Treatment of Giant Cell Tumor of Bone of the Spine — Enneking Stage 3 (Aggressive, Extracompartmental)

This protocol addresses giant cell tumor of bone (GCTB) arising in the spine at Enneking stage 3 — the symptomatic and extracompartmental (aggressive) presentation. At this stage, the lesion has extended beyond its compartment, posing distinct surgical and oncological challenges that require a specific, staged management strategy.

The majority of GCTBs are either symptomatic and intracompartmental (active; S2) or symptomatic and extracompartmental (aggressive; S3). Stage 3 spinal lesions call for a tailored preoperative and operative approach distinct from lower-stage disease.

Management of stage 3 spinal GCTB involves a combined preoperative and surgical strategy. A bone-targeted medical agent is administered in the preoperative setting to modify the extraosseous lesion before a definitive spinal resection is undertaken. The specific therapy, its parameters, and the surgical technique are defined in the full protocol.

Complete regimen, sequencing, and operative details are available in the structured protocol below.

Success is defined by new ossification and cortical integrity of the spinal lesion, together with a clinically meaningful reduction in soft tissue mass. Specific response thresholds and monitoring criteria are specified in the full protocol.