile spine: retrospective analysis of 102 patients in a single center. Ann Surg Oncol 23(2):134–141Google Scholar
  7. 7.
    Takeuchi Akihiko, Tsuchiya Hiroyuki (2010) The prognostic factors of recurrent GCT: a cooperative study by the Eastern Asian Musculoskeletal Oncology Group. J Orthop Sci 24(4):431–441Google Scholar
  8. 8.
    Stew Fri W, Coley Badleyl (1938) Malignant giant cell tumor of bone. Am J Pathol 5(4):529–531Google Scholar
  9. 9.
    Frankel HL, Hancock DO, Hyslop G (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. Spinal Cord 12(7):179–192CrossRefGoogle Scholar
  10. 10.
    Song S, Hong JC, McDonnell SE et al (2012) Combined modality therapy for rectal cancer: the relative value of posttreatment versus pretreatment CEA as a prognostic marker for disease recurrence. Ann Surg Oncol 23(1):654–667Google Scholar
  11. 11.
    Malek F, Krueger P, Hatmi ZN, Malayeri AA, Faezipour H, O’Donnell RJ (2006) Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy. Int Orthop 30(6):495–498CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jorgensen P, Follerås G, Rydholm A (2006) Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. J Bone Jt Surg Br 5(3):1–5Google Scholar
  13. 13.
    Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ (2005) Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res 43(5):211–218CrossRefGoogle Scholar
  14. 14.
    Boriani S, Bandiera S, Casadei R (2012) Giant cell tumor of the mobile spine: a review of 49 cases. Spine 37(122):37–45 (Phila Pa 1976) CrossRefGoogle Scholar
  15. 15.
    Hart RA, Boriani S, Biagini R, Currier B, Weinstein JN (1997) A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine. Spine 22(17):73–82 (Phila Pa 1976) Google Scholar
  16. 16.
    Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y (1997) Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine 22(3):24–33 (Phila Pa 1976) CrossRefGoogle Scholar
  17. 17.
    Cheng YY, Huang L, Lee KM, Xu JK, Zheng MH, Kumta SM (2004) Bisphosphonates induce apoptosis of stromal tumor cells in giant cell tumor of bone. Calcif Tissue Int 75(7):1–7Google Scholar
  18. 18.
    Balke M (2010) Bisphosphonate treatment of aggressive primary, recurrent and metastatic giant cell tumour of bone. BMC Cancer 10(4):62Google Scholar
  19. 19.
    Zhang W, Zhang Y, Li P (2011) Administration of sodium ibandronate in the treatment of complicated giant cell tumor of the spine. Spine 36(11):66–72 (Phila Pa 1976) Google Scholar
  20. 20.
    Tse LF, Wong KC, Kumta SM, Huang L, Chow TC, Griffith JF (2008) Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case–control study. Bone 4(2):68–73CrossRefGoogle Scholar
  21. 21.
    Otto S, Sotlar K, Ehrenfeld M, Pautke C (2011) Osteonecrosis of the jaw as a possible rare side effect of annual bisphosphonate administration for osteoporosis: a case report. J Med Case Rep 5(4):77Google Scholar
  22. 22.
    Malone Shawn (1995) Long-term follow-up of efficacy and safety of megavoltage radiotherapy in high-risk giant cell tumors of bone. Int J Radiat Oncol Biol Phys 33(3):689–694CrossRefPubMedGoogle Scholar
  23. 23.
    Ma Y, Xu W, Yin H, Huang Q, Liu T, Yang X, Wei H, Xiao J (2015) Therapeutic radiotherapy for giant cell tumor of the spine: a systemic review. Eur Spine J 24(8):1754–1760 (Epub 6 May 2015) CrossRefPubMedGoogle Scholar
  24. 24.
    Nair MK, Jyothirmayi R (1999) Radiation therapy in the treatment of giant cell tumor of bone. Int J Radiat Oncol Biol Phys 4(3):1065–1069CrossRefGoogle Scholar
  25. 25.
    Chen ZX, Gu DZ, Yu ZH, Qian TN, Huang YR, Hu YH, Gu XZ (1987) Radiation therapy of giant cell tumor of bone: analysis of 35 patients. Int J Radiat Oncol Biol Phys 12(3):329–334CrossRefGoogle Scholar
  26. 26.
    Wei F, Liu X, Liu Z (2010) Interferon alfa-2b for recurrent and metastatic giant cell tumor of the spine: report of two cases. Spine 35(14):18–22 (Phila Pa 1976) Google Scholar
  27. 27.
    Thomas D, Henshaw R, Skubitz K (2010) Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol 11(2):75–80Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yifei Ma
    • 1
  • Jialin Li
    • 1
  • Jun Pan
    • 2
  • Wangjun Yan
    • 1
  • Quan Huang
    • 1
  • Tielong Liu
    • 1
  • Xinghai Yang
    • 1
  • Cheng Yang
    • 1
  • Wei Xu
    • 1
  • Haifeng Wei
    • 1
    Email author
  • Jianru Xiao
    • 1
    Email author
  1. 1.Department of Orthopedic Oncology, Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Medical Student Unit, Changhai HospitalThe Second Military Medical UniversityShanghaiChina

Personalised recommendations