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Murphy GT, Shatz J, Bonar SF, Mahar A, Boyle R. Rate of evolution on imaging of a benign primary bone tumour - giant cell tumour. ANZ J Surg 2024; 94:1409-1411. [PMID: 38727028 DOI: 10.1111/ans.19029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Geoffrey T Murphy
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Julie Shatz
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - S Fiona Bonar
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Annabelle Mahar
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Richard Boyle
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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2
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Yadav SK, Rajnish RK, Prakash V, Nalwa A. Malignant giant cell tumour of distal ulna. BMJ Case Rep 2024; 17:e258047. [PMID: 38350706 PMCID: PMC10868299 DOI: 10.1136/bcr-2023-258047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Giant cell tumour (GCT) accounts for 5% of all primary bone tumours. GCT in the distal third of ulna is quite rare. We present a case of recurrent GCT in distal third of ulna with malignant features involving tenosynovium. The case was treated by wide resection of tumour and on follow up, patient recovered well with no evidence of further recurrence. Considering the features, according to the literature reviewed, is the first case of its type.
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Affiliation(s)
| | - Rajesh Kumar Rajnish
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vimal Prakash
- Orthopedics, All India Institute of Medical Sciences, Jodhpur, India
| | - Aasma Nalwa
- Pathology, All India Institute of Medical Sciences, Jodhpur, India
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3
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Yadav SS. "A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management". Indian J Orthop 2023; 57:1689-1696. [PMID: 37766948 PMCID: PMC10519896 DOI: 10.1007/s43465-023-00921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 09/29/2023]
Abstract
Background The management of the GCT continues to be controversial. The most accepted treatment reported is extended curettage with various adjuvants. However, the rate of recurrence has been very high (10-66%). For better understanding of the lesion and its management, it has become necessary to revise the existing grading system. Materials and Methods The recommendation of the proposed grading is based on 480 cases of GCT along with the analysis of other major reports published. Out of these, 279 were grade-II and 109 grade-III which were subjected to en bloc excision and reconstruction with non-vascularized fibular graft. Depending on the site, the grafts were stabilized with a suitable plate or extra long Kirschner wires. Results The observations made in 480 cases over a period of 5 decades revealed that for Campanacci grade-II and grade-III lesions, en bloc excision and suitable reconstruction resulted in minimum recurrence rate of 1.2%. The fibular reconstruction after excision has proved advantageous to our patients as it provides a stable joint in the form of an arthrodesis of the neighboring joint. Conclusion GCT of bone has been a challenging lesion. Extended curettage has been recommended as the choice of treatment but the reported rate of recurrence has been high. En bloc excision and suitable reconstruction with fibular strut graft have resulted in 1.2% recurrence. It is, therefore, suggested the existing grading system should be revised mainly for grade-II and grade-III lesions which can bring down the high rate of recurrence in this unpredictable tumor. Level of Evidence Level-IV.
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4
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Smolle MA, Roessl V, Leithner A. Effect of Local Adjuvants Following Curettage of Benign and Intermediate Tumours of Bone: A Systematic Review of the Literature. Cancers (Basel) 2023; 15:4258. [PMID: 37686534 PMCID: PMC10487159 DOI: 10.3390/cancers15174258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Local adjuvants are used upon intralesional resection of benign/intermediate bone tumours, aiming at reducing the local recurrence (LR) rate. However, it is under debate whether, when and which local adjuvants should be used. This PRISMA-guideline based systematic review aimed to analyse studies reporting on the role of adjuvants in benign/intermediate bone tumours. All original articles published between January 1995 and April 2020 were potentially eligible. Of 344 studies identified, 58 met the final inclusion criteria and were further analysed. Articles were screened for adjuvant and tumour type, follow-up period, surgical treatment, and development of LR. Differences in LR rates were analysed using chi-squared tests. Altogether, 3316 cases (10 different tumour entities) were analysed. Overall, 32 different therapeutic approaches were identified. The most common were curettage combined with high-speed burr (n = 774; 23.3%) and high-speed burr only (n = 620; 18.7%). The LR rate for studies with a minimum follow-up of 24 months (n = 30; 51.7%) was 12.5% (185/1483), with the highest rate found in GCT (16.7%; 144/861). In comparison to a combination of curettage, any adjuvant and PMMA, the sole application of curettage and high-speed burr (p = 0.015) reduced the LR rate in GCT. The overall complication rate was 9.6% (263/2732), which was most commonly attributable to postoperative fracture (n = 68) and osteoarthritis of an adjacent joint during follow-up (n = 62). A variety of adjuvants treatment options are reported in the literature. However, the most important step remains to be thorough curettage, ideally combined with high-speed burring.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (V.R.); (A.L.)
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5
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Sarkar S, Laik JK, Kaushal R, Mishra M, Rajak M. A Rare Giant Cell Tumour in the Distal Radius of a Seven-Year-Old Girl: A Case Report. Cureus 2023; 15:e40270. [PMID: 37383302 PMCID: PMC10298832 DOI: 10.7759/cureus.40270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/30/2023] Open
Abstract
A giant cell tumour (GCT) is a benign and locally aggressive tumour that is usually observable in a skeletally mature patient involving the end of long bones. The reported incidence of this tumour in a skeletally immature patient is extremely rare. However, we report one such case in the distal radius of a seven-year-old female patient. Having presented with painful swelling of the right distal forearm, she underwent clinical and radiological examination, and a diagnosis of distal radius GCT was made. The tumour was treated with curettage, fibular graft, and synthetic bone graft. This case report shows the importance of including GCT in children as a differential diagnosis. This tumour may have a good prognosis if diagnosed and treated early.
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Affiliation(s)
- Somit Sarkar
- Joint Replacement and Orthopedics, Tata Main Hospital, Jamshedpur, IND
| | - Jayanta K Laik
- Joint Replacement and Orthopedics, Tata Main Hospital, Jamshedpur, IND
| | - Ravi Kaushal
- Orthopedics, Manipal Tata Medical College, Jamshedpur, IND
- Joint Replacement and Orthopedics, Tata Main Hospital, Jamshedpur, IND
| | | | - Manoj Rajak
- Joint Replacement and Orthopedics, Tata Main Hospital, Jamshedpur, IND
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6
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Muacevic A, Adler JR, Sakhre R. En Bloc Resection With Reconstruction Using a Customized Megaprosthesis in a Case of Proximal Humerus Giant Cell Tumor: A Case Report. Cureus 2023; 15:e34217. [PMID: 36852360 PMCID: PMC9958242 DOI: 10.7759/cureus.34217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
A giant cell tumor is a common, benign but locally aggressive bone tumor faced by orthopedic surgeons. The proximal humerus is a rare site of occurrence for this tumor, and the challenges posed while approaching such a case are discussed in this report of a 29-year-old male who presented with pain, swelling, and restricted motion at the left shoulder. Plain radiographs and MRI were suggestive of an aggressive giant cell tumor of the proximal humerus, which was confirmed on histopathological examination. Due to the lesion's extensive soft-tissue involvement, en-bloc resection with reconstruction was planned, but due to the COVID-19 pandemic, surgery was delayed. During the same period, the patient had trivial trauma to the same shoulder, following which the size of the lesion began increasing. The patient was operated on with en-bloc resection and reconstruction with a custom megaprosthesis; following the surgery, there was a complete resolution of pain and improvement in the range of motion. En bloc resection and replacement with a customized megaprosthesis, though technically demanding, offer a safe and cost-effective modality for limb salvage surgery for large giant cell tumors, with good functional outcomes and decreased chances of recurrence.
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Affiliation(s)
- Alexander Muacevic
- Orthopedics and Traumatology, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur, IND
| | - John R Adler
- Orthopedics and Traumatology, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur, IND
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7
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Priya M, Xavier J, John S, Angral S, Malhotra M, Bhardwaj A, Varshney S, Venkatesan S. Metastasis in Sinonasal Region Revealing a Silent Primary: A Series of 2 Cases with Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:1967-1972. [PMID: 36452680 PMCID: PMC9702466 DOI: 10.1007/s12070-020-01931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Metastasis to the nasal cavity and paranasal sinuses are very rare and only few cases have been reported so far. Metastatic nasal mass with silent primary renal cell carcinoma (RCC) is even rarer. So are giant cell tumors which rarely affects soft tissues whether superficial or deep. These rarely occur in nasal cavity. We would like to discuss 2 cases-one being a 74 year old female with a solitary asymptomatic extensive metastatic lesion in sinonasal area of silent primary renal cell carcinoma and other being a 38 year old female multiple lytic expansile lesions in facial and skull bones who was previously treated for giant cell tumor of long bone-tibia. We aim to bring their occurrence to notice as they are rare, to highlight importance of these tumors in differential diagnosis of sinonasal masses and treatment options for the same.
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Affiliation(s)
- Madhu Priya
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Joyson Xavier
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Saumya John
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Sumeet Angral
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Manu Malhotra
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Abhishek Bhardwaj
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Saurabh Varshney
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Sneha Venkatesan
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
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8
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Behera KC, Singla M, Yadav U, KP M, Shukla T, Gupta A, Sheoran A, Kundu ZS, Devgun A, Paul S. A Tertiary Care Centre Experience of Recurrent Giant Cell Tumor Around the Knee Joint. Cureus 2022; 14:e29788. [PMID: 36340544 PMCID: PMC9618282 DOI: 10.7759/cureus.29788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Giant cell tumor (GCT) is a benign but locally aggressive bone tumor. It has a peak incidence between 30-40 years with a predilection for the epiphyseal/metaphyseal region of bone. The most common locations for bone GCT are the distal femur, proximal tibia, distal radius, and sacrum in decreasing order. Material and Methods: In this retrospective study, 22 patients (13 females and nine males) with recurrent giant cell tumors around the knee joint between 2009-2022, with a mean age of 30.2 years (range: 18-55) were included. The patients were followed up monthly for three months, three-monthly for the next two years, six-monthly for the next five years, and thereafter, yearly. The mean follow-up period was 36.97 months (range 23-120 months). Results: There were 19 recurrences after curettages and three after resections. Re-extended curettage was done in 17 cases and the resultant cavities were filled with autologous bone grafts in six and with polymethyl methacrylate (PMMA) cement in the other 11 cases. Reconstruction with megaprosthesis was done in two patients whereas knee arthrodesis was done in two patients after wide resection. The average Musculoskeletal Tumor Society (MSTS) score of our series of 22 patients was 23.1 (Range: 19-30). Conclusion: Campanacci grade 1 and 2 lesions can be successfully treated with extended curettage and bone grafting/bone cementing. For patients with grade 3 lesions, there are two options available according to the financial status of the patient; the first option is reconstruction with prosthesis and the other option is arthrodesis.
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9
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Yadav U, Nemani M, Malik M, Paul S, Mittal A, Agrawal GK, Yadav N. Intercalary Elbow Resection and Arthrodesis for Giant Cell Tumor of Distal Humerus: Something Is Better Than Nothing. Cureus 2022; 14:e28698. [PMID: 36204034 PMCID: PMC9527064 DOI: 10.7759/cureus.28698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Giant cell tumor (GCT) of the bone is a benign, locally aggressive neoplasm of epiphyseal origin. Most common sites for GCTs include the distal femur, proximal tibia, and the distal end of radius with the distal humerus being involved rarely. GCT is predominantly managed by extended curettage followed by adjuvant therapy to reduce recurrence. Juxta-articular GCTs are difficult to manage due to the destruction of the articular cartilage and subchondral bone which necessitates the need for joint reconstruction or fusion to salvage the joint. Aggressive and recurrent GCTs can be managed by wide resection of the tumor to reduce local recurrence followed by joint reconstruction or fusion. Joint reconstruction using a total elbow arthroplasty has been described for limb salvage as it provides a good functional outcome. We present a case of an aggressive GCT of the distal humerus that was treated using wide resection with humero-ulnar arthrodesis as an alternative in situations where joint reconstruction is not possible due to the unavailability of the prosthesis or socio-economic factors. The patient was asymptomatic after two years of follow-up, had no signs of recurrence, and had good hand functions.
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10
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Kamal AF, Hilmy F. Giant cell tumor with secondary aneurysmal bone cyst of the left calcaneus. Int J Surg Case Rep 2022; 100:107697. [PMID: 36242890 PMCID: PMC9574781 DOI: 10.1016/j.ijscr.2022.107697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Giant cell tumors (GCT) of the feet bones are rare, comprising of <1 % of cases. The lack of well-documented cases and similarity with other tumors under radiologic and histological evaluation makes diagnosis difficult. Current treatment modalities for GCT still result in a relatively high recurrence rate, making the overall management of the case a challenge. We reported a 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application. Case presentation A 27-year-old male presented with lump on the left heel since seven months before admission. Physical examination demonstrated solid, palpable mass on the left heel region and limited ankle motion. Magnetic resonance imaging examination demonstrated expansile bone tumor at the left calcaneus with cystic components building fluid levels and hemorrhagic components, suggestive of giant cell tumors with secondary ABC. The patient is diagnosed with giant cell tumor with secondary ABC of the left calcaneus Campanacci grade 2. The patient was managed limb salvage surgery by curettage and subsequent mix of femoral head allograft and bone cement application to fill the defect. Discussion Conservative surgery via careful curettage is typically preferred for lower Campanacci grade lesions followed by bone reconstruction. In terms of filling bone defects, it is known that both bone cement and allografts have advantages and disadvantages. We hence decided to perform limb salvage surgery via curettage due to the size of the tumor and bone reconstruction using a mix of femoral head allograft and bone cement to fill the defect. Conclusion Curettage and bone allograft with bone cement reconstruction is an option for surgical management of lower Campanacci grade 2 GCT of the calcaneus. A 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application. Conservative curettage, followed by bone allograft application is effective and safe to manage lower Campanacci grades of giant cell tumors of the calcaneus
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fahresa Hilmy
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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11
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Yadav U, Singla M, Sheoran A, Behera K, Garg A, Kundu ZS, Gupta A, Devgun A, Kumar R, Yadav P. Recurrent Giant Cell Tumour of Distal End Radius: Treatment and Outcomes After Further Surgeries. Cureus 2022; 14:e27451. [PMID: 36051721 PMCID: PMC9420457 DOI: 10.7759/cureus.27451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
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12
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Nagano A, Urakawa H, Tanaka K, Ozaki T. Current management of giant-cell tumor of bone in the denosumab era. Jpn J Clin Oncol 2022; 52:411-416. [PMID: 35199172 DOI: 10.1093/jjco/hyac018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/14/2022] Open
Abstract
Giant-cell tumor of bone is a rare, locally aggressive and rarely metastasizing primary bone tumor. The mainstay of treatment remains controversial and is decided by the balance between adequate surgical margin and sufficient adjacent joint function. Although curettage with a high-speed burr and local adjuvants can maintain normal joint function, many reports have revealed a high local recurrence rate. Conversely, en bloc resection and reconstruction with prostheses for highly aggressive lesions have reportedly lower local recurrence rates and poorer functional outcomes. Denosumab-a full human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa β ligand-was approved by the Food and Drug Authority in 2013 for use in surgically unresectable or when resection is likely to result in severe morbidity for skeletally mature adolescents and adults with giant-cell tumor of bone. However, subsequent studies have suggested that the local recurrence rate would be increased by preoperative use of denosumab. In systematic reviews of the local recurrence rate after preoperative use of denosumab, conclusions vary due to the small sample sizes of the studies reviewed. Therefore, controversy regarding the treatment of giant-cell tumor of bone is ongoing. Here, this review elucidates the management of giant-cell tumor of bone, especially with the local adjuvant and neoadjuvant use of denosumab, and presents the current, evidence-based treatment for giant-cell tumor of bone.
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Affiliation(s)
- Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Hospital, Aichi, Japan
| | - Kazuhiro Tanaka
- Department of Endoprosthetic Surgery, Oita University, Yufu, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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13
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Florio M, Careri S, Zoccali C, Aulisa AG, Falciglia F, Toniolo RM, Giordano M. Reconstruction of metatarsal bone after giant cell tumor resection with no vascularized fibular graft in a pediatric patient: Case report and review of literature. Front Pediatr 2022; 10:970309. [PMID: 36313876 PMCID: PMC9597191 DOI: 10.3389/fped.2022.970309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
The Giant Cell tumor (GCT) is a benign, locally aggressive lesion that cause bone destruction and shows a malignant potential. It is a relatively common skeletal tumor that is therefore typically seen in young adults. Few cases are described in literature of GCT in the immature skeleton, and the metatarsal is an unusual location for a primary bone GCT, especially in pediatric age. Therefore, there are very few data reported regarding the management protocol of GCT in metatarsal bones. We report a case about the use of no vascularized fibular graft for an original Y-shaped reconstruction of the metatarsal bone after Giant Cell Tumor resection in a 9 years-old patient, and performed a literature review about metatarsal bone reconstruction in skeletally immature patient.
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Affiliation(s)
- M Florio
- Department of Surgery and Transplant, Division of Traumatology, Bambino Gesu' Children Hospital (IRCCS), Rome, Italy
| | - S Careri
- Department of Surgery and Transplant, Division of Traumatology, Bambino Gesu' Children Hospital (IRCCS), Rome, Italy
| | - C Zoccali
- Department of Human Anatomy, Histology, Forensic Medicine, Orthopedics, Sapienza University, Rome, Italy
| | - A G Aulisa
- Department of Surgery and Transplant, Division of Traumatology, Bambino Gesu' Children Hospital (IRCCS), Rome, Italy.,University of Cassino and Southern Lazio, Cassino, Italy
| | - F Falciglia
- Department of Surgery and Transplant, Division of Traumatology, Bambino Gesu' Children Hospital (IRCCS), Rome, Italy
| | - R M Toniolo
- Department of Surgery and Transplant, Division of Traumatology, Bambino Gesu' Children Hospital (IRCCS), Rome, Italy
| | - M Giordano
- Department of Surgery and Transplant, Division of Traumatology, Bambino Gesu' Children Hospital (IRCCS), Rome, Italy
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14
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Yang YF, Wang JW, Gao XS, Huang JW, Xu ZH. Joint Salvage and Biological Repair of Massive-Cavity Bone Defects After Extensive Curettage of Campanacci Grade II or III Giant Cell Tumor Around the Knee With Vascularized Fibular Autograft and Cancellous Allograft. Ann Plast Surg 2021; 87:537-541. [PMID: 34176896 DOI: 10.1097/sap.0000000000002893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to report the clinical outcomes of repair of massive-cavity bone defects after extensive curettage of Campanacci grade II or III giant cell tumor (GCT) around knee with vascularized fibular autograft and cancellous allograft. METHODS There were 12 consecutive patients with Campanacci grade II or III GCT around knee treated in our department between 2004 and 2016. All the patients underwent clinical evaluation, plain radiography, and/or magnetic resonance imaging of the knee right after admission. To preserve their knee function, we repaired the massive-cavity bone defects after extensive curettage of GCT by vascularized fibular autografts and cancellous allograft. All the patients were evaluated through clinical examinations, plain radiography of the knee and chest, and Musculoskeletal Tumor Society (MSTS) scores of the lower extremity in the follow-ups. RESULTS The follow-up ranged from 1.5 to 12.0 years (mean, 4.2 years). There were no local recurrences or lung metastasis in any of the 12 patients at the last follow-up. Ten patients had no pain or experienced occasional pain, and 9 were able to resume their previous work. The mean range of motion of knee flexion was 117 degrees, and the extension was -6 degrees. The mean MSTS score was 24.7, and a total of 10 patients had excellent or good MSTS scores. CONCLUSIONS It is reliable to achieve knee joint salvage and repair massive-cavity bone defects after extensive curettage with vascularized fibular autograft and cancellous allograft in patients with Campanacci grade II or III GCT around the knee.
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Affiliation(s)
- Yun-Fa Yang
- From the Department of Orthopaedic Surgery, Guangzhou First People's Hospital, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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15
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Konishi E, Outani H, Mano M, Nagata S, Shirai T, Naka N, Hori Y, Takenaka S, Haga H, Toguchida J, Kakunaga S, Kuwae Y, Hoshi M, Inoue T, Aono M, Morinaga Y, Nakashima Y. Giant cell tumor of bone - Analysis of 213 cases involving extra-craniofacial bones. Pathol Int 2021; 71:500-511. [PMID: 34125982 PMCID: PMC8453959 DOI: 10.1111/pin.13107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
We elucidated clinicopathological characteristics of giant cell tumor of bone (GCTB) in Japan, and significant clinicopathological factors for predicting local recurrence. Clinicopathological profiles of 213 patients with GCTB (100 male, 113 female) involving extra‐craniofacial bones were retrieved. Pathological slides obtained at the initial surgery were reviewed. Fourteen pathological and five clinical features were statistically analyzed to disclose prognostic significance. Patient age ranged from 12–80 years (Average 38.7). Long bones were most frequently affected (86.4%), especially around the knee (62.9%). Histological features are basically similar to those previously reported. Within a follow‐up period (24–316 months, average 106.1 months), the local recurrence rate is 29.1%. Metastasis has occurred in 9 patients. Cox regression analysis of representative clinicopathological features shows that younger age, higher mitotic count, smaller zones of stromal hemorrhage, considerable vascular invasion and absence of ischemic necrosis are significant predictors for local recurrence. Initial operative method (curettage) is a significant risk factor in univariate analysis but not by multivariate analysis (P = 0.053). Denosumab administration increases risk but not significantly (P = 0.053). Histone 3.3 G34W immunopositivity is not significant for predicting local recurrence.
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Affiliation(s)
- Eiichi Konishi
- Department of Pathology, Kyoto Prefectural University of Medicine Graduate School of Medicine, Kyoto, Japan
| | - Hidetatsu Outani
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Mano
- Department of Pathology, Osaka National Hospital, Osaka, Japan
| | - Shigenori Nagata
- Department of Pathology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Kyoto Prefectural University of Medicine Graduate School of Medicine, Kyoto, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Takenaka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigeki Kakunaga
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan
| | - Yuko Kuwae
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Manabu Hoshi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Masanari Aono
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yukiko Morinaga
- Department of Pathology, Kyoto Prefectural University of Medicine Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Nakashima
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Tran V, Slavin J. Bone Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Wang PH, Wu CL, Chen CM, Wang JY, Wu PK, Chen WM. Adjuvant therapy by high-speed burr may cause intraoperative bone tumor seeding: an animal study. BMC Musculoskelet Disord 2020; 21:507. [PMID: 32736546 PMCID: PMC7395403 DOI: 10.1186/s12891-020-03544-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/28/2020] [Indexed: 12/28/2022] Open
Abstract
Background Bone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery. Methods A porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr. Results The intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III. Conclusions High-speed burring may cause explosive bone cement spray, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The wide range of bone cement spray caused by high-speed burr was inspected in this pilot study, which may lead to tumor seeding. Level of evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pai-Han Wang
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201 Shi-Pai Road, Beitou District, Taipei, 11217, Taiwan.,Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Lun Wu
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201 Shi-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Chao-Ming Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201 Shi-Pai Road, Beitou District, Taipei, 11217, Taiwan.,Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jir-You Wang
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201 Shi-Pai Road, Beitou District, Taipei, 11217, Taiwan.,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201 Shi-Pai Road, Beitou District, Taipei, 11217, Taiwan. .,Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wei-Ming Chen
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201 Shi-Pai Road, Beitou District, Taipei, 11217, Taiwan.,Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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18
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Howard EL, Gregory J, Tsoi K, Evans S, Flanagan A, Cool P. Comorbidities and Pregnancy Do Not Affect Local Recurrence in Patients With Giant Cell Tumour of Bone. Cureus 2020; 12:e9164. [PMID: 32802601 PMCID: PMC7419151 DOI: 10.7759/cureus.9164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study evaluates the relationship between pregnancy, comorbid conditions and giant cell tumour of bone. Furthermore, it examines if pregnancy and comorbid conditions affect the outcome following treatment for this tumour. A multi-centre retrospective review was conducted of consecutive patients with a confirmed histological diagnosis of giant cell tumour of bone between June 2012 and May 2017. A total of 195 patients were identified from two centres. Of these, 168 patients were treated with curative intent and had more than six months follow-up. Data were collected on pregnancy status, comorbid conditions, site of disease, surgical management and local recurrence rates. Statistical analysis included the Fisher exact test and Kaplan-Meier survival analysis. There were 72 females of childbearing age, of which 15 (21%) were currently pregnant or had been pregnant within the last six months. The pregnancy rate is higher than the highest reported pregnancy rate over the last 10 years (8.4%; Fisher test, p = 0.033). Women were more likely to have a comorbid condition than men (Fisher test, p < 0.002) and had a higher rate of autoimmune disease than the normal population (p = 0.015). Men were older than women (Wilcoxon test, p = 0.046) and had less risk of local recurrence (logrank test, p = 0.014). Pregnancy or comorbid conditions did not increase the local recurrence rate. Predictors for local recurrence included location in the distal radius (logrank test, p < 0.001), intralesional treatment (logrank test, p = 0.008) and age less than 40 (logrank test, p = 0.043). In conclusion, giant cell tumour of bone is more common in pregnant females and patients with immune disease. Comorbidities and pregnancy do not affect the local recurrence rate. Male patients over 40 years of age have a lower risk of local recurrence, and patients with disease in the distal radius have a high risk of recurrence.
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Affiliation(s)
- Emma L Howard
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Jonathan Gregory
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Kim Tsoi
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Scott Evans
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Adrienne Flanagan
- Pathology, The Royal Orthopaedic Hospital NHS Foundation Trust, Stanmore, GBR
| | - Paul Cool
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR.,Medical Sciences, Keele University, Keele, GBR
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Luna LP, Sankaran N, Ehresman J, Sciubba DM, Khan M. Successful percutaneous treatment of bone tumors using microwave ablation in combination with Zoledronic acid infused PMMA cementoplasty. J Clin Neurosci 2020; 76:219-225. [DOI: 10.1016/j.jocn.2020.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/21/2020] [Indexed: 12/20/2022]
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20
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Metovic J, Annaratone L, Linari A, Osella-Abate S, Musuraca C, Veneziano F, Vignale C, Bertero L, Cassoni P, Ratto N, Comandone A, Grignani G, Piana R, Papotti M. Prognostic role of PD-L1 and immune-related gene expression profiles in giant cell tumors of bone. Cancer Immunol Immunother 2020; 69:1905-1916. [PMID: 32377818 DOI: 10.1007/s00262-020-02594-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
Giant cell tumor of bone (GCTB) is a locally aggressive and rarely metastatic tumor, with a relatively unpredictable clinical course. A retrospective series of 46 GCTB and a control group of 24 aneurysmal bone cysts (ABC) were selected with the aim of investigating the PD-L1 expression levels and immune-related gene expression profile, in correlation with clinicopathological features. PD-L1 and Ki67 were immunohistochemically tested in each case. Furthermore, comprehensive molecular analyses were carried out using NanoString technology and nCounter PanCancer Immune Profiling Panel, and the gene expression results were correlated with clinicopathological characteristics. PD-L1 expression was observed in 13/46 (28.3%) GCTB (and in 1/24, 4.2%, control ABC, only) and associated with a shorter disease free interval according to univariate analysis. Moreover, in PD-L1-positive lesions, three genes (CD27, CD6 and IL10) were significantly upregulated (p < 0.01), while two were downregulated (LCK and TLR8, showing borderline significance, p = 0.06). Interestingly, these genes can be related to maturation and immune tolerance of bone tissue microenvironment, suggesting a more immature/anergic phenotype of giant cell tumors. Our findings suggest that PD-L1 immunoreactivity may help to select GCTB patients with a higher risk of recurrence who could potentially benefit from immune checkpoint blockade.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, University of Turin, Turin, Italy
| | - Laura Annaratone
- Department of Medical Sciences, University of Turin, Turin, Italy
- Pathology Division, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | | | | | | | - Chiara Vignale
- Department of Oncology, University of Turin, Turin, Italy
| | - Luca Bertero
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nicola Ratto
- Division of Orthopedics, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Alessandro Comandone
- Division of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy
- ASL Città di Torino, Turin, Italy
| | | | - Raimondo Piana
- Division of Orthopedics, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy.
- Anatomia Patologica, Città della Salute e della Scienza Hospital, University of Turin, Via Santena 7, 10126, Turin, Italy.
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21
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Is Treatment with Denosumab Associated with Local Recurrence in Patients with Giant Cell Tumor of Bone Treated with Curettage? A Systematic Review. Clin Orthop Relat Res 2020; 478:1076-1085. [PMID: 31794487 PMCID: PMC7170677 DOI: 10.1097/corr.0000000000001074] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Denosumab, a monoclonal antibody that binds to receptor activation of nuclear factor-kappa ß ligand (RANKL), has been used as a drug to treat aggressive giant cell tumors of bone. It is unclear whether preoperative denosumab therapy is associated with the local recurrence risk in patients with giant cell tumors of bone treated with curettage. Early evidence suggests that denosumab treatment is associated with a reduction in local recurrence, but other studies have questioned that premise. Curettage after a short course of denosumab (3 to 4 months) has been recommended, especially for large, aggressive giant cell tumors in which complete curettage is difficult to achieve. No randomized studies have documented the benefit of this approach, and some investigators have reported higher local recurrence after denosumab treatment. Due to this confusion, we performed a systematic analysis of existing reports to attempt to answer this question and determine whether the appropriate preoperative denosumab therapy duration could be established. QUESTIONS/PURPOSES (1) Is the use of preoperative denosumab associated with local recurrence risk in patients with giant cell tumors of bone treated with curettage compared with those treated with curettage alone? (2) Is the preoperative denosumab therapy duration associated with local recurrence after curettage? METHODS We searched the PubMed, EMBASE, and CENTRAL databases on April 26, 2019 and included both randomized and non-randomized studies that compared local recurrence between patients who had giant cell tumors of bone and were treated with curettage after preoperative denosumab and patients treated with curettage alone. Two authors independently screened the studies. There were no randomized studies dealing with denosumab in giant cell tumors of bone, and generally, denosumab was used for more aggressive tumors. We assessed the quality of the included studies using the Risk of Bias Assessment tool for Non-randomized Studies, with a moderate overall risk of bias. We registered our protocol in PROSPERO (registration number CRD42019133288). We selected seven eligible studies involving 619 patients for the final analysis. RESULTS The proportion of patients with local recurrence ranged from 20% to 100% in the curettage with preoperative denosumab group and ranged from 0% to 50% in the curettage-alone group. The odds ratio of local recurrence ranged from 1.07 to 37.80 in no more than 6 months of preoperative denosumab duration group and ranged from 0.60 to 28.33 in more than 6 months of preoperative denosumab duration group. CONCLUSIONS The available evidence for the benefit of denosumab in more aggressive giant cell tumors is inconclusive, and denosumab treatment may even be associated with an increase in the proportion of patients experiencing local recurrence. Because there are no randomized studies and the existing studies are of poor quality due to indication bias (the most aggressive Campanacci 3 lesions or those where even a resection would be difficult and result in morbidity are generally the patients who are treated with denosumab), the evidence to suggest a disadvantage is weak. Denosumab treatment should be viewed with caution until more definitive, randomized studies documenting a benefit (or not) have been conducted. Furthermore, we could not find evidence to suggest an appropriate length of preoperative denosumab before curettage.
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He Y, Guo J, Ding X, van Ooijen PMA, Zhang Y, Chen A, Oudkerk M, Xie X. Convolutional neural network to predict the local recurrence of giant cell tumor of bone after curettage based on pre-surgery magnetic resonance images. Eur Radiol 2019; 29:5441-5451. [PMID: 30859281 DOI: 10.1007/s00330-019-06082-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/24/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To predict the local recurrence of giant cell bone tumors (GCTB) on MR features and the clinical characteristics after curettage using a deep convolutional neural network (CNN). METHODS MR images were collected from 56 patients with histopathologically confirmed GCTB after curettage who were followed up for 5.8 years (range, 2.0 to 9.5 years). The inception v3 CNN architecture was fine-tuned by two categories of the MR datasets (recurrent and non-recurrent GCTB) obtained through data augmentation and was validated using fourfold cross-validation to evaluate its generalization ability. Twenty-eight cases (50%) were chosen as the training dataset for the CNN and four radiologists, while the remaining 28 cases (50%) were used as the test dataset. A binary logistic regression model was established to predict recurrent GCTB by combining the CNN prediction and patient features (age and tumor location). Accuracy and sensitivity were used to evaluate the prediction performance. RESULTS When comparing the CNN, CNN regression, and radiologists, the accuracies of the CNN and CNN regression models were 75.5% (95% CI 55.1 to 89.3%) and 78.6% (59.0 to 91.7%), respectively, which were higher than the 64.3% (44.1 to 81.4%) accuracy of the radiologists. The sensitivities were 85.7% (42.1 to 99.6%) and 87.5% (47.3 to 99.7%), respectively, which were higher than the 58.3% (27.7 to 84.8%) sensitivity of the radiologists (p < 0.05). CONCLUSION The CNN has the potential to predict recurrent GCTB after curettage. A binary regression model combined with patient characteristics improves its prediction accuracy. KEY POINTS • Convolutional neural network (CNN) can be trained successfully on a limited number of pre-surgery MR images, by fine-tuning a pre-trained CNN architecture. • CNN has an accuracy of 75.5% to predict post-surgery recurrence of giant cell tumors of bone, which surpasses the 64.3% accuracy of human observation. • A binary logistic regression model combining CNN prediction rate, patient age, and tumor location improves the accuracy to predict post-surgery recurrence of giant cell bone tumors to 78.6%.
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Affiliation(s)
- Yifeng He
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, HaiNing Rd.100, Shanghai, 200080, China
- Radiology Department, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, RuiJin No.2 Rd.197, Shanghai, 200025, China
| | - Jiapan Guo
- University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Xiaoyi Ding
- Radiology Department, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, RuiJin No.2 Rd.197, Shanghai, 200025, China
| | - Peter M A van Ooijen
- University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Yaping Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, HaiNing Rd.100, Shanghai, 200080, China
| | - An Chen
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, HaiNing Rd.100, Shanghai, 200080, China
| | - Matthijs Oudkerk
- University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Xueqian Xie
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, HaiNing Rd.100, Shanghai, 200080, China.
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23
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Wide Resection and Iliac Crest Arthrodesis for Multiply Recurrent Giant Cell Tumor of First Metatarsal. Case Rep Orthop 2019; 2018:4521841. [PMID: 30631621 PMCID: PMC6304854 DOI: 10.1155/2018/4521841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/31/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022] Open
Abstract
Case Giant cell tumor of bone is a benign, aggressive neoplasm commonly arising in the femur, tibia, and distal radius and less commonly in the hands and feet. We describe a 22-year-old woman who underwent wide resection of multiply recurrent first metatarsal giant cell tumor and reconstruction with iliac crest arthrodesis. Conclusion To our knowledge, there have been no previous reports of managing multiply recurrent giant cell tumor of the first metatarsal. The patient was without pain and exercising without difficulty 18 months following surgery. This method appears useful for reconstructing the foot following multiply recurrent giant cell tumor of the metatarsal.
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Cui HM, Yu YL, He Y, Kong LZ, Fan CY. Management of elbow dysfunction associated with giant cell tumor of the distal humerus: achieving oncologic safety and good function by a combined reconstruction. J Shoulder Elbow Surg 2019; 28:120-125. [PMID: 30348545 DOI: 10.1016/j.jse.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of our study was to evaluate the functional outcomes and oncologic results of elbow salvage surgery using arthrolysis combined with ligament repair and external fixation for reconstruction of the elbow after tumor excision and autografting. METHODS We retrospectively reviewed 6 patients with elbow dysfunction associated with giant cell tumor of the distal humerus. All patients were treated with our combined protocol. We assessed the Musculoskeletal Tumor Society system score, range of motion, Mayo Elbow Performance Score, recurrence, and complications for each patient. RESULTS The mean follow-up period was 48 months (range, 36-60 months). There were no cases of postoperative fracture, infection, elbow dislocation, elbow stiffness, or local recurrence. The average Musculoskeletal Tumor Society score was 28 of 30 points (93%; range, 87%-100%). The Mayo Elbow Performance Score improved from a mean of 61 points to 93 points, with mean flexion of 135° and mean extension of 3°. CONCLUSIONS Local tumor resection, autografting, and elbow reconstruction by arthrolysis combined with ligament repair and external fixation can be performed with oncologic safety and provide satisfactory functional outcomes with low complication rates.
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Affiliation(s)
- Hao-Min Cui
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ya-Ling Yu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu He
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ling-Zhi Kong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cun-Yi Fan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China.
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25
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Pannu CD, Kandhwal P, Raghavan V, Khan SA, Rastogi S, Jayaswal A. Role of Bisphosphonates as Adjuvants of Surgery in Giant Cell Tumor of Spine. Int J Spine Surg 2018; 12:695-702. [PMID: 30619673 DOI: 10.14444/5087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The role of bisphosphonates is well established in giant cell tumor of bone (GCTB) of extremities, but its role in spine GCTB is still not established. Our main purpose was to evaluate the role of bisphosphonates in spinal GCTB with the help of radiologic assessment. Methods A retrospective analysis of all spine GCTB patients who underwent an operation from July 2005 to January 2014 was done. Patients of spine GCTB in whom bisphosphonates were given constituted the study group. This group was compared to patients in whom bisphosphonates were not given. Preoperative and postoperative radiographs and CT scans were studied. A thorough evaluation of the presence of sclerosis was done on them. Bisphosphonates were considered to be effective if either sclerosis or new bone formation was present. Results A total of 13 cases of spine GCT underwent operation from July 2005 to January 2014. All patients of GCTB spine who underwent an operation after 2008 at our institute were given bisphosphonates postoperatively. Of 13 cases, bisphosphonates were given postoperatively in 6 patients: 5 patients were female and 1 patient was male. Of these 6 patients, 3 patients had sacrum GCTB and 1 patient each had T9, T11, and L5 vertebrae GCTB. Average follow-up period was 39.33 months (minimum follow-up was 18 months and maximum follow-up was 72 months). Postoperative sclerosis was present in all 6 patients. No recurrence of the tumor was present in the bisphosphonate group, but 2 patients had a recurrence in the group that did not receive bisphosphonates. Conclusions Bisphosphonates are effective and safe adjuvant therapy along with appropriate surgical intervention in spinal GCTBs and may have a role in decreasing the recurrence of this tumor.
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Affiliation(s)
- Chaitanya Dev Pannu
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kandhwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Raghavan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shishir Rastogi
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Jayaswal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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He Y, Zhou Y, Zhang J, Yuan F, Wang J, Du L, Zhou Q, Liang J, Ding X. Tumor immunohistochemistry and preoperative magnetic resonance imaging features predict local recurrence of giant cell tumor of bone following intralesional curettage. Oncol Lett 2018; 17:1425-1434. [PMID: 30675196 PMCID: PMC6341842 DOI: 10.3892/ol.2018.9778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 02/06/2018] [Indexed: 12/30/2022] Open
Abstract
Giant cell tumor of bone (GCTB) is among the most prevalent types of tumor of the bone in East and Southeast Asia. The high rate of local recurrence following intralesional curettage poses a challenge for the clinical treatment of GCTB. In the present study, the expression of matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), receptor activator of nuclear factor-κB (RANK) and RANK ligand (RANKL) in GCTB was investigated by immunohistochemical staining. A correlation between expression and preoperative magnetic resonance imaging (MRI) features was identified. The patients were followed up for ≥2 years after intralesional curettage. The rates of local recurrence were compared among different groups. A total of 74 cases of GCTB in the proximal tibia or distal femur were investigated. MRI features were retrospectively examined by correlation analysis. The expression of MMP-9 was demonstrated to be associated with cystic changes and the 'paint brush borders' sign (P<0.05), and positively associated with the expression of RANKL (P<0.05) and VEGF (P<0.05). Cystic changes, the 'paint brush borders' sign and adjacent soft tissue invasion were associated with high rates of local recurrence (P<0.05) and were therefore identified as significant risk factors. Pathologically, the 'paint brush borders' sign was demonstrated to be indicative of local invasion of the bone. These findings may be useful for predicting local recurrence of GCTB, and may provide important insight into the preoperative MRI features and molecular expression patterns of GCTB tumors.
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Affiliation(s)
- Yifeng He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Yu Zhou
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Ji Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Fei Yuan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jun Wang
- Shanghai Institute of Traumatology and Orthopedics, Shanghai Key Laboratory for The Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Lianjun Du
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Qi Zhou
- Shanghai Institute of Traumatology and Orthopedics, Shanghai Key Laboratory for The Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jing Liang
- Shanghai Institute of Traumatology and Orthopedics, Shanghai Key Laboratory for The Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
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Itkin B, Straminsky S, De Ronato G, Lewi D, Marantz A, Bardach A. Prognosis of metastatic giant cell tumor of bone in the pre-denosumab era. A systematic review and a meta-analysis. Jpn J Clin Oncol 2018; 48:640-652. [PMID: 29741702 DOI: 10.1093/jjco/hyy067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/20/2018] [Indexed: 12/16/2022] Open
Abstract
Background Data on long-term prognosis of metastatic GCT (mGCT) is scant. The frequency of spontaneous regressions (SRs) is unknown. We aimed to estimate the prognosis of mGCT. Methods We searched electronic scientific literature databases and generic Internet from January 1980 to August 2017. After identifying eligible studies we performed descriptive analyses and meta-analyses to estimate overall survival (OS), disease specific survival (DSS) and frequency of SRs in the years before the widespread use of denosumab. We performed pre-specified subgroup analyses of studies published before and after 2000 and of those with more and less than 10 years of follow-up. Results After retrieving and combining data from 26 relevant retrospective case-series totaling 242 patients with a median follow-up of 6.9 years, the estimated pooled OS was 86.9% (95% CI 78.0-94.2). Pooled DSS was 88.0% (95% CI 79.7-94.7). SRs were observed in 4.5% of patients. In the subgroup of studies published after 2000 mGCT was the only cause of death of affected subjects. In case-series with a follow-up longer than 10 years pooled DSS was 69.7% (95% CI 25.5-99.8). Conclusions To our knowledge this is the first study to derive estimated pooled OS and DSS of mGCT based on a large dataset. SRs were not exceptional phenomena. In a long run the disease could impact in a significant way on the life expectancy of affected subjects.
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Affiliation(s)
- Boris Itkin
- Department of Medical Oncology, Juan A. Fernandez Hospital
| | | | | | - Daniel Lewi
- Department of Medical Oncology, Juan A. Fernandez Hospital
| | - Adolfo Marantz
- Department of Medical Oncology, Juan A. Fernandez Hospital
| | - Ariel Bardach
- Institute for Clinical Effectiveness and Health Policy, Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Argentina
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He Y, Wang J, Zhang J, Du L, Lu Y, Xu J, Yuan F, Tan Y, Ding X. Magnetic resonance feature of "paintbrush borders" sign as a novel way to predict recurrence of giant cell tumor of bone after curettage: a pilot study. J Int Med Res 2017; 46:710-722. [PMID: 29239274 PMCID: PMC5971501 DOI: 10.1177/0300060517720345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To identify the prognostic factors for local recurrence of giant cell tumor of bone (GCTB) through assessment of the preoperative imaging features of the tumor border. Methods Patients with GCTBs treated with intralesional procedures in the proximal tibia and distal femur were prospectively enrolled and then followed up for at least 2 years. The GCTBs were grouped according to their preoperative imaging features. GCTBs treated with en bloc resection were enrolled for investigation of the pathologic basis of specific imaging features. Differences between rates were evaluated by the chi-square test or Fisher’s exact test; independent factors were identified by multivariate logistic regression analysis. Results Fifty-three patients were enrolled and successfully followed up. Relapse occurred in 22 patients. Patients with a “paintbrush borders” sign (n = 21) had a significantly higher rate of local recurrence (71.43%) than patients without this sign (21.88%). The “paintbrush borders” sign was identified as an independent prognostic factor for local recurrence. Other imaging features were not significantly associated with recurrence. The “paintbrush borders” sign showed a correlation with local invasion of bone. Conclusion The “paintbrush borders” sign on preoperative magnetic resonance imaging is an independent prognostic factor for local recurrence of GCTB.
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Affiliation(s)
- Yifeng He
- 1 Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- 2 Shanghai Key Laboratory for Bone and Joint Diseases, Shanghai Institute of Orthopedics and Traumatology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji Zhang
- 1 Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianjun Du
- 1 Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Lu
- 1 Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianqiang Xu
- 3 Department of Orthopedics, Ruijin Hospital, 66281 Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Fei Yuan
- 4 Department of Pathology, Ruijin Hospital, 66281 Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yimin Tan
- 1 Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- 1 Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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He Y, Wang J, Zhang J, Yuan F, Ding X. A prospective study on predicting local recurrence of giant cell tumour of bone by evaluating preoperative imaging features of the tumour around the knee joint. Radiol Med 2017; 122:546-555. [PMID: 28271359 DOI: 10.1007/s11547-017-0745-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/22/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the role of medical imaging in predicting local recurrence of giant cell tumour of bone (GCTB) by assessing the preoperative imaging features of GCTB around the knee. METHODS Forty-eight consecutive GCTBs in the proximal tibia and distal femur treated with curettage were prospectively enrolled. Patients were grouped in terms of their imaging features on radiography, computed tomography (CT) and magnetic resonance imaging (MRI). All patients were followed up for at least two years after surgery. The association between preoperative imaging features and local recurrence was investigated. Imaging features were retrospectively studied by correlation analysis. The differences between rates were tested by the Chi square and Fisher exact tests; independent factors were determined by multivariate logistic regression analysis. RESULTS Cystic change and adjacent soft tissue invasion were associated with a higher rate of local recurrence compared to the negative groups (P < 0.05). Cystic change was identified as an independent risk factor for local recurrence of GCTB (P < 0.05). Expansibility was correlated with the "soap bubble" sign and the fluid-fluid level (P < 0.05); the "soap bubble" sign was correlated with osteosclerosis and the fluid-fluid level (P < 0.05); cortical bone involvement was correlated with adjacent soft tissue invasion (P < 0.05); and cystic change was correlated with the fluid-fluid level (P < 0.05). CONCLUSION Cystic change was an independent risk factor for local recurrence of GCTB. Adjacent soft tissue invasion might indirectly relate to local relapse. A cluster of association relationships between imaging features was revealed.
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Affiliation(s)
- Yifeng He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China
| | - Jun Wang
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China
| | - Fei Yuan
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
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Zhang J, Li Y, Li D, Xia J, Li S, Yu S, Liao Y, Li X, Li H, Yang Z. Clinical effects of three surgical approaches for a giant cell tumor of the distal radius and ulna. Mol Clin Oncol 2016; 5:613-617. [PMID: 27900098 DOI: 10.3892/mco.2016.1031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 09/06/2016] [Indexed: 01/11/2023] Open
Abstract
The aim of the present study was to assess the curative effects of three surgical approaches for a giant cell tumor (GCT) of the distal radius and ulna. A total of 27 patients with GCT on distal radius and ulnas (7 and 20, respectively), confirmed by biopsy, were treated with individualized treatment regimens, according to the Campanacci's grade system: i) Curettage plus inactivated tumor bed and allogeneic bone graft/bone cement augmentation for Campanacci's grade I GCT of the distal radius and ulna (Group A); ii) simple en bloc resection for Campanacci's grade II and III GCT of the distal ulna (Group B); iii) en bloc resection and reconstruction with non-vascularized fibular autograft/allogeneic bone graft for Campanacci's II and III GCT of the distal radius (Group C). Postoperative recurrence and complications were recorded. The Musculoskeletal Tumor Society Score was used to assess functional results. The mean follow-up time was 25 months (range, 9-125 months). A total of 3 patients exhibited tumor recurrence at 9, 11 and 15 months following surgery (1 case succumbed to pulmonary metastasis at 27 months). Overall, the incidence of the postoperative recurrence of the GCT of the distal ulna and radius were 14.3 (1/7) and 10% (2/20), respectively, with a statistical P-value of 0.762. No statistically significant difference was observed regarding the incidence of the postoperative recurrence, postoperative complications and MSTS results among the three surgical approaches for the GCT on distal ulna and radius (all P>0.05). However, statistically significant differences were noted when the incidence of the postoperative recurrence of curettage (Group A) was compared with that of en bloc resection (Groups B and C) (P=0.024). In conclusion, in order to achieve the best clinical effects for patients with GCT on distal radius and ulna, individualized treatment regimens must be designed according to the different Campanacci's grades and tumor locations.
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Affiliation(s)
- Jing Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Yi Li
- Department of Oncology, Kunming General Hospital of Chengdu Military Command, Kunming, Yunnan 650118, P.R. China
| | - Dongqi Li
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Junfeng Xia
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Su Li
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Shunling Yu
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Yedan Liao
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Xiaojuan Li
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Huilin Li
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
| | - Zuozhang Yang
- Department of Orthopedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan, Kunming, Yunnan 650118, P.R. China
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Kim SC, Cho W, Chang UK, Youn SM. Clinical Outcome of Treatment for Patients with Giant Cell Tumor in Spine. J Korean Neurosurg Soc 2015; 58:248-53. [PMID: 26539269 PMCID: PMC4630357 DOI: 10.3340/jkns.2015.58.3.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/07/2015] [Accepted: 08/19/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The treatment of giant cell tumor (GCT) is mainly performed surgically. However, GCT in spine seems difficult to treat because of the limited surgical accessibility and proximity. In this report, we analyzed the outcome of GCT treatment in spine. METHODS Between 2000 and 2012, 19 patients received treatment for GCT in spine. Median age at their first diagnosis was 31 years, 10 patients were male, and 9 female. Fourteen tumors were located in the sacrum, 1 in cervical, 1 in thoracic and 3 in lumbar spine. As primary treatment, gross total removal (GTR) was done in 6 patients, and subtotal removal (STR) in 13 patients. Radiation therapy (RT) as an adjuvant therapy was performed in 2 cases in GTR group and 10 cases in STR group. RESULTS During the follow-up, 7 patients had local recurrence (36.8%). The average period until recurrence after primary treatment was 14 months. No recurrence was detected in GTR group. Recurrence was noted in 7 out of 13 patients who underwent STR. These differences were statistically significant (p=0.024). A median of recurrence free period (RFP) was 84 months. Also average RFP of the RT group was 112 months, and non-RT group was 65 months. These differences were statistically significant (p=0.041). CONCLUSION Treatment of choice for GCT in spine is a complete removal of tumor without neurological deficits. In case of incomplete removal, radiation therapy may be a useful adjuvant treatment modality.
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Affiliation(s)
- Seon Chun Kim
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Wonik Cho
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Ung-Kyu Chang
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sang Min Youn
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Chan CM, Adler Z, Reith JD, Gibbs CP. Risk factors for pulmonary metastases from giant cell tumor of bone. J Bone Joint Surg Am 2015; 97:420-8. [PMID: 25740033 DOI: 10.2106/jbjs.n.00678] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Giant cell tumor (GCT) of bone is a rare, benign, aggressive bone tumor with an unusual capacity to metastasize to the lung. It was the goal of this study to identify patient and treatment-specific variables associated with the development of pulmonary metastases of GCT of bone. METHODS From 1980 to 2009, 291 patients with benign GCT of bone were treated at our institution, and 167 were followed for at least two years. Eleven (6.6%) of these 167 patients developed biopsy-confirmed pulmonary metastasis. All patients were evaluated relative to nine patient, disease, and treatment-specific variables. RESULTS We identified four properties of benign GCT of bone associated with an increased risk of metastasis on univariate analysis: age at diagnosis, axial location of the primary GCT, primary Enneking stage-3 disease, and local recurrence. Multivariate analysis showed local recurrence to be an independent risk factor for pulmonary metastasis (adjusted odds ratio, 7.42). CONCLUSIONS There is an increased risk of pulmonary metastasis of GCT of bone in patients who are younger, present with Enneking stage-3 disease, develop local recurrence, and/or present with axial disease. The mode of treatment was not found to be associated with the development of pulmonary metastasis.
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Affiliation(s)
- Chung Ming Chan
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL 32607. E-mail address for C.M. Chan:
| | - Zachary Adler
- Newport Orthopaedic Institute, 22 Corporate Plaza Drive, Newport Beach, CA 92660
| | - John D Reith
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL 32607. E-mail address for C.M. Chan:
| | - C Parker Gibbs
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL 32607. E-mail address for C.M. Chan:
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Gouin F, Rochwerger AR, Di Marco A, Rosset P, Bonnevialle P, Fiorenza F, Anract P. Adjuvant treatment with zoledronic acid after extensive curettage for giant cell tumours of bone. Eur J Cancer 2014; 50:2425-31. [PMID: 25088085 DOI: 10.1016/j.ejca.2014.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/09/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Giant cell tumours (GCT) of bone are benign neoplasms associated with a high rate of local recurrence after extensive intra-lesional curettage. Recently, understanding of the biological molecular availability of strong anti-osteoclastic drugs has suggested their potential value in reducing local recurrences after curettage. Through a phase II clinical trial, we investigated the effect of a short treatment with zoledronic acid (ZOL) after intra-lesional curettage of GCT, as well as local recurrence and tolerance of the treatment. METHODS AND PATIENTS Twenty-four patients were enrolled in a multicentre, phase 2 study. The patients were treated with extensive intra-lesional curettage followed by five courses of ZOL (4 mg IV every 3 weeks). The clinical and biological tolerance of each patient was assessed. Patients were reviewed clinically and by X-ray every 6 months until the end of the study (36 months). RESULTS Eighteen out of 20 patients reported side-effects with ZOL, mainly grade 1 and 2 effects. The local recurrence rate was 15%; three patients had a recurrence, one at 4 months (huge GCT of the sacrum), one at 24 months (patient who discontinued the treatment after the first course of ZOL), and one after the observational period, at 58 months. Finally, local relapse-free survival was 82 ± 9% at 60 months. CONCLUSION Short adjuvant treatments with ZOL after extensive intra-lesional curettage of GCT were associated with a low rate of recurrence but did not prevent local recurrence in this study. No serious general adverse effects were observed. More studies are needed to evaluate the potential benefit of medical bisphosphonate injections combined with intra-lesional curettage in the treatment of GCTB.
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Affiliation(s)
- Francois Gouin
- Orthopaedics and Traumatology Department, University Hospital of Nantes CHU, Hôtel-Dieu, 44 093 Nantes Cedex, France; LPRO, Inserm U957, UFR Médecine, Université de Nantes, 1 Rue Gaston Veil, 44000 Nantes, France.
| | | | - Antonio Di Marco
- University Hospital de Hautepierre, Av. Molière, 67 000 Strasbourg, France.
| | - Philippe Rosset
- University Hospital Trousseau, Rue des Loches, 37 004 Tours, France.
| | - Paul Bonnevialle
- University Hospital of Purpan, Place du Dr. Baylac, 31 059 Toulouse, France.
| | - Fabrice Fiorenza
- University Hospital Dupuytren, Av. Martin Luther King, 87 042 Limoges, France.
| | - Philippe Anract
- University Hospital of Cochin-Port Royal, Av. Du Fb Saint Jacques, 75 014 Paris, France.
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A retrospective analysis of 140 patients with giant cell tumor in the extremity: a multicenter study based on four hospitals in South China. Cancer Epidemiol 2013; 37:294-9. [PMID: 23419818 DOI: 10.1016/j.canep.2013.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/12/2013] [Accepted: 01/29/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Update reports are rarely available regarding the bone giant cell tumors (GCTs) in the extremity in Chinese people. The aim of this study was to review the epidemiological characteristics of bone GCT in the extremity based on the clinical data from four hospitals in South China. METHODS We searched medical electronic records from January 2001 to December 2011 in four hospitals in South China to identify patients with definite diagnosis of extremity GCT. Epidemiological data including gender, tumor site, age at the time of first diagnosis, local recurrence and pulmonary metastasis were collected and analyzed statistically. Differences between-genders were particularly analyzed regarding first diagnosis age, tumor site, local recurrence and pulmonary metastasis. T-test and Chi-square test were used for continuous and dichotomous variables, respectively. RESULTS A total of 140 GCT patients (87 males and 53 females) were identified. The gender ratio was 1.64 for a male predominance. GCTs were mostly located around the knee (67 cases). 92 patients were in their 20s to 40s upon first diagnosis. The average age at the time of first diagnosis for all was 30.49 years, 30.76 years for males and 30.06 years for females (P = 0.757). GCT recurred locally in 50 patients (26 males and 24 females) with no gender difference (P = 0.065). The average interval from first surgery to local recurrence was 21.42 months. Pulmonary metastasis was found in 11 patients (8 males and 3 females) also with no gender difference (P = 0.667). The average interval from first diagnosis to metastasis was 36.45 months. CONCLUSIONS Extremity GCT may have a male predominance in Chinese population and mostly occur at 20-40 years of age and around the knee. Follow-ups for GCT patients should be carried on for at least 3 years after primary surgery according to the average intervals for possible local recurrence and pulmonary metastasis.
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Giant cell tumour of bone: a new evaluating system is necessary. INTERNATIONAL ORTHOPAEDICS 2012; 36:2521-7. [PMID: 23052276 DOI: 10.1007/s00264-012-1664-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 09/11/2012] [Indexed: 12/28/2022]
Abstract
Giant cell tumour (GCT) of bone is still one of the most obscure and intensively studied tumours of bone. The histogenesis of GCT remains unclear. The recommended therapy of GCT evolved during the 20th century. The best treatment should ensure local control and maintain function. Curettage has been the preferred treatment for most GCTs. Good results have also been published on the use of high-speed burr and local adjuvants. Local tumour control can be satisfactorily achieved by wide excision. However, treatment options for GCT have remained fairly static over the past 30 years and there is no widely held consensus regarding the standard treatment selection for all patients. This challenge may result from the fact that there are no single clinical, radiographic, histological or morphological aspects that allow surgeons to accurately predict the trend of a single lesion to recur. In this research, a comprehensive review of the previously described radiographic staging systems by Enneking and Campanacci et al. and the shortfalls associated with them are provided, and then the possible risk factors of predicting local recurrence or evaluating functional outcome of GCT are also discussed. A new preoperative evaluating system of GCT may be necessary and feasible, so that surgeons may accurately assess the aggressiveness or severity of GCT in order to reliably guide treatment decisions and predict outcomes.
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Liu YP, Li KH, Sun BH. Which treatment is the best for giant cell tumors of the distal radius? A meta-analysis. Clin Orthop Relat Res 2012; 470:2886-94. [PMID: 22773395 PMCID: PMC3442009 DOI: 10.1007/s11999-012-2464-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 06/19/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intralesional excision and en bloc resection are used to treat giant cell tumors (GCTs) of the distal radius. However, it is unclear whether one provides lower rates of recurrences and fewer complications, and whether the use of polymethylmethacrylate (PMMA) after curettage reduces the risk of recurrence. QUESTIONS/PURPOSES We examined whether curettage was associated with lower rates of recurrence and fewer major complications compared with en bloc excision, and whether PMMA resulted in lower rates of recurrence compared with a bone graft. METHODS We systematically searched the literature using the criteria, "giant cell tumor" AND "curettage" OR "intralesional excision" OR "resection". Six relevant articles were identified that reported data for 80 curettage cases (PMMA, n = 49; bone graft, n = 26; no PMMA or bone grafts, n = 5) and 59 involving en bloc excision. A meta-analysis was performed using these data. RESULTS Overall, patients in the intralesional excision group had a higher recurrence rate (relative risk [RR], 2.80; 95% CI, 1.17-6.71), especially for Campanacci grade 3 GCTs (RR, 4.90; 95% CI, 1.36-17.66), yet fewer major complications (RR, 0.21; 95% CI, 0.09-0.54) than the en bloc resection group. The use of PMMA versus bone graft did not affect the recurrence rate (RR, 0.98; 95% CI, 0.44-2.17). CONCLUSIONS Based on data obtained from the limited number of studies available, intralesional excision appears to be more appropriate for the treatment of local lesions (e.g., grades 1 and 2) than grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant. LEVEL OF EVIDENCE Level III, therapeutic study (systematic review). See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yu-peng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008 PR China
| | - Kang-hua Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008 PR China
| | - Bu-hua Sun
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008 PR China
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Park YS, Lee JK, Baek SW, Park CK. The rare case of giant cell tumor occuring in the axial skeleton after 15 years of follow-up: Case report. Oncol Lett 2012; 2:1323-1326. [PMID: 22848310 DOI: 10.3892/ol.2011.402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 08/24/2011] [Indexed: 11/06/2022] Open
Abstract
The majority of giant cell tumors (GCTs) occur in the ends of the long bones. The presence of more than one GCT in the axial skeleton is rare. A GCT is capable of remaining clinically latent following treatment and becoming active a number of years later. We report an extremely rare case of GCT occurring in the axial skeleton, involving the sacrum, thoracic spine and parieto-occipital skull in more than 15 years of follow-up.
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Affiliation(s)
- Ye-Soo Park
- Department of Orthopaedic Surgery, Guri Hospital, 249-1
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Wan R, Zhang W, Xu J, Hao P, Yang Y, Shen Y, Ding X, Qiu S. The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton. J Orthop Sci 2012; 17:464-9. [PMID: 22526715 DOI: 10.1007/s00776-012-0228-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 03/21/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND The treatment for recurrent giant cell tumor (GCT) remains controversial. In this study, we evaluated the outcome of surgical intervention for recurrent GCT. METHOD Twenty-seven patients (14 males and 13 females) with recurrent GCT were recruited. Their primary GCTs were all treated with intralesional surgery. Among these recurrent GCTs, 9 grade III and 1 grade II tumors were treated with en bloc resection and endoprosthetic replacement, whereas 16 grade II and 1 grade III tumors were treated with intralesional curettage and PMMA bone cement filling. RESULTS The mean interval between initial surgery and first recurrence was 28.8 months (range 7-97 months). About 70 % of first recurrences affected bones around the knee, 44 % in the proximal tibia and 26 % in the distal femur. Of 27 patients, 3 women treated with intralesional procedures suffered second recurrences in the proximal tibia. No second recurrence was found in patients with en bloc resection. Two grade III re-recurrence GCTs were treated with en bloc resection, and 1 grade II was treated with an intralesional procedure. One patient with en bloc resection developed tumor metastasis in both lungs. Compared to patients with intralesional treatment, the functional score was significantly decreased in patients with en bloc resection (p < 0.01). CONCLUSION The re-recurrence risk of grade III GCTs can be significantly decreased by wide en bloc resection and endoprosthetic replacement. However, intralesional treatment is a good option for less aggressive (<grade II) recurrent GCTs because it can preserve ideal limb function and reduce surgical complications.
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Affiliation(s)
- Rong Wan
- Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, Liu W. Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am 2012; 94:461-7. [PMID: 22398741 DOI: 10.2106/jbjs.j.01922] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are no recent reports of giant cell tumors of bone in a large series of Chinese people. The present study was designed to review the epidemiological characteristics and outcomes of surgical management in a large series of Chinese patients with giant cell tumor of an extremity, treated at a single institution. METHODS The records and images of 621 patients in whom a benign giant cell tumor in an extremity was treated between 1989 and 2009 were reviewed retrospectively. There were 359 male and 262 female patients. The mean age at diagnosis was 31.4 years (range, eleven to seventy-one years). Sixty-six percent of the giant cell tumors were localized around the knee. Surgical treatments primarily included curettage, extensive curettage, and resection. The median duration of follow-up was forty-nine months (range, eighteen to 256 months). RESULTS Giant cell tumor accounted for 13.7% of all primary bone tumors treated at our institution. Multivariate Cox regression analysis indicated that the only variable that contributed to recurrence-free survival was the type of surgical treatment. The local recurrence rate after extensive curettage was 8.6%, which was significantly lower than the 56.1% recurrence rate after curettage alone. Bone-grafting did not affect local tumor control after extensive curettage; the local recurrence rate was 11.1% if bone graft was used. Recurrent giant cell tumor can be treated by further curettage or resection, with acceptable re-recurrence rates of 6.7% and 9.3% respectively. The Musculoskeletal Tumor Society Score for patients treated with extensive curettage was 92.6%, which was significantly higher than that for patients treated with resection. Twenty-one (3.4%) of the 621 patients developed benign pulmonary metastasis, with a favorable outcome, and three patients presented with multifocal giant cell tumors. CONCLUSIONS The incidence of giant cell tumor in the Chinese population may be higher than that in Western countries, and it has a male predilection. The results of the present study suggest that extensive curettage provides favorable local control and satisfactory functional outcomes.
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Affiliation(s)
- Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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Giant cell tumors of the axial skeleton. Sarcoma 2012; 2012:410973. [PMID: 22448122 PMCID: PMC3289906 DOI: 10.1155/2012/410973] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 10/27/2011] [Accepted: 11/01/2011] [Indexed: 11/18/2022] Open
Abstract
Background. We report on 19 cases of giant cell tumor of bone (GCT) affecting the spine or sacrum and evaluate the outcome of different treatment modalities. Methods. Nineteen patients with GCT of the spine (n = 6) or sacrum (n = 13) have been included in this study. The mean followup was 51.6 months. Ten sacral GCT were treated by intralesional procedures of which 4 also received embolization, and 3 with irradiation only. All spinal GCT were surgically treated. Results. Two (15.4%) patients with sacral and 4 (66.7%) with spinal tumors had a local recurrence, two of the letter developed pulmonary metastases. One local recurrence of the spine was successfully treated by serial arterial embolization, a procedure previously described only for sacral tumors. At last followup, 9 patients had no evidence of disease, 8 had stable disease, 1 had progressive disease, 1 died due to disease. Six patients had neurological deficits. Conclusions. GCT of the axial skeleton have a high local recurrence rate. Neurological deficits are common. En-bloc spondylectomy combined with embolization is the treatment of choice. In case of inoperability, serial arterial embolization seems to be an alternative not only for sacral but also for spinal tumors.
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Balke M, Neumann A, Szuhai K, Agelopoulos K, August C, Gosheger G, Hogendoorn PC, Athanasou N, Buerger H, Hagedorn M. A short-term in vivo model for giant cell tumor of bone. BMC Cancer 2011; 11:241. [PMID: 21668953 PMCID: PMC3125284 DOI: 10.1186/1471-2407-11-241] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 06/13/2011] [Indexed: 11/18/2022] Open
Abstract
Background Because of the lack of suitable in vivo models of giant cell tumor of bone (GCT), little is known about its underlying fundamental pro-tumoral events, such as tumor growth, invasion, angiogenesis and metastasis. There is no existing cell line that contains all the cell and tissue tumor components of GCT and thus in vitro testing of anti-tumor agents on GCT is not possible. In this study we have characterized a new method of growing a GCT tumor on a chick chorio-allantoic membrane (CAM) for this purpose. Methods Fresh tumor tissue was obtained from 10 patients and homogenized. The suspension was grafted onto the CAM at day 10 of development. The growth process was monitored by daily observation and photo documentation using in vivo biomicroscopy. After 6 days, samples were fixed and further analyzed using standard histology (hematoxylin and eosin stains), Ki67 staining and fluorescence in situ hybridization (FISH). Results The suspension of all 10 patients formed solid tumors when grafted on the CAM. In vivo microscopy and standard histology revealed a rich vascularization of the tumors. The tumors were composed of the typical components of GCT, including (CD51+/CD68+) multinucleated giant cells whichwere generally less numerous and contained fewer nuclei than in the original tumors. Ki67 staining revealed a very low proliferation rate. The FISH demonstrated that the tumors were composed of human cells interspersed with chick-derived capillaries. Conclusions A reliable protocol for grafting of human GCT onto the chick chorio-allantoic membrane is established. This is the first in vivo model for giant cell tumors of bone which opens new perspectives to study this disease and to test new therapeutical agents.
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Affiliation(s)
- Maurice Balke
- Department of Trauma and Orthopedic Surgery, University of Witten-Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Str, Cologne, Germany.
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Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res 2011; 469:1181-7. [PMID: 20857250 PMCID: PMC3048273 DOI: 10.1007/s11999-010-1560-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 08/26/2010] [Indexed: 02/06/2023]
Abstract
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 rerecurrence-free 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). RESULTS The rate of rerecurrence after wide resection was 6%. Intralesional curettage showed an overall rerecurrence rate of 32%. Implantation of polymethylmethacrylate (PMMA) instead of bone grafting was associated with a lower risk of subsequent recurrence in intralesional procedures (14% versus 50%). Extracompartmental disease did not increase the risk of rerecurrence. Pulmonary metastases occurred in seven patients and appeared independent of the surgical treatment modality chosen. CONCLUSIONS Intralesional curettage with methylmethacrylate for recurrent GCT provided equivalent tumor control compared with resection in this retrospective study. If joint salvage is possible, we advocate this treatment over resection in recurrent GCTs to preserve the native joint articulation. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res 2011; 469:591-9. [PMID: 20706812 PMCID: PMC3018195 DOI: 10.1007/s11999-010-1501-7] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 07/21/2010] [Indexed: 01/31/2023]
Abstract
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.
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Resnick CM, Margolis J, Susarla SM, Schwab JH, Hornicek FJ, Dodson TB, Kaban LB. Maxillofacial and axial/appendicular giant cell lesions: unique tumors or variants of the same disease?--A comparison of phenotypic, clinical, and radiographic characteristics. J Oral Maxillofac Surg 2010; 68:130-7. [PMID: 20006167 DOI: 10.1016/j.joms.2009.04.106] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 04/21/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE The relationship between giant cell lesions (GCLs) of the maxillofacial (MF) skeleton and those of the axial/appendicular (AA) skeleton has been long debated. The present study compared the clinical and radiographic characteristics of subjects with MF and AA GCLs. MATERIALS AND METHODS This was a retrospective cohort study of patients treated for GCLs at Massachusetts General Hospital from 1993 to 2008. The predictor variables included tumor location (MF or AA) and clinical behavior (aggressive or nonaggressive). The outcome variables included demographic, clinical, and radiographic parameters, treatments, and outcomes. Descriptive and bivariate statistics were computed, and P <or= .05 was considered significant. RESULTS The sample included 93 subjects: 45 with MF (38 with aggressive and 7 with nonaggressive) and 48 with AA (30 with aggressive and 18 with nonaggressive). Comparing the patients with MF and AA GCLs, those with MF lesions presented younger (P < .001), and the lesions were more commonly asymptomatic (P < .001), smaller (P < .001), and managed differently (P < .001) than AA lesions. When stratified by clinical behavior, aggressive tumors were diagnosed earlier than nonaggressive tumors (P < .001). Controlling for location and clinical behavior, patients with MF aggressive lesions were younger (P < .001) than those with AA aggressive lesions. MF nonaggressive lesions were more commonly asymptomatic (P = .04), smaller (P = .05), and less commonly locally destructive (P = .05) than AA nonaggressive lesions. CONCLUSIONS These results suggest that MF and AA GCLs represent a similar, if not the same, disease. Comparing the aggressive and nonaggressive subgroups, more similarities were found than when evaluating without stratification by clinical behavior. The remaining differences could be explained by the likelihood that MF tumors are diagnosed earlier than AA tumors because of facial exposure and dental screening examinations and radiographs.
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Affiliation(s)
- Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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Errani C, Ruggieri P, Asenzio MAN, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev 2009; 36:1-7. [PMID: 19879054 DOI: 10.1016/j.ctrv.2009.09.002] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 09/18/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
Giant cell tumor is still one of the most controversial and discussed bone tumors. Surgical treatment options include intralesional excision or segmental resection. Curettage has a higher recurrence rate but does preserve adjacent joint function. After curettage, the use of adjuvant therapies is still controversial. Three hundred forty-nine patients with giant cell tumors of the extremity, treated in a single institution, were analyzed in a retrospective study. Two hundred patients underwent curettage of the lesion and in 64 of these cases, three local adjuvants, such as phenol, alcohol and cement, were employed. The hypothesis is that an "aggressive curettage" with phenol, alcohol and cement provides better local control and functional results. The correlation between tumor in the proximal femur and higher recurrence rate has not been recorded before. The results of the present study suggest that an "aggressive curettage" reduces the recurrence rate in a disease whose aggressiveness is not easy to predict. Special attention must be given to giant cell tumors not only in the distal radius, but also in the proximal femur, where the treatment is more difficult and associated with a higher rate of local recurrence.
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Affiliation(s)
- Costantino Errani
- Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Moskovszky L, Szuhai K, Krenács T, Hogendoorn PCW, Szendrői M, Benassi MS, Kopper L, Füle T, Sápi Z. Genomic instability in giant cell tumor of bone. A study of 52 cases using DNA ploidy, relocalization FISH, and array-CGH analysis. Genes Chromosomes Cancer 2009; 48:468-79. [DOI: 10.1002/gcc.20656] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Balke M, Ahrens H, Streitbuerger A, Koehler G, Winkelmann W, Gosheger G, Hardes J. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol 2008; 135:149-58. [PMID: 18521629 DOI: 10.1007/s00432-008-0427-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 05/22/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the recurrence rate of giant cell tumors of bone (GCTB) is relatively high exact data on treatment options for the recurrent cases is lacking. The possible surgical procedures range from repeated intralesional curettage to wide resection. METHODS Two hundred and fourteen patients with histologically certified GCTB have been treated at the authors department from 1980 to 2007. Sixty-seven patients with at least one local recurrence were included in this study. The mean follow-up was 77.3 months. The data was evaluated according the re-recurrence rate with regard to the surgical procedure for the recurrence. RESULTS The mean time until the first local recurrence was 22.0 months; the mean number of recurrences per patient was 1.4. The recurrence occurred in 69.7% (46 out of 66 patients) within the first 2 years. If after intralesional procedures (curettage or intralesional resection) no adjunct was used the re-recurrence rate was 58.8% (10 out of 17 patients) and decreased to 21.7% (5 out of 23 patients) if a combination of all adjuncts (PMMA + burring) was used. The likelihood of re-recurrence was reduced by the factor 5.508 which was clearly significant (P = 0.016). In case of wide resection no re-recurrence occurred. Seven patients (10.5%) developed pulmonary metastases. Fourteen patients (20.9%) finally received an endoprosthesis; 12 due to tumor recurrence, 2 due to secondary arthritis. CONCLUSION Recurrent GCTB can be treated by further curettage with additional burring and cementing with an acceptable re-recurrence rate of 21.7%. The rate of patients finally needing an endoprosthesis is 20.9%. Due to the high rate of pulmonary metastases recurrent GCTB may be considered as a severe disease.
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Affiliation(s)
- Maurice Balke
- Department of Orthopedic Surgery, University of Muenster, Albert-Schweitzer-Str. 33, 48149, Munster, Germany.
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Donthineni R, Boriani L, Ofluoglu O, Bandiera S. Metastatic behaviour of giant cell tumour of the spine. INTERNATIONAL ORTHOPAEDICS 2008; 33:497-501. [PMID: 18461324 DOI: 10.1007/s00264-008-0560-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Revised: 03/04/2008] [Accepted: 03/05/2008] [Indexed: 11/25/2022]
Abstract
Lung metastases from giant cell tumours (GCT) of the spine have not been specifically addressed in the literature. We reviewed our cases and compared the incidence, treatment, and outcomes with those from the extremities. Between 1970 and 2006, we identified seven cases (three females and four males) of lung metastases from a total of 51 cases of GCT of the spine (13.7%). Four of the seven patients had presented to our institution with a spine recurrence after previous treatments and the rest developed recurrences later. The treatments for the lung nodules consisted of metastectomy in two and chemotherapy in six patients. At the latest follow-up (ranging from 18 to 126 months), two had died of the disease, two had no evidence of the disease, and three were alive with disease. Our series shows a higher metastatic rate from spine GCT as compared to those from the extremities, but the overall behaviour and treatment outcomes of the lung metastases are similar. When there is a recurrence of GCT, with or without metastases, the local and possibly the metastases should be biopsied to confirm the original diagnosis. Progression of benign GCT into an aggressive sarcoma has been documented, and the method of management should be altered.
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Affiliation(s)
- Rakesh Donthineni
- Spine & Orthopaedic Oncology, Alta Bates Summit Medical Center, Oakland, CA 94609, USA.
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Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 2008; 90:1060-7. [PMID: 18451399 DOI: 10.2106/jbjs.d.02771] [Citation(s) in RCA: 263] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of adjuvants after curettage has been well established for the treatment of giant cell tumor of bone. The purpose of this study was to analyze the rates of recurrence following different types of treatment as well as the influence of various factors of tumor presentation on those rates. METHODS The data regarding benign giant cell tumors of the appendicular skeleton from ten bone tumor centers were evaluated. Axial and malignant tumors were excluded. The recurrence rates associated with the different treatment modalities were analyzed, and hazard ratios for a recurrence were calculated for multiple factors of tumor presentation. RESULTS The study included 384 surgical procedures, involving 256 primary and 128 recurrent tumors. The mean duration of follow-up was 64.2 months. Wide excision was performed in seventy-eight cases (20.3%), and an intralesional procedure was done in 306 (79.7%). Of the intralesional procedures, 103 (33.7%) were performed without the use of adjuvants, 102 (33.3%) included filling with polymethylmethacrylate, seventy-four (24.2%) included polymethylmethacrylate filling after phenolization, and twenty-seven (8.8%) included use of local toxins. The overall recurrence rate after the intralesional procedures was 49% when no adjuvants had been used, 22% when polymethylmethacrylate only had been used as an adjuvant, 27% when polymethylmethacrylate had been used after phenolization, and 15% when phenol or other local toxins had been used (without polymethylmethacrylate). The highest rate of recurrence (36%) after curettage with adjuvants was associated with extracompartmental tumors. Recurrent tumors were not at increased risk for another recurrence, even when they were extracompartmental. The recurrence rate following curettage of a primary tumor without the use of adjuvants (55%) was higher than that following the same treatment of a recurrent tumor (39%) (p = 0.033). CONCLUSIONS Use of polymethylmethacrylate as an adjuvant significantly reduces the recurrence rate following intralesional treatment of benign giant cell tumors, and it appears to be the therapy of choice for primary as well as recurrent giant cell tumors of bone. The significantly better results following treatment of recurrent tumors without adjuvants compared with the results of the same treatment of primary tumors were probably related to increased surgical thoroughness brought about by the surgeon's awareness of dealing with a riskier tumor.
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Affiliation(s)
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- Orthopädische Klinik Volmarstein, Universität Witten/Herdecke, Wetter, Germany.
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Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 2008; 134:969-78. [PMID: 18322700 DOI: 10.1007/s00432-008-0370-x] [Citation(s) in RCA: 274] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 02/15/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study. PATIENTS AND METHODS The mean age was 33.3 years with a female-to-male ratio of 1.2 : 1. The mean follow up was 59.8 months. The recurrence rate of patients who received first treatment at our institution was 16.6%. The most common primary treatment was curettage (188 patients) usually followed by adjuvant local therapy. The effects of bone cement (PMMA), burring and hydrogen peroxide (H(2)O(2)) were statistically analyzed and the influence of a subchondral bone graft on the recurrence rate was evaluated. RESULTS PMMA alone (n = 52) reduces the likelihood of recurrence by the factor 8.2, additional high-speed burring (n = 39) by the factor 3.9 (compared to PMMA only). H(2)O(2) (n = 42) seems to have an additional effect comparable to that of phenol although it did not reach statistical significance. CONCLUSION The combination of all adjuncts (PMMA, burring, H(2)O(2) - n = 42) reduces the likelihood of recurrence by the factor 28.2 compared to curettage only and therefore should be recommended as a standard treatment. If the tumor reaches close to the articulating surface a subchondral bone graft (n = 42) can be performed without risking a higher recurrence rate. We add seven cases of pulmonary metastases and two cases of multicentricity to the literature. Bisphosphonates and interferon alpha may have a beneficial effect.
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Affiliation(s)
- Maurice Balke
- Department of Orthopedic Surgery, University of Muenster, Muenster, Germany.
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