Higher local recurrence rates after intralesional surgery for giant cell tumor of the proximal femur compared to other sites (original) (raw)
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Giant Cell Tumor of Bone: Risk Factors for Recurrence
Clinical Orthopaedics and Related Research®, 2011
Background Many surgeons treat giant cell tumor of bone (GCT) with intralesional curettage. Wide resection is reserved for extensive bone destruction where joint preservation is impossible or when expendable sites (eg, fibular head) are affected. Adjuvants such as polymethylmethacrylate and phenol have been recommended to reduce the risk of local recurrence after intralesional surgery. However, the best treatment of these tumors and risk factors for recurrence remain controversial. Questions/purposes We evaluated the recurrence-free survival after surgical treatment of GCT to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence. Methods We retrospectively reviewed 118 patients treated for benign GCT of bone between 1985 and 2005. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum followup was 36 months (mean, 108.4 ± 43.7; range, 36-233 months). Results Wide resection had a lower recurrence rate than intralesional surgery (5% versus 25%). Application of polymethylmethacrylate decreased the risk of local recurrence after intralesional surgery compared with bone grafting; phenol application alone had no effect on the risk of recurrence. Pulmonary metastases occurred in 4%; multidisciplinary treatment including wedge resection, chemotherapy, and radiotherapy achieved disease-free survival or stable disease in all of these patients. Conclusion We recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. Because pulmonary metastases are rare and aggressive treatment of pulmonary metastases is usually successful, we believe the potential for metastases should not by itself create an indication for wide resection of primary tumors. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Recurrent Giant Cell Tumor of Long Bones: Analysis of Surgical Management
Clinical Orthopaedics and Related Research®, 2011
Background Treatment of giant cell tumor of bone (GCT) often is complicated by local recurrence. Intralesional curettage is the standard of care for primary GCTs. However, there is controversy whether intralesional curettage should be preferred over wide resection in recurrent GCTs. Questions/purposes We investigated the rerecurrencefree survival after surgical treatment of recurrent GCTs to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of further recurrence. Patients and Methods We retrospectively reviewed the medical records of 46 patients with recurrent GCTs of long bones treated with wide resection or intralesional curettage and compared these cohorts. Recurrence rates, risk factors for recurrence, and the development of pulmonary metastases were determined. The minimum followup was 37 months (mean, 134 months; range, 37-337 months).
Distal femur giant cell tumor -therapeutic challenge: A case report
International Journal of Orthopaedics Sciences, 2021
Background: Giant cell tumor (GCT) is a benign, locally aggressive bone tumor with rarely tendency to metastasize. The location of giant cell tumors in areas like distal femur, proximal tibia, etc. makes the management of the tumor challenging. Inadequate curettage may lead to recurrence of the tumor, which has to be kept in mind even before planning for surgery. Aims and Objectives: Large giant cell tumor management has always been difficult. Even more difficult is tackling the complication like recurrence. This case was studied to know how the extended curettage with phenol crystal helps in reducing the risk of recurrence of GCT. Methods: An 18 year old male clinically and radiologically diagnosed to have GCT in the medial condyle right distal femur was taken up for extended curettage with phenol crystal wash, bone grafting and cementation with allograft mixed with bone cement and medial condylar plating for right distal femur. Followed by a histo-pathological examination of the curetted sample. Regular follow-up of the patient was done at 1, 3, 6, 12 and 18 months post operatively to assess for recurrence of the tumor. Result: Histo-pathologically the diagnosis of giant cell tumor was confirmed. At regular follow-ups of 1, 3, 6, 12 and 18 months post operatively and also an MRI done at 12 months follow-up period showed no evidence of recurrence of the tumor. Conclusion: Giant cell tumor management has better outcomes with extended curettage with phenol crystal wash followed by bone grafting, cementing and plating. This study has shown no evidence of recurrence with the following technique at 18 months follow-up period. Phenol crystals can be used as a better alternative to liquid nitrogen for extended curettage.
Journal of Orthopaedic Surgery, 2016
Purpose.To review the functional outcome and local recurrence rate of 29 patients who underwent segmental excision or intralesional curettage with adjuvant therapy for giant cell tumour (GCT) of bone.Methods.Records of 17 men and 12 women (mean age, 30.17 years) who underwent segmental excision (n=18) or intralesional curettage followed by adjuvant therapy (n=11) for GCT of the femur (n=13), tibia (n=8), radius (n=6), or ulna (n=2) were reviewed. Nine of the patients had recurrent GCT of bone and had undergone segmental excision (n=6) or intralesional curettage (n=3) elsewhere. Functional outcome was evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system.Results.The mean follow-up period was 6.4 (range, 3–13.5) years. 14 patients were followed up for 3 to 5 years, 12 for 5 to 10 years, and 3 for >10 years. Of 20 patients with primary GCT of bone, 12 underwent segmental excision and had no recurrence, and 8 underwent intralesional curettage, 2 of whom developed l...
Annals of Medicine and Surgery, 2019
Introduction: GCT is a benign primary bone tumor which is known to cause local recurrence as well as distant metastases. The standard care of treatment of GCT in our institution is the extended intralesional curettage followed by the use bone cement and either phenol or alcohol as adjunct therapy. This offers preservation of joint closest to tumor and decreased risk of recurrence compared to curettage alone. Therefore, the objective of this study was to assess the recurrence of GCT of the bone and time of recurrence-free survival after primary surgery (curettage with adjunct therapy) and determine the influence of factors like site of tumor involvement and demographic factors on the risk of recurrence. Methods: Non-funded, non-commercial single group retrospective cohort study was conducted at a tertiary care university hospital. Total of 44 patients treated for primary GCT of the bone between 1995 and 2015 at our institution were included. Medical record files were reviewed for demographic characteristics, intra-operative findings and post-operative follow-up. Risk factors for recurrence and mean recurrence free survival was calculated using appropriate statistical analysis. Results: Proximal tibia was the most commonly involved bone followed by distal femur, while intralesional curettage with either phenol or alcohol as adjunct was the most common primary treatment. Mean follow-up period for all patients was 52.1 ± 43.9 months. Out of the 46 tumors operated primarily at our institution, recurrence developed in eight (17.4%) cases. Extra-compartmental spread of tumor and tumor grade were identified to have a significant association with recurrence (P = 0.013 and 0.043 respectively). Estimated recurrence free survival at 2 and 5-year interval was 0.85 and 0.83 respectively. Conclusion: Extra-compartmental extension of tumor and a higher-grade lesion is significantly associated with development of recurrence in cases of GCT of bone.
Late recurrence of giant cell tumour of bone after curettage and adjuvant treatment: a case report
Journal of orthopaedic surgery (Hong Kong), 2010
We report a rare case of late recurrence of a giant cell tumour (GCT) of bone 16 years after curettage and cryosurgery treatment. A 46-year-old man presented with swelling and progressively worsening pain in the lateral aspect of his right distal femur. He had undergone 4 procedures elsewhere to manage a GCT of bone and its recurrence 16 to 23 years previously. He underwent en bloc resection with an adequate wide margin and reconstruction with prosthesis. At the one-year follow-up, there was no evidence of recurrence or metastasis.
The archives of bone and joint surgery, 2019
Background Giant cell tumor of bone (GCTB) is a locally aggressive lesion with an unpredictable behavior. Herein, the aim of this study was to evaluate the epidemiological characteristics, as well as clinical and functional outcomes of GCTB in a relatively large series of patients. Methods Patients with the diagnosis of GCTB were included in this retrospective study. Whenever the preservation of the articular surface was possible, surgical options included extended curettage; otherwise, wide resection was implemented. In case of extended curettage, the cavity was filled with cement or bone graft. In addition, the functional and oncologic outcomes of these surgical strategies were compared. The functional outcome of the patients was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. Results A total of 120 GCTB patients, including 55 males (45.8%) and 65 females (54.2%), were evaluated. The three involved locations with highest frequency included distal femur (26%...
Clinical outcome of operative treatment in 18 cases of giant cell tumors of bones
Journal of Chitwan Medical College, 2020
Background: Giant Cell Tumor of the bone (GCTB) has got variable outcome after the different methods of surgical treatment depending upon the site and grade of lesion and extent of tumor removal. This retrospective prospective analysis of operatively treated cases of GCTB of different sites aimed to highlight the clinical outcome. Methods: This was a prospective observational study of 18 cases of GCTB; proximal tibia (n=6), distal femur (n=5), distal radius (n=4), proximal femur (n=1), proximal fibula (n=1) and anterior arc of first rib (n=1) treated with different operative management with mean follow up of 53.61 months. Functional outcome with Musculoskeletal Tumor Society Score (MSTS), recurrence and complications were analyzed with at least 24 months of follow up. Results: There were 10 females and 8 males with average age at presentation 27.3 years (range 15-38). Average duration of symptom was 4.72 months. 2 were cases of recurrence previously operated and 16 were de novo cas...
Wide resection versus curettage with adjuvant therapy for giant cell tumour of bone
Journal of orthopaedic surgery (Hong Kong), 2016
To determine the association between type of surgery (wide resection versus curettage with adjuvant therapy) and outcome in patients with giant cell tumour (GCT) of bone. Records of 30 male and 52 female consecutive patients aged 10 to 62 years who underwent wide resection (n=57) or curettage with adjuvant therapy (n=25) for primary GCT of bone were reviewed. The surgical decision was based on patient age, tumour location, functional demand, and patient preference. The median tumour size was 8.5 cm. Tumours were classified as stage 1 (n=4), stage 2 (n=60), and stage 3 (n=18), and 25%, 68.3%, and 83.3% of them were treated with wide resection, respectively. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score; the maximum score was 30. The wide resection and curettage with adjuvant therapy groups were comparable in terms of patient age, gender, tumour size, location, symptoms, tumour stage, type of biopsy, and MSTS score. The MSTS score was excellent i...
Present day controversies and consensus in curettage for giant cell tumor of bone
Journal of Clinical Orthopaedics and Trauma, 2019
Background: The ideal treatment for giant cell tumor of bone (GCTB) is still controversial. The purpose of this study was to evaluate whether curettage was successful in the treatment of GCTB. Intralesional curettage with adjuvant therapies, such as high-speed burring, polymethylmethacrylate, phenol, ethanol, and liquid nitrogen, may be used to reduce the local recurrence rate. However, there is no consensus on the optimal use of curettage, along with fillers and adjuvants, to limit the recurrence rate. Methods: We performed a systematic review of articles using the terms long bones, GCTB, and treatment. Case reports, reviews, opinion articles, or technique notes were excluded based on the abstract. Twentysix articles included in this review were then studied to establish the index in suggesting the surgical treatment of GCTB. Results: The patient's gender, their age, the Campanacci grade of their tumor, and the type of surgery they had were not significantly associated with the local recurrence rate. Local recurrences seemed to be associated with the site of the tumor, occurring more frequently in the proximal femur or distal radius. A pathological fracture was not a contraindication for intralesional curettage. Treatment with denosumab did not decrease the local recurrence rate in patients who had been treated with curettage. Conclusion: The current literature seems to suggest that the ideal treatment for GCTB is to remove the tumor while preserving as much of the joint as possible. Local recurrent tumors can be treated with curettage to keep the re-recurrence rate within an acceptable limit. The choice for how to treat GCTB in the proximal femur or distal radius requires special attention.