Invasive Giant Cell Tumor of The Lateral Skull Base: A Systematic Review, Meta-analysis and Case Illustration

Abstract Objective The current literature regarding cranial giant cell tumor (GCT) management includes scattered case reports and small case series. We present a comprehensive literature review and meta-analysis on this subject, along with a case report describing our management of a temporal GCT. Methods A systematic literature review of all reports on GCTs of the skull was performed followed by a meta-analysis examining the effect of radiation and degree of resection on tumor recurrence. Results Fifty-nine abstracts (1945-2015), reporting 110 GCT cases were reviewed. After exclusions were applied 31 manuscripts (67 patients) were selected for meta-analysis. Average age was 33.7 years old with 1:1 gender ratio. Tumor location: temporal (37), sphenoid (20), occipital (6), frontal (2), TMJ (2). Treatment methods: surgery + radiation (25), surgery alone (41) or radiation alone (1). Degree of resection for 66 surgical patients was: 34 gross total (GTR), 31 subtotal (STR), 1 not recorded. Mean f/u time: 36 months. Recurrence occurred in 8.8% of the GTR group and 32.3% of the STR group (OR= 0.203, 95% CI: 0.033-0.937, p= 0.018). Odds ratio for STR alone compared to STR + radiation was 14.01 (p=0.0038). Conclusion GCTs of the skull commonly affect young adults with an equal gender distribution and are often centered in temporal bone. GTR results in lowest recurrence rates and should be the goal of treatment. If GTR cannot be achieved, the combination of STR and radiation results in similar recurrence rates. With the advent of Denosumab, there is now a role for chemotherapy in the treatment of GCTs.