Benign Tumors of the Spine

Has New Chemotherapy and Interventional Radiology Changed the Treatment Paradigm?

Raphaële Charest-Morin, MD, FRCSC; Stefano Boriani, MD; Charles G. Fisher, MD, MHSc, FRCSC; Shreyaskumar R. Patel, MD; Norio Kawahara, MD, PhD; Ehud Mendel, MD, FACS; Chetan Bettegowda, MD, PhD; Laurence D. Rhines, MD

Disclosures

Spine. 2016;41(20s):S178-S185. 

In This Article

Abstract and Introduction

Abstract

Study Design. Clinically based systematic review.

Objective. To determine the role of (A) medical treatment and (B) interventional radiology as either adjuvant or stand-alone treatment in primary benign bone tumors of the spine.

Methods. A multidisciplinary panel of spine surgeons, radiation oncologists, and medical oncologists elaborated specific focused questions regarding aneurysmal bone cyst, giant cell tumor, and osteoid osteoma. Denosumab, bisphosphonate, interferon, bone marrow aspirate, doxycycline, thermal ablation, and selective arterial embolization were identified as areas of interest for the article. A systematic review was performed through MEDLINE and EMBASE. Recommendations based on the literature review and clinical expertise were issued using the GRADE system.

Results. The overall quality of the literature is very low with few multicenter prospective studies. For giant cell tumor, combination with Denosumab identified 14 pertinent articles with four multicenter prospective studies. Nine studies were found on bisphosphonates and six for selective arterial embolization. The search on aneurysmal bone cyst and selective arterial embolization revealed 12 articles. Combination with Denosumab, Doxycycline, and bone marrow aspirate identified four, two, and three relevant articles respectively. Eleven focused articles were selected on the role of thermal ablation in osteoid osteoma.

Conclusion. Alternative and adjuvant therapy for primary benign bone tumors have emerged. Their ability to complement or replace surgery is now being scrutinized and they may impact significantly the algorithm of treatment of these tumors. Most of the data are still emerging and further research is desirable. Close collaboration between the different specialists managing these pathologies is crucial.

Level of Evidence: N/A

Introduction

Giant cell tumor of the bone (GCT), aneurysmal bone cyst (ABC), and osteoid osteoma (OO) are benign active/aggressive tumors. Surgery has been the mainstay of the treatment with either intralesional or en bloc resection. Surgical treatment of primary bone tumors is associated with significant morbidity and mortality.[1–3] Alternative therapies and adjuvant treatments have been developed with the goal of reducing morbidity while achieving similar, if not better, outcomes. In recent years, there has been growing interest in the use of Denosumab, interferon, and bisphosphonate as an adjuvant in the treatment of GCT. Case series where selective arterial embolization (SAE) has been used as a stand-alone treatment of ABC have been published. Thermal ablation of osteoid osteoma is accepted as a standard of care in the appendicular skeleton and is now making its way to the spinal axis. The exact role, safety, and effectiveness of these alternative/adjuvant treatments remain to be defined.

A systematic review designed to answer two clinically relevant research questions was developed through consensus among a multidisciplinary panel of experts:

  1. What is the role of medical treatment as a preoperative adjuvant option and definitive treatment of GCT and ABC?

  2. What is the role of interventional radiology as an adjuvant option and treatment of GCT, ABC, and OO?

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