1
|
Becker RG, Galia CR, Pestilho JFCS, Antunes BP, Baptista AM, Guedes A. GIANT CELL TUMOR OF BONE: A MULTICENTER EPIDEMIOLOGICAL STUDY IN BRAZIL. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e273066. [PMID: 38532872 PMCID: PMC10962070 DOI: 10.1590/1413-785220243201e273066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/20/2023] [Indexed: 03/28/2024]
Abstract
Introduction Giant cell tumor of bone (GCTB) mainly affects young adults' long bone epiphyses, threatening bone strength and joint function. Surgery is the primary treatment, although post-surgery recurrence is significant. This study analyzes patient profiles, treatments, and outcomes for GCTB in Brazil. Methods We retrospectively assessed local recurrence, metastasis, and treatment approaches in 643 GCTB patients across 16 Brazilian centers (1989-2021), considering regional differences. Results 5.1% (n=33) developed pulmonary metastases, 14.3% (n=92) had pathological fractures, and the local recurrence rate was 18.2% (n=114). Higher rates of pulmonary metastases (12.1%) and advanced tumors (Campanacci III, 88.9%) were noted in lower-income North and Northeast regions. The North also had more pathological fractures (33.3%), extensive resections (61.1%), and amputations (27.8%). These regions faced longer surgical delays (36-39 days) than the South and Southeast (27-33 days). Conclusions Our findings corroborate international data, underscoring regional disparities in Brazil that may lead to worse outcomes in disadvantaged areas. This highlights the need for improved orthopedic oncology care in Brazil's economically and structurally challenged regions. Level of Evidence III; Retrospective Cohort.
Collapse
Affiliation(s)
- Ricardo Gehrke Becker
- Hospital de Clínicas de Porto Alegre (HCPA), Department of Orthopedics and Trauma, Porto Alegre, RS, Brazil
- Instituto do Câncer Infantil, Porto Alegre, RS, Brazil
| | - Carlos Roberto Galia
- Hospital de Clínicas de Porto Alegre (HCPA), Department of Orthopedics and Trauma, Porto Alegre, RS, Brazil
| | | | - Bruno Pereira Antunes
- Hospital de Clínicas de Porto Alegre (HCPA), Department of Orthopedics and Trauma, Porto Alegre, RS, Brazil
| | - André Mathias Baptista
- Hospital de Clínicas de Porto Alegre (HCPA), Department of Orthopedics and Trauma, Porto Alegre, RS, Brazil
- Universidade de São Paulo (USP), School of Medicine, São Paulo, SP, Brazil
| | - Alex Guedes
- Santa Casa de Misericórdia da Bahia, Hospital Santa Izabel, Orthopedic Oncology Group, Salvador, BA, Brazil
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Aoude A, Nikomarov D, Perera JR, Ibe IK, Griffin AM, Tsoi KM, Ferguson PC, Wunder JS. Giant cell tumour of bone. Bone Joint J 2023; 105-B:559-567. [PMID: 37121582 DOI: 10.1302/0301-620x.105b5.bjj-2022-1231.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Giant cell tumour of bone (GCTB) is a locally aggressive lesion that is difficult to treat as salvaging the joint can be associated with a high rate of local recurrence (LR). We evaluated the risk factors for tumour relapse after treatment of a GCTB of the limbs. A total of 354 consecutive patients with a GCTB underwent joint salvage by curettage and reconstruction with bone graft and/or cement or en bloc resection. Patient, tumour, and treatment factors were analyzed for their impact on LR. Patients treated with denosumab were excluded. There were 53 LRs (15%) at a mean 30.5 months (5 to 116). LR was higher after curettage (18.4%) than after resection (4.6%; p = 0.008). Neither pathological fracture (p = 0.240), Campanacci grade (p = 0.734), soft-tissue extension (p = 0.297), or tumour size (p = 0.872) affected the risk of recurrence. Joint salvage was possible in 74% of patients overall (262/354), and 98% after curettage alone (262/267). Of 49 patients with LR after curettage, 44 (90%) underwent repeated curettage and joint salvage. For patients treated by curettage, only age less than 30 years (p = 0.042) and location in the distal radius (p = 0.043) predicted higher LR. The rate of LR did not differ whether cement or bone graft was used (p = 0.753), but may have been reduced by the use of hydrogen peroxide (p = 0.069). Complications occurred in 15.3% of cases (54/354) and did not differ by treatment. Most patients with a GCTB can undergo successful joint salvage by aggressive curettage, even in the presence of a soft-tissue mass, pathological fracture, or a large lesion, with an 18.4% risk of local recurrence. However, 90% of local relapses after curettage can be treated by repeat joint salvage. Maximizing joint salvage is important to optimize long-term function since most patients with a GCTB are young adults. Younger patients and those with distal radius tumours treated with joint-sparing procedures have a higher rate of local relapse and may require more aggressive treatment and closer follow-up.
Collapse
Affiliation(s)
- Ahmed Aoude
- Orthopedics Spine and Oncology, Montreal General Hospital, McGill University, Montreal, Canada
| | - David Nikomarov
- Musculoskeletal Oncology Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan R Perera
- Orthopaedic Oncology, Royal National Orthopaedic Hospital, London, UK
| | - Izuchukwu K Ibe
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anthony M Griffin
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Kim M Tsoi
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Zhao L, Chen J, Hu Y, Ye Z, Tao K. Mid-term results of giant cell tumours with pathologic fractures around the knee: a multicentre retrospective study. BMC Musculoskelet Disord 2022; 23:1061. [PMID: 36471308 PMCID: PMC9720985 DOI: 10.1186/s12891-022-06005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aims of this work are to present a classification of "complex fracture" and "simple fracture", to compare their features, treatments and prognosis in patients with giant cell tumour with pathologic fractures around the knee, and to determine the best surgical method for patients who have giant cell tumour around the knee with different degrees of fracture. METHODS Data from 130 patients with pathologic fractures from giant cell tumour around the knee who underwent surgical treatment from March 2000 to November 2015 at 6 institutes around China were collected and analysed. A multicentric study design was used to explore the epidemiological features and to compare differences in the surgical procedures and prognosis of the two fracture groups. The mean age at diagnosis was 37.1 years old (range, 13-77 years). The median follow-up was 126.5 months, ranging from 68 to 370 months. RESULTS The general clinical and imaging features of the groups of patients with simple and complex fractures, namely, sex, age, the lesion site, living or working environment, eccentric growth patterns, Campanacci grading system, and duration of symptoms before treatment, showed varying degrees of differences, but with no statistical significance (p > 0.05). The incidence rate of surrounding soft tissue mass was 35.2% (32/91) in the group with simple fractures, whereas it was 87.2% (34/39) in the group with complex fractures, which showed a significant difference (p < 0.05). Wide resection and reconstruction with joint replacement were performed more often in patients with complex fractures (61.5%, 24/39). Intralesional procedures were performed more often in patients with simple fractures (56.0%, 51/91). The difference showed significant differences (p < 0.05). The local recurrence rate was 17.6% (16/91) in the group with simple fractures, whereas it was 10.3% (4/39) in the complex fracture group, showing a significant difference (p < 0.05). A total of 2.3% of patients (n = 3,3/130) developed a skip lesion. The complication rates were 4.6% (4/87) and 14.7% (5/34), respectively, in the two groups with simple or complex fractures, showing a significant difference (p < 0.05). The mean MSTS and TESS scores with simple fractures were 26.6 (range, 13-30) and 84.1 (range, 29-100), respectively, whereas the mean scores in the group with complex fractures were 25.5 (range, 18-30) and 78.3 (range, 30-100), respectively, also showing a significant difference (p < 0.05). CONCLUSION Our classification of "simple fracture" and "complex fracture" could guide decisions regarding the best surgical method for lesions in patients who have giant cell tumour around the knee with different degrees of fracture.
Collapse
Affiliation(s)
- Liming Zhao
- grid.413168.9Department of Joint Surgery, Ningbo No.6 Hospital, No. 1059 East Zhongshan Road, Ningbo, 315040 Zhejiang Province China
| | - Jiapei Chen
- Langfang Health Vocational College, Siguang South Road, Langfang, 065000 Hebei Province China
| | - Yongcheng Hu
- grid.417028.80000 0004 1799 2608Department of Orthopaedic Oncology, Tianjin Hospital, No. 406 Jiefang South Road, Tianjin, 300211 China
| | - Zhaoming Ye
- grid.412465.0Department of Orthopaedic Oncology, The Second Affiliated Hospital of Zhejiang University, No. 1511 Jianghong Road, Hangzhou, 315040 Zhejiang Province China
| | - Kun Tao
- grid.413168.9Department of Joint Surgery, Ningbo No.6 Hospital, No. 1059 East Zhongshan Road, Ningbo, 315040 Zhejiang Province China
| |
Collapse
|
5
|
Outcome of Reoperation for Local Recurrence Following En Bloc Resection for Bone Giant Cell Tumor of the Extremity. Curr Oncol 2022; 29:6383-6399. [PMID: 36135072 PMCID: PMC9498107 DOI: 10.3390/curroncol29090503] [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: 08/01/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
En bloc resection is typically performed to treat giant cell tumors of bone (GCTB), particularly when curettage can be challenging owing to extensive bone cortex destruction with soft tissue extension. Few reports have addressed the clinical outcomes after reoperation for local recurrence in patients with GCTB who underwent en bloc resection. In this multicenter retrospective study, we investigated local recurrence, distant metastasis, malignant transformation, mortality, and limb function in patients treated for local recurrence following en bloc resection for GCTB. Among 205 patients who underwent en bloc resection for GCTB of the extremities between 1980 and 2021, we included 29 with local recurrence. En bloc resection was performed for large tumors with soft tissue extension, pathological fractures with joint invasion, complex fractures, and dispensable bones, such as the proximal fibula and distal ulna. Local re-recurrence, distant metastasis, malignant transformation, and mortality rates were 41.4% (12/29), 34.5% (10/29), 6.9% (2/29), and 6.9% (2/29), respectively. The median Musculoskeletal Tumor Society score was 26 (interquartile range, 23–28). The median follow-up period after surgery for local recurrence was 70.1 months (interquartile range, 40.5–123.8 months). Local recurrence following en bloc resection for GCTB could indicate an aggressive GCTB, necessitating careful follow-up.
Collapse
|
6
|
ElDesouqi AAI, Ragab RK, Ghoneim ASAH, Sabaa BM, Rafalla AAM. Treatment of giant cell tumor of bone using bone grafting and cementation with versus without gel foam. ALEXANDRIA JOURNAL OF MEDICINE 2022. [DOI: 10.1080/20905068.2022.2084868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - Raafat Kamal Ragab
- Department of Orthopedic Surgery and Traumatology, University of Alexandria, Alexandria, Egypt
| | | | - Bassma Mohamed Sabaa
- Department of Orthopedic Surgery and Traumatology, University of Alexandria, Alexandria, Egypt
| | | |
Collapse
|
7
|
Burden of complications after giant cell tumor surgery. A single-center retrospective study of 192 cases. Orthop Traumatol Surg Res 2022; 108:103047. [PMID: 34500112 DOI: 10.1016/j.otsr.2021.103047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical complications are frequent with giant cell tumor of bone; recurrence is the best known and most widely studies; other causes of failure have been less well investigated. We therefore performed a retrospective study to identify and assess the main reasons for surgical revision. HYPOTHESIS Recurrence is the main cause of surgical revision in giant cell tumor of bone, but other complications, such as mechanical issues or infection, are underestimated. PATIENTS AND METHODS A single-center retrospective study included 192 patients (included from 2000 to 2016) undergoing first giant cell tumor of bone surgery in a bone tumor reference center. Surgery consisted in curettage for 152 patients (79%) and resection for 40 (21%). The 3 main reconstruction techniques were filling (136 patients; 71%), prosthesis (18 patients; 9%), and fusion (14 patients: 7%). Filling used cement in 9 cases (7%) and bone graft in 127 (93%). Cumulative incidence functions were calculated. RESULTS There were 171 revision procedures in 92 patients: 43 for mechanical reasons, 30 for infection, 86 for tumor recurrence, 12 for other causes. Cumulative incidence of revision at 10years was 36% (95% CI: 27-44) for recurrence, 26% (95% CI: 17-36) for mechanical causes, and 13% (95% CI: 9-19) for infection, for overall cumulative incidence of revision of 61% (95% CI: 50-69). DISCUSSION Risk of all-cause surgical revision in giant cell tumor of bone was 61% at 10years, with recurrence accounting for only half of cases. LEVEL OF EVIDENCE IV.
Collapse
|
8
|
Tsukamoto S, Mavrogenis AF, Akahane M, Honoki K, Kido A, Tanaka Y, Donati DM, Errani C. Risk factors of fracture following curettage for bone giant cell tumors of the extremities. BMC Musculoskelet Disord 2022; 23:477. [PMID: 35590280 PMCID: PMC9118605 DOI: 10.1186/s12891-022-05447-x] [Citation(s) in RCA: 1] [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: 10/18/2021] [Accepted: 05/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2-14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities. METHODS This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16). RESULTS Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8-8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3-118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8-96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2-97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1-99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7-99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7-97.3; p = 0.003). CONCLUSIONS For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840g, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562 Holargos, Athens, Greece
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840g, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840g, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
9
|
Koucheki R, Gazendam A, Perera J, Griffin A, Ferguson P, Wunder J, Tsoi K. Management of giant cell tumors of the distal radius: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:759-772. [PMID: 35377078 DOI: 10.1007/s00590-022-03252-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/09/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The treatment of giant cell tumors (GCT) of the distal radius remains challenging, with no consensus on the optimal surgical management. Surgical management remains the mainstay of treatment with options including intralesional curettage and en-bloc resection with reconstruction. The objective of this systematic review and meta-analysis was to evaluate and compare the outcomes of these two procedures. METHODS Using OVID-Medline and Embase databases, a systematic literature search was performed. Comparative studies, assessing intralesional curettage and en-bloc resection in patients with GCTs of the distal radius, were included. Data regarding rates of local recurrence, metastasis, overall complications, and functional outcomes, were collected and analyzed. The ROBINS-I tool was utilized for risk of bias appraisal within each study outcome. RESULTS Thirteen studies (n = 373 patients) reporting on 191 intralesional curettage procedures and 182 en-bloc resections were included in the analysis. The average age of participants was 31.9 (SD ± 2.4) years and average follow-up was 7.1 (SD ± 3.6) years. Patients that underwent intralesional curettage were more likely to develop local recurrence (Risk Ratio (RR) 3.3, 95% CI, [2.1, 5.4], p < 0.00001) when compared to patients that underwent en-bloc resection. In Campanacci grade 3 lesions, the risk for local recurrence was 5.9 (95% CI, [2.2, 16.3], p = 0.0006) times higher in patients that received intralesional curettage. Patients that underwent intralesional curettage showed an 84% reduction in the relative risk of developing overall complications compared to en-bloc resection (95% CI, [0.1, 0.4], p < 0.00001), and a larger decrease in Visual Analog Scale and lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores (p < 0.00001). Risk ratio for developing a local recurrence, with PMMA versus bone graft following an intralesional procedure was not significant (RR 1.2, 95% CI, [0.6, 2.6], p = 0.62). CONCLUSIONS In the surgical management of GCT of the distal radius, intralesional curettage increased local recurrence compared to en-bloc resection with reconstruction, particularly in grade 3 tumors. However, it led to significantly fewer operative complications, lower pain scores, and improved functional outcomes compared to en-bloc resection. Both treatment options remain relevant in the contemporary management of GCTs of the distal radius. Surgical decision making should include both patient and tumor factors when determining the optimal treatment strategy for these patients. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
Collapse
Affiliation(s)
- Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Biomedical Engineering, Toronto, ON, Canada.
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.,Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jonathan Perera
- Royal National Orthopaedic Hospital NHS Trust, Greater London, UK
| | - Anthony Griffin
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter Ferguson
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Jay Wunder
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Kim Tsoi
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
10
|
Deventer N, Budny T, Gosheger G, Rachbauer A, Puetzler J, Theil JC, Kovtun D, de Vaal M, Deventer N. Giant Cell Tumor of Bone: A Single Center Study of 115 cases. J Bone Oncol 2022; 33:100417. [PMID: 35242511 PMCID: PMC8881473 DOI: 10.1016/j.jbo.2022.100417] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Giant cell tumor of bone (GCTB) is a rarely metastasizing, locally aggressive tumor. GCTB recurs frequently after intralesional curettage. Denosumab is a potential neoadjuvant treatment option for borderline resectable lesions.
Background Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor that represents about 4–5% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and may include intralesional curettage with adjuvants or, in rare cases, wide resection. In recent years the monoclonal antibody denosumab has been introduced as a potential (neo-)adjuvant systemic treatment option for patients with borderline resectable or unresectable lesions. Currently several studies reported that the use of denosumab prior to curettage possibly increase the risk of local recurrence. Methods In this retrospective study we reviewed 115 cases of GCT with a mean follow-up of 65.6 (24–404) months who underwent a surgical treatment with or without preoperative denosumab therapy in our institution. Potential risk factors for LR and complications were analyzed. Results The study includes 47 male (40.9%) and 68 female (59.1%) patients with a mean age of 33.9 (10–77) years and a mean follow-up of 65.6 (24–404) months. Denosumab was used in 33 (28.7%) cases, in 14 cases (12.2%) in a neoadjuvant setting and in 17 cases preoperatively before re-curettage (14.8%) after LR. In 105 cases (91.3%) an intralesional curettage was performed. The overall LR rate was 47.8% (55 cases). Patients who underwent intralesional curettage and bone cement augmentation without neoadjuvant denosumab treatment had LR in 42.2% (38/90) of the cases. Patients who underwent neoadjuvant denosumab treatment prior to curettage had LR in 28.6% (4/14). Re-recurrence was frequent in patients with neoadjuvant denosumab treatment who had LR after initial curettage (50%, 8/16). After wide resection and endoprosthetic replacement one case (20%) of local recurrence was detectable (1/5 cases). Conclusions GCTB recurs frequently after intralesional curettage and cement augmentation. While denosumab is a potential (neo-)adjuvant treatment option that might be used for lesions that are difficult to resect, surgeons should be aware that LR is still frequent.
Collapse
Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- Corresponding author.
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Anna Rachbauer
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Puetzler
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Christoph Theil
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Dmytrii Kovtun
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Nils Deventer
- Department of General Paediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| |
Collapse
|
11
|
Singh RK, Parihar PH, Mishra GV, Dhande RP, Patwa PA. A case report on aggressive giant cell tumor of greater trochanter: a divergent site. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Giant cell tumor is a tumor of benign nature which usually arises in the long bone, but it can also be seen at unusual sites. Only few cases have been reported so far regarding involvement of greater trochanter of the femur as it is a very divergent site for giant cell tumors; our case is one of them. Giant cell tumors are seen in 20–40 years of age in the metaepiphyseal regions of the long bones. If femur has to be involved, it is in the distal end usually.
Case presentation
We present a case of a 45-year-old female with chief complains of swelling and left hip pain since over a month. Magnetic resonance imaging was done where the location and extent of the tumor was found. What makes this case interesting is that on fine needle aspiration cytology the lesion showed multinucleated giant osteoclasts in the background of osseous matrix of spindle cells suggesting Giant cell tumor.
Conclusion
It is sometimes tricky to make a diagnosis of these lesions on imaging as the typical features may not be present, and hence, in such circumstances helping the clinicians with additional information like location, extent, margins is of utmost importance.
Collapse
|
12
|
Tsukamoto S, Mavrogenis AF, Tanaka Y, Kido A, Kawaguchi M, Errani C. Denosumab Does Not Decrease Local Recurrence in Giant Cell Tumor of Bone Treated With En Bloc Resection. Orthopedics 2021; 44:326-332. [PMID: 34618637 DOI: 10.3928/01477447-20211001-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We performed a systematic analysis of existing studies to determine whether preoperative denosumab reduces the risk of local recurrence for patients with giant cell tumor of bone treated with en bloc resection and to address the optimal duration of preoperative denosumab with respect to the risk of local recurrence after en bloc resection. Denosumab did not decrease the risk of local recurrence after en bloc resection; the proportion of patients with local recurrence was 3.6% (2 of 56) in the en bloc resection with preoperative denosumab group vs 14.2% (40 of 280) in the en bloc resection alone group, with an overall pooled odds ratio of 0.76 (P=.67). Meta-regression models revealed no association between the duration of preoperative denosumab and the odds of local recurrence after en bloc resection (P=.83). Administration of denosumab for 3 months before en bloc resection is appropriate for sufficient bone hardening to reduce tumor cell spillage and does not result in denosumab-related complications. [Orthopedics. 2021;44(6):326-332.].
Collapse
|
13
|
Tsukamoto S, Mavrogenis AF, Tanaka Y, Kido A, Honoki K, Tanaka Y, Errani C. Metastasectomy Versus Non-Metastasectomy for Giant Cell Tumor of Bone Lung Metastases. Orthopedics 2021; 44:e707-e712. [PMID: 34618641 DOI: 10.3928/01477447-20211001-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Approximately 2% to 9% of giant cell tumor of bone (GCTB) metastasizes systemically, mainly to the lungs. The biological behaviors and clinical courses of lung metastases are difficult to predict, and their treatment recommendations vary, including metastasectomy and non-metastasectomy with chemotherapy (denosumab, interferon-alfa, bisphosphonates), with radiation therapy, or with observation alone. However, it is unclear whether metastasectomy for GCTB lung metastases decreases the mortality rate of these patients. Therefore, the authors performed this systematic review to compare metastasectomy and non-metastasectomy for GCTB patients with operable lung metastasis. Of the 919 relevant studies, 16 studies (138 patients) were included for analysis; 61.6% of patients had metastasectomy and 38.4% had non-metastasectomy. Analysis showed that mortality rates were similar for the patients who had metastasectomy compared with those who did not; the proportion of patients who died of disease was 7.1% in the metastasectomy group and 17.0% in the non-metastasectomy group, with an overall pooled odds ratio of 0.64 (P=.36). Therefore, physicians should reconsider the potential risks and benefits of metastasectomy for patients with GCTB and lung metastasis, because metastasectomy does not reduce the mortality rate in these patients. [Orthopedics. 2021;44(6):e707-e712.].
Collapse
|
14
|
Late Local Recurrence of Bone Giant Cell Tumors Associated with an Increased Risk for Malignant Transformation. Cancers (Basel) 2021; 13:cancers13143644. [PMID: 34298856 PMCID: PMC8304778 DOI: 10.3390/cancers13143644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023] Open
Abstract
Simple Summary In giant cell tumor of bone (GCTB), an intermediate malignant bone tumor, approximately 4% of cases can undergo malignant transformation. We analyzed risk factors for malignant transformation of GCTB treated without radiotherapy and retrospectively reviewed medical files of 461 patients with GCTB of the extremities who had undergone surgery alone, with no radiotherapy or denosumab therapy. Malignant transformation occurred in 15 of 461 patients (3.3%) at a median follow-up period of 192 months. The median follow-up duration was 89.4 months. Multivariate analysis revealed that local recurrence was an independent prognostic factor for unfavorable malignant transformation. The interval between the last surgery to local recurrence and malignant transformation was longer than that to local recurrence of benign GCTB, with a median of 15.2 (IQR, 5.2–25.4) years versus 1.3 (IQR, 0.8–2.6) months, respectively (p < 0.001). Late local recurrence of GCTB is associated with a higher risk of malignant transformation. Abstract In giant cell tumor of bone (GCTB), an intermediate malignant bone tumor, approximately 4% of all cases undergo malignant transformation. Accordingly, we analyzed risk factors for malignant transformation of GCTB treated without radiotherapy. We retrospectively reviewed medical records of 530 patients with GCTB of the extremities, admitted and treated at two institutions between January 1980 and December 2019. Overall, 4 patients with primary malignant GCTB, 4 patients with missing data, 3 patients with a history of radiotherapy, 22 patients with a follow-up of less than 6 months, and 36 patients who received denosumab were excluded. Accordingly, 461 patients were included for further analysis. Malignant transformation was observed in 15 of 461 patients (3.3%) at a median follow-up period of 192 months. The median follow-up duration was 89.4 months. Multivariate analysis revealed that local recurrence was an independent prognostic factor for unfavorable malignant transformation (Hazard ratio [HR], 11.33; 95% confidence interval [CI] 2.33–55.13; p = 0.003 for once versus none and HR, 11.24; 95% CI, 1.76–71.96; and p = 0.011 for twice or more versus none). The interval between the last surgery to local recurrence and malignant transformation was longer than that to local recurrence of benign GCTB, with a median of 15.2 years (interquartile range [IQR], 5.2–25.4) versus 1.3 months (IQR, 0.8–2.6), respectively (p < 0.001). Late local recurrence of GCTB is associated with a higher risk of malignant transformation.
Collapse
|
15
|
Perrin DL, Visgauss JD, Wilson DA, Griffin AM, Abdul Razak AR, Ferguson PC, Wunder JS. The role of Denosumab in joint preservation for patients with giant cell tumour of bone. Bone Joint J 2021; 103-B:184-191. [PMID: 33380180 DOI: 10.1302/0301-620x.103b1.bjj-2020-0274.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up. METHODS Patients with GCTB of the limb considered high-risk for unsuccessful joint salvage, due to minimal periarticular and subchondral bone, large soft tissue mass, or pathological fracture, were treated with Denosumab followed by extended intralesional curettage with the goal of preserving the joint surface. Patients were followed for local recurrence, metastasis, and secondary sarcoma. RESULTS A total of 25 patients with a mean age of 33.8 years (18 to 67) with high-risk GCTB received median six cycles of Denosumab before surgery. Tumours occurred most commonly around the knee (17/25, 68%). The median follow-up was 57 months (interquartile range (IQR) 13 to 88). The joint was salvaged in 23 patients (92%). Two required knee arthroplasty due to intra-articular fracture and arthritis. Local recurrence developed in 11 patients (44%) at a mean of 32.5 months (3 to 75) following surgery, of whom four underwent repeat curettage and joint salvage. One patient developed secondary osteosarcoma and another benign GCT lung metastases. CONCLUSION The use of Denosumab for joint salvage was associated with a higher than expected rate of local recurrence at 44%. Neoadjuvant Denosumab for joint-sparing procedures should be considered with caution in light of these results. Cite this article: Bone Joint J 2021;103-B(1):184-191.
Collapse
Affiliation(s)
- David Louis Perrin
- Section of Orthopaedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Julia D Visgauss
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - David A Wilson
- Division of Orthopaedic Surgery, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Albiruni R Abdul Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
16
|
Ke J, Cheng S, Yao MY, Chu X, Wang M, Zeng XL, Yang T, Zhang C, Zhong H, Zhang Y. Novel Strategy of Curettage and Adjuvant Microwave Therapy for the Treatment of Giant Cell Tumor of Bone in Extremities: A Preliminary Study. Orthop Surg 2021; 13:185-195. [PMID: 33442922 PMCID: PMC7862174 DOI: 10.1111/os.12865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives To evaluate whether curettage with adjuvant microwave therapy was successful in the treatment of giant cell tumor of the bone (GCTB) in extremities, especially for GCTB with pathological fractures and GCTB of the distal radius. Methods This was a retrospective study of 54 cases of GCTB of the extremities treated by curettage with adjuvant microwave therapy between 2007 and 2019. Five patients were lost to follow up and excluded from the study. A total of 33 male and 21 female patients were included in this study. Patients were aged 15–57 years (mean 29.72 ± 10.48 years). Among these patients, there were 10 cases of GCTB with pathological fractures and eight cases of GCTB of the distal radius; one of these cases was combined with a pathological fracture. Comprehensive imaging examinations (X‐rays [including lesion site and chest], CT, MRI, emission computed tomography, and pathology examination) of all patients were reviewed. The clinical staging of these patients were evaluated radiologically using the Campanacci classification system based on the extent of spread of the tumor. All patients underwent curettage with adjuvant microwave therapy. Clinical and imaging evaluations were performed in all cases to check for recurrence or metastasis. Lower limb and upper limber function were assessed using the Musculoskeletal Tumor Society score (MSTS), and wrist function was assessed according to the disabilities of the arm, shoulder and hand (DASH) score. Data on surgical‐related complications were recorded. Results All cases were followed up for 24–126 months (mean 60.69 ± 29.61 months). There were 24 patients with a Campanacci grade of 3 and 30 with a Campanacci grade of 2. The 52 patients were continuously disease‐free. The local recurrence rate was 3.70% (2 patients). One patient had recurrence in the proximal femur, and the other developed in soft tissue of the calf muscle. No recurrence occurred for GCTB of the distal radius. One recurrence occurred in a GCTB with pathological fractures. The intervals were 9 and 28 months, respectively. The cases of recurrence all had a Campanacci grade of 3 (8.33%). The median MSTS among the 54 patients was 27.67 ± 3.81. The mean wrist function DASH score was 8.30 ± 2.53. The mean MSTS was 28.67 ± 1.63 and 26.71 ± 5.49 for patients with GCTB of the distal radius and for those with pathological fractures, respectively. In comparing patients with and without pathological fractures, there was no significant difference in the MSTS functional score. Five patients had complications after the surgery. Conclusion Curettage with adjuvant microwave ablation therapy provided favorable local control and satisfactory functional outcomes in the treatment of GCTB, especially for cases with pathological fractures and those with GCTB of the distal radius.
Collapse
Affiliation(s)
- Jin Ke
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Meng-Yu Yao
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Chu
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ming Wang
- Department of Orthopaedics, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Xiao-Long Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chi Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hua Zhong
- Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| |
Collapse
|
17
|
Tsukamoto S, Ciani G, Mavrogenis AF, Ferrari C, Akahane M, Tanaka Y, Rocca M, Longhi A, Errani C. Outcome of lung metastases due to bone giant cell tumor initially managed with observation. J Orthop Surg Res 2020; 15:510. [PMID: 33160367 PMCID: PMC7648999 DOI: 10.1186/s13018-020-02038-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background The outcomes of patients with lung metastases from giant cell tumor of bone (GCTB) vary from spontaneous regression to uncontrolled growth. To investigate whether observation is an appropriate first-line management approach for patients with lung metastases from GCTB, we evaluated the outcomes of patients who were initially managed by observation. Methods We retrospectively reviewed the data of 22 patients with lung metastases from histologically confirmed GCTB who received observation as a first-line treatment approach. The median follow-up period was 116 months. Results Disease progression occurred in 12 patients (54.5%). The median interval between the discovery of lung metastases and progression was 8 months. Eight patients underwent metastasectomy following initial observation. The median interval between the discovery of lung metastases and treatment by metastasectomy was 13.5 months. None of the patients experienced spontaneous regression. Of the 22 patients, 36.4% needed a metastasectomy, and 9.1% required denosumab treatment during the course of the follow-up period. Disease progression occurred in 45.5% of the 11 patients with lung nodules ≤ 5 mm, while all five of the patients with lung nodules > 5 mm experienced disease progression. Progression-free survival was significantly worse in the group with lung nodules > 5 mm compared to the group with lung nodules ≤ 5 mm (p = 0.022). Conclusions Observation is a safe first-line method of managing patients with lung metastases from GCTB. According to radiological imaging, approximately half of the patients progressed, and approximately half required a metastasectomy or denosumab treatment. However, patients with lung nodules > 5 mm should receive careful observation because of the high rate of disease progression in this group.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
| | - Giovanni Ciani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Holargos, Athens, Greece
| | - Cristina Ferrari
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Michele Rocca
- Thoracic Surgery Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alessandra Longhi
- Oncology Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Costantino Errani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
18
|
Singaravadivelu V, Kavinkumar V. Giant Cell Tumour Around Knee Managed by Curettage and Zoledronic Acid with Structural Support by Fibula Cortical Struts. Malays Orthop J 2020; 14:42-49. [PMID: 33403061 PMCID: PMC7752021 DOI: 10.5704/moj.2011.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage. Materials and Methods: This study was carried out in ten cases of biopsy-proven GCTs: five males and five females, in the age group between 18 and 39 years. All patients were given three doses of zoledronic acid, one pre-operative and two post-operative. Extended curettage was done three weeks after the pre-operative dose of zoledronate. The cavity was left empty in all the cases. Fibular struts were used to support the cavity from collapse. Patients were followed-up for post-operative local recurrence. The functional status of the patients was assessed during each visit using the Musculoskeletal Tumour Society (MSTS) score. Results: There were no recurrences at a follow-up of two years. All patients had a stable knee and were able to bear weight fully. The average knee flexion was 75º. The average MSTS score of the study was 92%. Conclusion: Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function.
Collapse
Affiliation(s)
- V Singaravadivelu
- Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, India
| | - V Kavinkumar
- Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, India
| |
Collapse
|
19
|
Machak GN, Snetkov AI. The impact of curettage technique on local control in giant cell tumour of bone. INTERNATIONAL ORTHOPAEDICS 2020; 45:779-789. [PMID: 33094400 DOI: 10.1007/s00264-020-04860-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although consensus has been reached regarding the main aspects of intralesional surgery for giant cell tumour of the bone (GCTB), debates continue about the most effective combination of local adjuvants. The purpose of study was to analyze the previous experience and determine the most effective curettage approach for GCTB. METHODS We summarized the findings from 89 papers published from 1962 to 2020 related to this subject. Database consisted of 137 treated groups that included 6441 patients who underwent different curettage techniques without pre-operative administration of bisphosphonates or RANKL inhibitors. RESULTS Recurrence rates after simple curettage ranged between 27 and 82% with a median value at 47%. The use of one or two local adjuvants reduced the incidence of recurrences approximately by 50% when compared with simple curettage. High-speed burring combined with chemical adjuvants or followed by poly(methyl methacrylate) cementation with or without bone grafting further improved the local control leading to good and excellent results; however, these were not documented in all studies. Simultaneous use of burring, chemical adjuvants, and cementation, which we named here as combined curettage, allowed to down local relapses to the range of 0-26%, with a median at 11%. Oncologic outcomes after combined curettage are significantly better when compared with simple curettage (p < 0.0001) and other variants of enhancement (p = 0.001). CONCLUSIONS Combined curettage appears to provide the most potent and comprehensive impact on residual tumour cells located in risk zones. This approach should be considered for locally advanced tumours when function-preserving surgery is planned. Additional comparative studies are required to define the optimal curettage enhancement for each individual patient.
Collapse
Affiliation(s)
- Gennady N Machak
- Priorov Central Institute for Traumatology and Orthopedics, Moscow, Russian Federation.
| | - Andrey I Snetkov
- Priorov Central Institute for Traumatology and Orthopedics, Moscow, Russian Federation
| |
Collapse
|
20
|
Jamshidi K, Zandrahimi F, Haji Agha Bozorgi M, Arefpour AM, Bagherifard A, Al-Baseesee HH, Mirzaei A. Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 45:289-297. [PMID: 33001283 DOI: 10.1007/s00264-020-04836-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE For the treatment of giant cell tumour of the bone (GCTB) around the knee, preserving the native joint confers advantages over scarifying it. But, there is a controversy about the efficacy of intralesional curettage versus en bloc resection for treatment of such lesions. In this study, we compared local recurrence, functional outcomes, and complications of extended curettage and en bloc resection in these lesions. METHODS Patients with grade 3 GCTB of the distal femur or proximal tibia who were presented with a pathologic fracture and treated with either en bloc resection (n = 22) or extended curettage (n = 20) were included. The mean follow-up of the patients was 6.4 ± 1.9 years in the resection group and 5.5 ± 2.4 years in the extended curettage group. The primary outcome was a local recurrence. Secondary outcomes were limb function evaluated by the Musculoskeletal Tumor Society (MSTS) score and rate of complications. RESULTS Local recurrence was seen in four (20%) patients of the curettage group and three (13.7%) patients of the resection group (P = 0.69). The mean MSTS score was 24 ± 1.9 in the resection group and 26.5 ± 1.3 in the curettage group (P < 0.001). The number of complications was not significantly different between the two study groups (P = 0.49). However, the number of complications that required revision surgery was significantly more in the resection group (P = 0.049). CONCLUSION In grade 3 GCTB around the knee with pathologic fracture, extended curettage results in comparable oncologic outcomes to en bloc resection, while providing better function and a lower rate of revision.
Collapse
Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Zandrahimi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Haji Agha Bozorgi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Arefpour
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
21
|
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.
Collapse
|
22
|
He H, Zeng H, Luo W, Liu Y, Zhang C, Liu Q. Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection? Front Oncol 2019; 9:946. [PMID: 31608235 PMCID: PMC6769105 DOI: 10.3389/fonc.2019.00946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
Aims: This study aimed to compare and evaluate the oncological and functional prognosis of two surgical approaches for giant cell tumor of the bone (GCTB) around the knee joint and provide worthy suggestion for clinical treatment. Patients and Methods: This study included 93 patients, who were divided into the extended curettage (EC) group and segmental resection (SR) group. Relevant preoperative and postoperative data were collected, oncological and functional prognosis were evaluated, and postoperative complications of the two groups were analyzed. Local recurrence was assessed via clinical and radiological tests. Functional prognosis was evaluated using the Musculoskeletal tumor Society (MSTS) scoring system. Results: The EC group had 69 patients; it included 57 primary cases and 12 recurrent cases. The SR group had 24 patients (12 men and 12 women; mean age, 34.9 years), including 15 primary cases and 9 recurrent cases. In this study, six cases (6.5%; EC group, 5 cases; SR group 1 case) recurred within 18 months postoperatively. There was a significant difference in the mean MSTS score between the two groups (p < 0.001). Nononcologic complications occurred frequently in the EC group than in the SR group (28.0 vs. 16.7%), but no complications had serious consequences, and the functional prognosis was not affected. Conclusion: EC and SR for GCTB around the knee joint can achieve satisfactory oncological prognosis, but we should individually select the most suitable surgical method according to Campanacci grade, age, and long-term complications of patients and consider the functional prognosis to ensure excellent oncological prognosis.
Collapse
Affiliation(s)
- Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yupeng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
23
|
Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:11-17. [PMID: 31297594 DOI: 10.1007/s00590-019-02496-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distal radius giant cell tumour (GCT) is known to be associated with distinct management difficulties, including high rates of local recurrence and lung metastases compared to other anatomic locations. Multiple treatment options exist, each with different outcomes and complications. QUESTIONS/PURPOSES To compare oncological and functional outcomes and complications following treatment of patients with distal radius GCT by extended intralesional curettage (EIC) or resection-arthrodesis. METHODS Patients operated on for distal radius GCT were identified from prospectively collected databases at four Canadian musculoskeletal oncology specialty centres. There were 57 patients with a mean age of 35.4 years (range 17-57). Thirteen tumours were Campanacci grade 2, and 40 were Grade 3 (4 unknown). Twenty patients presented with an associated pathologic fracture. There were 34 patients treated by EIC and 23 by en bloc resection and wrist arthrodesis. All resections were performed for grade 3 tumours. The mean follow-up was 86 months (range 1-280). RESULTS There were a total of 11 (19%) local recurrences: 10 of 34 (29%) in the EIC group compared to only 1 of 23 (4%) in the resection-arthrodesis group (p = 0.028). For the 10 patients with local recurrence following initial treatment by EIC, 7 underwent repeat EIC, while 3 required resection-arthrodesis. The one local recurrence following initial resection was managed with repeat resection-arthrodesis. Six of the 11 local recurrences followed treatment of Campanacci grade 3 tumours, while 4 were in grade 2 lesions and in one case of recurrence the grade was unknown. There were no post-operative complications after EIC, whereas 7 patients (30%) had post-operative complications following resection-arthrodesis including 4 infections, one malunion, one non-union and one fracture (p = 0.001). The mean post-operative Musculoskeletal Tumor Society score was 33.5 in the curettage group compared to 27 in the resection group (p = 0.001). The mean Toronto Extremity Salvage Score was 98.3% following curettage compared to 91.5% after resection (p = 0.006). No patients experienced lung metastasis or death. CONCLUSIONS EIC is an effective alternative to wide resection-arthrodesis following treatment of distal radius GCT, with the advantage of preserving the distal radius and wrist joint function, but with a higher risk of local recurrence. Most local recurrences following initial treatment by EIC could be managed with iterative curettage and joint preservation. Wide excision and arthrodesis were associated with a significantly lower risk of tumour recurrence but was technically challenging and associated with more frequent post-operative complications. EIC was associated with better functional scores. Resection should be reserved for the most severe grade 3 tumours and recurrent and complex cases not amenable to treatment with EIC and joint salvage. LEVEL OF EVIDENCE III, retrospective comparative trial.
Collapse
|
24
|
Chen Z, Zhao G, Chen F, Xia J, Jiang L. The prognostic significance of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio in giant cell tumor of the extremities. BMC Cancer 2019; 19:329. [PMID: 30961549 PMCID: PMC6454707 DOI: 10.1186/s12885-019-5511-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background In this study, the influence of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of giant cell tumor (GCT) of the extremities were investigated. Methods The clinical parameters of 163 patients who were diagnosed with GCT of the extremities between July 2008 and January 2018 were retrospectively analyzed. Optimal cutoff values of NLR and PLR were determined using receiver operating characteristic (ROC) analysis. According to optimal cutoff values, patients were divided into high NLR and low NLR groups or high PLR and low PLR groups. Kaplan-Meier and log-rank methods were used to compare the recurrence-free survival (RFS) between the high and low NLR groups, and between the high and low PLR groups. Univariate analysis was performed to determine the influence of age, gender, neutrophil count, lymphocyte count, platelet count, white blood cell count, tumor size, surgical approach and Campanacci stage on the prognosis of giant cell tumor of bone. The main predictors of RFS were determined by Cox multivariate regression analysis. Results The optimal cutoff value of NLR in giant cell tumor of the extremities was 2.32, which was used to classify patients into high and low NLR groups. The optimal cutoff value of PLR was 116.81, and was used to classify patients into high and low PLR groups. Campanacci stage, tumor maximum diameter, alkaline phosphatase, and C-reactive protein (CRP) were significantly associated with the high NLR and PLR. Cox multivariate regression analysis revealed that the Campanacci stage (HR = 3.28, 95% CI: 1.24~8.69) and NLR (HR = 4.18, 95% CI: 1.83~9.57) were independent prognostic factors for giant cell tumor of the extremities. Conclusion As a novel inflammatory index, NLR has some predictive power for the prognosis of patients with giant cell tumor of the extremities.
Collapse
Affiliation(s)
- Zhenhao Chen
- Department of Orthopaedic Surgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road(M), Shanghai, 200040, China
| | - Guanglei Zhao
- Department of Orthopaedic Surgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road(M), Shanghai, 200040, China
| | - Feiyan Chen
- Department of Orthopaedic Surgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road(M), Shanghai, 200040, China.
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road(M), Shanghai, 200040, China.
| | - Li Jiang
- Department of Orthopaedic Surgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road(M), Shanghai, 200040, China
| |
Collapse
|
25
|
Guo L, Jia P, Hu YC, Sun M, Wang Z, Zhang XN, Miao J. Measurement of morphological parameters of giant cell tumor of bone in the knee. Oncol Lett 2019; 17:3867-3873. [PMID: 30930988 PMCID: PMC6425395 DOI: 10.3892/ol.2019.10064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/23/2019] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to characterize the morphological parameters of giant cell tumor of bone (GCTB) in the knee. The imaging data of 250 patients with GCTB in the knee were retrospectively reviewed, and the morphological parameters were analyzed. The study included 137 cases with GCTB in the distal femur and 113 cases with GCTB in the proximal tibia. The maximal longitudinal diameter of the tumor was 6.616±2.322 cm in the femur group and 5.738±2.278 cm in the tibia group (P=0.003). The maximal transverse diameter in the two groups was 4.865±1.525 and 4.313±1.309 cm, respectively (P=0.003). The shortest distance from the articular surface (SDAS) in the two groups was 0.381±0.404 and 0.280±0.328 cm, respectively (P=0.035), whereas the longest distance from the articular surface in the two groups was 6.924±2.135 and 5.878±1.825 cm, respectively (P=0.001). There were statistically significant differences between the two groups in terms of the range of SDAS (P=0.043). Additionally, the incidence of pathological fractures in the femur was higher compared with that in the tibia (P=0.001), and the incidence of pathological fractures in the two groups gradually increased with the increase in lesion diameter. GCTB in the distal femur was larger compared with that in the proximal tibia, whereas GCTB in the tibia was closer to the articular surface compared with that in the femur. Furthermore, the incidence of pathological fractures in the femur was higher compared with that in the tibia.
Collapse
Affiliation(s)
- Lin Guo
- Department of Radiology, Tianjin Hospital, Tianjin 300211, P.R. China.,Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Peng Jia
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Yong-Cheng Hu
- Department of Bone Tumors, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Man Sun
- Department of Radiology, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Zhi Wang
- Department of Radiology, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Xue-Ning Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Jun Miao
- Department of Bone Tumors, Tianjin Hospital, Tianjin 300211, P.R. China
| |
Collapse
|
26
|
Tsukamoto S, Mavrogenis AF, Tanzi P, Leone G, Righi A, Akahane M, Kido A, Honoki K, Tanaka Y, Donati DM, Errani C. Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation. J Surg Oncol 2019; 119:864-872. [PMID: 30734307 DOI: 10.1002/jso.25391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are conflicting reports for the outcome of the patients with giant cell tumor of bone (GCTB) and pathological fracture at presentation treated with curettage or resection. This study compared local recurrence, complications, and function after curettage versus resection for these patients. MATERIALS AND METHODS We retrospectively studied the files of 46 patients with histologically confirmed GCTB of the extremities admitted and treated from 1982 to 2015. The median follow-up was 79.5 months (57.0-125.5 months). We evaluated local recurrence and type of surgery-related complications with imaging and function with the Musculoskeletal Tumor Society (MSTS) score. RESULTS Overall local recurrence was 6.5%. There were one patient with curettage and two patients with resection; local recurrence rate was similar between the two procedures but the time to local recurrence was shorter after curettage. MSTS score was significantly better after curettage. Complications occurred in two patients after curettage and in five patients after resection; because of the low number of patients with complications, a statistical comparison was not possible; however, by direct comparison of the numbers, complications were more common after resection compared with curettage. CONCLUSION Curettage is recommended for GCTB and pathological fracture at presentation because of similar local recurrence but better function compared with resection. The treating physicians should be aware and inform their patients for a shorter time to local recurrence after curettage and for more complications after resection.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Piergiuseppe Tanzi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Leone
- Department of Orthopaedic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Kido
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
27
|
Liu Y, Chen HJ, Zhang B, Liu XQ, Xiao J, Cheng CK, Dai M. A single-component and hemi-hip prosthesis followed up for 43 years: A case report. Medicine (Baltimore) 2019; 98:e14563. [PMID: 30813171 PMCID: PMC6407976 DOI: 10.1097/md.0000000000014563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Giant cell tumor (GCT) is a locally aggressive bone tumor with a high recurrence rate if not completely excised. And reconstructive hip surgery using an artificial prosthesis in a young active patient is controversial because of problems related to the durability of the artificial joint. PATIENT CONCERNS A 30-year-old man presented with right hip pain and other more severe symptoms, but without fever or night sweats. After 4 months, he experienced intense pain at the root of the right leg and limitation of motion after falling from a bicycle. DIAGNOSES Giant cell tumor. INTERVENTIONS The patient was treated with surgical resection of the total tumor, and hemiarthroplasty of the hip joint using a custom-made titanium femoral prosthesis. OUTCOMES The patient could perform activities of daily living, even walking long distance without pain. He continued to work as a teacher for 30 years and retired 11 years after the surgery. LESSONS A well-designed, custom-fitted, single-component, wear-resistant joint prosthesis should be the brand-new direction of development of artificial joints.
Collapse
Affiliation(s)
- Yuan Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hang-jun Chen
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xu-Qiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jun Xiao
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Cheng-Kung Cheng
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| |
Collapse
|
28
|
Errani C, Tsukamoto S, Ciani G, Donati DM. Present day controversies and consensus in curettage for giant cell tumor of bone. J Clin Orthop Trauma 2019; 10:1015-1020. [PMID: 31736607 PMCID: PMC6844202 DOI: 10.1016/j.jcot.2019.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The ideal treatment for giant cell tumor of bone (GCTB) is still controversial. The purpose of this study was to evaluate whether curettage was successful in the treatment of GCTB. Intralesional curettage with adjuvant therapies, such as high-speed burring, polymethylmethacrylate, phenol, ethanol, and liquid nitrogen, may be used to reduce the local recurrence rate. However, there is no consensus on the optimal use of curettage, along with fillers and adjuvants, to limit the recurrence rate. METHODS We performed a systematic review of articles using the terms long bones, GCTB, and treatment. Case reports, reviews, opinion articles, or technique notes were excluded based on the abstract. Twenty-six articles included in this review were then studied to establish the index in suggesting the surgical treatment of GCTB. RESULTS The patient's gender, their age, the Campanacci grade of their tumor, and the type of surgery they had were not significantly associated with the local recurrence rate. Local recurrences seemed to be associated with the site of the tumor, occurring more frequently in the proximal femur or distal radius. A pathological fracture was not a contraindication for intralesional curettage. Treatment with denosumab did not decrease the local recurrence rate in patients who had been treated with curettage. CONCLUSION The current literature seems to suggest that the ideal treatment for GCTB is to remove the tumor while preserving as much of the joint as possible. Local recurrent tumors can be treated with curettage to keep the re-recurrence rate within an acceptable limit. The choice for how to treat GCTB in the proximal femur or distal radius requires special attention.
Collapse
Affiliation(s)
- Costantino Errani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Corresponding author. Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, via pupilli n1, 40136, Bologna, Italy.
| | | | - Giovanni Ciani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | |
Collapse
|
29
|
Medellin MR, Fujiwara T, Tillman RM, Jeys LM, Gregory J, Stevenson JD, Parry M, Abudu A. Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture. Bone Joint J 2018; 100-B:1626-1632. [PMID: 30499317 DOI: 10.1302/0301-620x.100b12.bjj-2018-0189.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). PATIENTS AND METHODS A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. RESULTS The initial surgical treatment was curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. CONCLUSION In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.
Collapse
Affiliation(s)
| | - T Fujiwara
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - L M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J D Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - A Abudu
- Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
30
|
Wu M, Yao S, Xie Y, Yan F, Deng Z, Lei J, Cai L. A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee: A retrospective study of 27 cases. Medicine (Baltimore) 2018; 97:e13154. [PMID: 30407342 PMCID: PMC6250490 DOI: 10.1097/md.0000000000013154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The vast majority of giant-cell tumors occur around the knee and characteristically affect the subchondral bone. Thermal damage to the articular cartilage arising from the application of polymethylmethacrylate (PMMA) or extensive intralesional curettage presents a challenging problem to orthopedic surgeons and patients due to compliance issues. For this reason, we developed a new subchondral bone-grafting procedure to restore massive bone defects and reduce degenerative changes in the knee.The aim of this study was to describe the novel subchondral bone-grafting procedure and evaluate clinical outcomes in patients with giant-cell tumors around the knee.This retrospective single-center study included a total of 27 patients with giant-cell tumors in the distal femur and proximal tibia admitted to our department from January 2012 to December 2015 and treated with aggressive intralesional curettage. Eleven males and 16 females were included. All cases underwent subchondral autograft bone grafting followed by bone cement reconstruction and instrument internal fixation. The Musculoskeletal Tumor Society (MSTS) score and short form-36 (SF-36) were applied to assess the functional outcome of the knee joint and quality of life. Tumor recurrence, Kellgren and Lawrence (KL) grade, and the distance of the cement to the articular surface were assessed throughout the sample.All cases were followed up after surgery for an average of 32.9 ± 7.1 months (range 25-57 months). At the end of the follow-up period, all patients were alive and free from pulmonary metastasis. Complications associated with this surgery occurred only in 1 patient (3.7%), who presented with an incision infection that resolved with regular dressing and antibiotics. No fractures, instrument breakage, or joint fluid leakage occurred. Local recurrence occurred in 1 case (3.7%) at the distal femur after 23 months and was treated by wide resection followed by prosthesis reconstruction. Twenty-four patients (89%) did not develop radiographic findings of osteoarthritis: at the final follow-up 2 patients (7.4%), had progressed to KL1 and 1 patient had progressed to KL2. According to the MSTS scoring system, the functional score of the affected knee joint at the last follow-up ranged from 80% to 97%, with an average of 87.3%. The quality of life parameters assessed by the SF-36 survey at the last follow-up ranged from 47 to 96, with an average of 77.For patients with giant-cell tumor of bone near the knee, subchondral bone grafting combined with bone cement reconstruction is recommended as a feasible and effective treatment modality.
Collapse
|
31
|
Zheng K, Yu XC, Hu YC, Wang Z, Wu SJ, Ye ZM. How to Fill the Cavity after Curettage of Giant Cell Tumors around the Knee? A Multicenter Analysis. Chin Med J (Engl) 2018; 130:2541-2546. [PMID: 29067952 PMCID: PMC5678251 DOI: 10.4103/0366-6999.217093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Intralesional excision with curettage is the standard method of giant cell tumor (GCT) treatment, but the ideal filling material after curettage remains controversial. The purpose of this study was to compare the oncological and functional outcomes which underwent cementation or bone grafting after GCT curettage around the knee. Methods: We reported 136 cases with GCTs in distal femur or proximal tibia who accepted curettage from five clinical centers during the last 15 years. All patients were divided into two groups according to filling materials. Recurrence-free survival proportions were used to evaluate oncological outcomes while the Musculoskeletal Tumor Society (MSTS) 93 functional score was used to evaluate functional outcomes. Other parameters including surgical complication, general condition, and radiological classification had been analyzed. The valid statisitical data was analyzed using SPSS 13.0 software. Results: After GCT curettage, 86 patients (63.2%) accepted bone grafting while 50 patients (36.8%) accepted cementation. There was no statistical difference in age, gender, tumor location, radiological classification, fixation, follow-up time, and MSTS 93 functional score between cementation group and bone grafting group. The recurrence-free survival proportions showed that the recurrence rate in bone grafting group was higher than it in cementation group (P = 0.034). Surgical complication was lower in cementation group than that in bone grafting group but without statistically significant difference (P = 0.141). Conclusions: Parameters including patients’ age, gender, tumor location, and radiological classification did not affect surgeons’ treatments in cavity filling after GCT curettage. Cementation should be recommended because of easy usage, the similar postoperative knee function with bone grafting, and the better local tumor control than bone grafting.
Collapse
Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, The General Hospital of Jinan Military Commanding Region, Jinan, Shandong 250031, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, The General Hospital of Jinan Military Commanding Region, Jinan, Shandong 250031, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, China
| | - Zhen Wang
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Su-Jia Wu
- Department of Orthopaedics, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210000, China
| | - Zhao-Ming Ye
- Department of Orthopaedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | | |
Collapse
|
32
|
Wide resection versus curettage in giant cell tumor with pathological fracture? A systematic review and meta-analysis. J Clin Orthop Trauma 2018; 9:S15-S18. [PMID: 29628693 PMCID: PMC5883895 DOI: 10.1016/j.jcot.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Currently there is no consensus if wide resection and curettage in giant cell tumor have effect on local recurrence rate in the presence of a pathological fracture. MATERIAL AND METHOD We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients of giant cell tumor with and without a pathological fracture. The odds ratio (OR) of local recurrence between wide resection and curettage group in giant cell tumor with pathological fracture was calculated. RESULTS 05 eligible papers were selected for final analysis. This included patients, of whom (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients of pathological fracture treated with wide resection and curettage was 0.298% (95% Confidence interval (CI) 0.0669-1.329, p = 0.97). CONCLUSION Wide resection and curettage in patients of giant cell tumor with pathological fracture has difference in local recurrence rates. However the presence of a pathological fracture should no be only influential factor in the decision making to perform wide resection or curettage. A proper planning and judicious approach is required in giant cell tumor with pathological fracture for deciding the appropriate treatment method.
Collapse
|
33
|
Deng L, Yu L, Wei C, Wang B, Zhu S. [Intramedullary nail combined with auxiliary plate and bone cement in treatment of pathologic fracture of extremities caused by metastatic tumors]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1442-1446. [PMID: 29806384 DOI: 10.7507/1002-1892.201707047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the application of intramedullary nail fixation combined with auxiliary plate and bone cement in the palliative treatment of pathologic fracture of extremities caused by metastatic tumors. Methods Clinical data of 11 cases with pathologic fracture of extremities caused by metastatic tumors between April 2015 and October 2016 were retrospectively analyzed. All the patients were treated by intramedullary nail fixation combined with auxiliary plate and bone cement. There were 6 males and 5 females with an age of 54-72 years (mean, 62.9 years). The disease duration was 1.0-1.5 months. Of the 11 patients, 4 metastatic tumors were diagnosed at humerus, 6 at femur, and 1 at tibia, respectively. And the tumor infiltration length ranged from 3.3 to 5.6 cm (mean, 4.6 cm), the depth could reach the bilayer of limb bones. All the patients had suffered the limbs pain and incapability of physical movement. The preoperative visual analogue scale (VAS) score was 6.36±1.03, and the Karnofsky Performance Status (KPS) score was 42.73±10.09. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, KPS score, and Musculoskeletal Tumor Society (MSTS) score were used to evaluate the effectiveness at 3 months after operation. Results The operation time was 1.1-1.8 hours (mean, 1.5 hours), the intraoperative blood loss was 102.5-211.3 mL (mean, 135.6 mL). Postoperative limb incisions healed well without infection, necrosis, and delayed healing or other complications. All the patients were followed up 7-10 months (mean, 8.2 months). At 3 months after operation, the functions of limbs recovered. The VAS score decreased to 0.82±0.75 and the KPS score increased to 85.45±5.22, both showing significant difference when compared with preoperative ones ( t=35.218, P=0.000; t=-18.470, P=0.000); and the MSTS score was 23.91±2.47. At last follow-up, the anteroposterior and lateral X-ray films showed that all the limbs healing well and no breakage of intramedullary nail and steel plate, or loosening in bone cement, limb shortening, malalignment, or other complications occurred. Conclusion In treating metastatic tumors of extremities, the combination of intramedullary nail fixation with auxiliary plate and bone cement will contribute to an invariable length and fixed location for limbs, resulting in biomechanical stability for skeleton. Under this premise, the tumor lesions can be eliminated and pathological pains be relieved, so as to improve patients' life quality.
Collapse
Affiliation(s)
- Linglong Deng
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Li Yu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Chi Wei
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Bing Wang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Shaobo Zhu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071,
| |
Collapse
|
34
|
van der Heijden L, Dijkstra PDS, Blay JY, Gelderblom H. Giant cell tumour of bone in the denosumab era. Eur J Cancer 2017; 77:75-83. [PMID: 28365529 DOI: 10.1016/j.ejca.2017.02.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/12/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
Abstract
Giant cell tumour of bone (GCTB) is an intermediate locally aggressive primary bone tumour, occurring mostly at the meta-epiphysis of long bones. Overexpression of receptor activator of nuclear factor kappa-B ligand (RANKL) by mononuclear neoplastic stromal cells promotes recruitment of numerous reactive multinucleated osteoclast-like giant cells, causing lacunar bone resorption. Preferential treatment is curettage with local adjuvants such as phenol, alcohol or liquid nitrogen. The remaining cavity may be filled with bone graft or polymethylmethacrylate (PMMA) bone cement; benefits of the latter are a lower risk of recurrence, possibility of direct weight bearing and early radiographic detection of recurrences. Reported recurrence rates are comparable for the different local adjuvants (27-31%). Factors increasing the local recurrence risk include soft tissue extension and anatomically difficult localisations such as the sacrum. When joint salvage is impossible, en-bloc resection and endoprosthetic joint replacement may be performed. Local tumour control on the one hand and maintenance of a functional native joint and quality of life on the other hand are the main pillars of surgical treatment for this disease. Current knowledge and development in the fields of imaging, functional biology and systemic therapy are forcing us into a paradigm shift from a purely surgical approach towards a multidisciplinary approach. Systemic therapy with denosumab (RANKL inhibitor) or zoledronic acid (bisphosphonates) blocks, respectively inhibits, bone resorption by osteoclast-like giant cells. After use of zoledronic acid, stabilisation of local and metastatic disease has been reported, although the level of evidence is low. Denosumab is more extensively studied in two prospective trials, and appears effective for the optimisation of surgical treatment. Denosumab should be considered in the standard multidisciplinary treatment of advanced GCTB (e.g. cortical destruction, soft tissue extension, joint involvement or sacral localisation) to facilitate surgery at a later stage, and thereby aiming at immediate local control. Even though several questions concerning optimal treatment dose, duration and interval and drug safety remain unanswered, denosumab is among the most effective drug therapies in oncology.
Collapse
Affiliation(s)
- Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P D Sander Dijkstra
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
35
|
Zhang S, Zhang J, Wang X. Comparison of tumor curettage and resection for treatment of giant cell tumor of the bone around the knee joint. Pak J Med Sci 2016; 32:662-6. [PMID: 27375710 PMCID: PMC4928419 DOI: 10.12669/pjms.323.9654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: To analyze the efficacies of tumor curettage and resection for treatment of giant cell tumor of the bone (GCTB) around the knee joint (KJ). Methods: A total of 126 KJ-GCTB cases were treated at our department from August 2011 to February 2015. These cases were divided into two groups (A and B) according to treatment methods. Group A underwent tumor curettage, while group B underwent tumor resection. Results: The relapse rates did not differ significantly between the groups (P>0.05), while the complication rate in group A was significantly lower than that in group B (P<0.05). In addition, the Enneking score for group A was significantly higher than that for group B (P<0.05); in addition, postoperative local recurrence, histopathological grading according to Jaffe, and radiographic imaging-based Campanacci’s staging positively correlated (P<0.05). Conclusion: Tumor curettage was the preferred surgical approach for patients with KJ-GCTB.
Collapse
Affiliation(s)
- Sheng Zhang
- Sheng Zhang, Department of Orthopedics, Yan'an People's Hospital, Yan'an 716000, Shanxi Province, China
| | - Jianhua Zhang
- Jianhua Zhang, Department of Orthopedics, the Affiliated Hospital of Yan'an University, Yan'an 716000, Shanxi Province, China
| | - Xin Wang
- Xin Wang, Department of Orthopedics, Yan'an People's Hospital, Yan'an 716000, Shanxi Province, China
| |
Collapse
|
36
|
Traub F, Singh J, Dickson BC, Leung S, Mohankumar R, Blackstein ME, Razak AR, Griffin AM, Ferguson PC, Wunder JS. Efficacy of denosumab in joint preservation for patients with giant cell tumour of the bone. Eur J Cancer 2016; 59:1-12. [PMID: 26990281 DOI: 10.1016/j.ejca.2016.01.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/05/2016] [Accepted: 01/13/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Giant cell tumour of the bone (GCTB) is an aggressive osteolytic primary tumour. GCTB is rich in osteoclast-like giant cells and contains mononuclear cells that express RANK ligand (RANKL), a key mediator of osteoclast activation. The potential therapeutic effect of denosumab was investigated with special reference to its role in joint preservation. METHODS In this prospective non-randomised study patients with GCTB received denosumab for 6-11 months preoperatively. Serial radiographs and biopsy and resection tumour specimens were used to monitor response to denosumab. RESULTS All 20 patients experienced pain relief in the first month of treatment. All patients demonstrated a positive radiographic response with improved subchondral and cortical bone which allowed intralesional tumour resection and preservation of the joint and articular surface in 18 cases. Histological examination following denosumab revealed rarely detectable osteoclast-like giant cells. There was an obvious increase in osteoid matrix and woven bone which showed rare RANK staining amongst the mononuclear cells and only focal RANKL positivity. At median 30 months follow-up after resection, local tumour recurrence occurred in three patients. CONCLUSION Denosumab provides favourable and consistent clinical, radiographic and pathologic responses which facilitates less aggressive surgical treatment, especially joint preservation. However, the local recurrence rate for GCTB following resection does not seem to be affected by denosumab and remains a concern.
Collapse
Affiliation(s)
- Frank Traub
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Janith Singh
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Stephanie Leung
- Musculoskeletal Division, Department of Medical Imaging, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Rakesh Mohankumar
- Musculoskeletal Division, Department of Medical Imaging, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Martin E Blackstein
- Department of Medical Oncology, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Albiruni R Razak
- Department of Medical Oncology, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto M5G 1X5, ON, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto M5G 1X5, ON, Canada.
| |
Collapse
|
37
|
Salunke AA, Chen Y, Chen X, Tan JH, Singh G, Tai BC, Khin LW, Puhaindran ME. Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone?: a meta-analysis. Bone Joint J 2016; 97-B:1566-71. [PMID: 26530662 DOI: 10.1302/0301-620x.97b11.35326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether the presence of a pathological fracture increased the risk of local recurrence in patients with a giant cell tumour (GCT) of bone. We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients with a GCT with and without a pathological fracture at presentation. We computed the odds ratio (OR) of local recurrence in those with and without a pathological fracture. We selected 19 eligible papers for final analysis. This included 3215 patients, of whom 580 (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients with and without a pathological fracture was 1.05 (95% confidence interval (CI) 0.66 to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75 to 2.01, p = 0.417). A post hoc sample size calculation showed adequate power for both comparisons. There is no difference in local recurrence rates between patients who have a GCT of bone with and without a pathological fracture at the time of presentation. The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture.
Collapse
Affiliation(s)
- A A Salunke
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Y Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - X Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - J H Tan
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - G Singh
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - B C Tai
- National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - L W Khin
- National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - M E Puhaindran
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| |
Collapse
|
38
|
Carvallo PI, Griffin AM, Ferguson PC, Wunder JS. Salvage of the proximal femur following pathological fractures involving benign bone tumors. J Surg Oncol 2015; 112:846-52. [PMID: 26482583 DOI: 10.1002/jso.24072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/08/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To describe the surgical treatment of patients with a pathologic fracture through a benign tumor of the proximal femur to determine if there is a difference in local recurrence, complications or functional outcome compared to patients with tumors in the same location without pathologic fractures. METHODS From 1989-2010, of 97 patients, 29 presented with a pathologic fracture (PF) through a proximal femoral benign bone tumor and 68 presented without a pathologic fracture (NPF). Outcomes of the two groups were compared in terms of surgical management, postoperative complications, local recurrence and functional scores. RESULTS Fibrous dysplasia, giant cell tumor of bone and chondroblastoma were the most common subtypes. Most patients were managed with joint preservation in both PF (86.2%) and NPF (98.5%) groups (P = 0.03). Local recurrence risk was similar for patients in the PF (10.3%) and NPF (8.8%) groups. Mean follow-up was 105.7 months (P = 0.8). Functional outcome scores were high in both groups and not statistically significantly different. CONCLUSIONS The majority of pathologic fractures through a benign bone tumor of the proximal femur can be successfully treated with curettage, burring, bone grafting and internal fixation without increasing the risk of local recurrence or negatively impacting functional outcome.
Collapse
Affiliation(s)
- Pedro I Carvallo
- University Post-Graduate Orthopaedic Oncology Program, Universidad Central de Venezuela, Servicios Oncológicos Hospitalarios, Seguro Social, Caracas, Venezuela
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
39
|
López-Pousa A, Martín Broto J, Garrido T, Vázquez J. Giant cell tumour of bone: new treatments in development. Clin Transl Oncol 2015; 17:419-30. [PMID: 25617146 PMCID: PMC4448077 DOI: 10.1007/s12094-014-1268-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 01/01/2023]
Abstract
Giant cell tumour of bone (GCTB) is a benign osteolytic tumour with three main cellular components: multinucleated osteoclast-like giant cells, mononuclear spindle-like stromal cells (the main neoplastic components) and mononuclear cells of the monocyte/macrophage lineage. The giant cells overexpress a key mediator in osteoclastogenesis: the RANK receptor, which is stimulated in turn by the cytokine RANKL, which is secreted by the stromal cells. The RANK/RANKL interaction is predominantly responsible for the extensive bone resorption by the tumour. Historically, standard treatment was substantial surgical resection, with or without adjuvant therapy, with recurrence rates of 20–56 %. Studies with denosumab, a monoclonal antibody that specifically binds to RANKL, resulted in dramatic treatment responses, which led to its approval by the United States Food and Drugs Administration (US FDA). Recent advances in the understanding of GCTB pathogenesis are essential to develop new treatments for this locally destructive primary bone tumour.
Collapse
Affiliation(s)
- A López-Pousa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,
| | | | | | | |
Collapse
|
40
|
van der Heijden L, Dijkstra PDS, van de Sande MAJ, Kroep JR, Nout RA, van Rijswijk CSP, Bovée JVMG, Hogendoorn PCW, Gelderblom H. The clinical approach toward giant cell tumor of bone. Oncologist 2014; 19:550-61. [PMID: 24718514 DOI: 10.1634/theoncologist.2013-0432] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We provide an overview of imaging, histopathology, genetics, and multidisciplinary treatment of giant cell tumor of bone (GCTB), an intermediate, locally aggressive but rarely metastasizing tumor. Overexpression of receptor activator of nuclear factor κB ligand (RANKL) by mononuclear neoplastic stromal cells promotes recruitment of numerous reactive multinucleated giant cells. Conventional radiographs show a typical eccentric lytic lesion, mostly located in the meta-epiphyseal area of long bones. GCTB may also arise in the axial skeleton and very occasionally in the small bones of hands and feet. Magnetic resonance imaging is necessary to evaluate the extent of GCTB within bone and surrounding soft tissues to plan a surgical approach. Curettage with local adjuvants is the preferred treatment. Recurrence rates after curettage with phenol and polymethylmethacrylate (PMMA; 8%-27%) or cryosurgery and PMMA (0%-20%) are comparable. Resection is indicated when joint salvage is not feasible (e.g., intra-articular fracture with soft tissue component). Denosumab (RANKL inhibitor) blocks and bisphosphonates inhibit GCTB-derived osteoclast resorption. With bisphosphonates, stabilization of local and metastatic disease has been reported, although level of evidence was low. Denosumab has been studied to a larger extent and seems to be effective in facilitating intralesional surgery after therapy. Denosumab was recently registered for unresectable disease. Moderate-dose radiotherapy (40-55 Gy) is restricted to rare cases in which surgery would lead to unacceptable morbidity and RANKL inhibitors are contraindicated or unavailable.
Collapse
Affiliation(s)
- Lizz van der Heijden
- Departments of Orthopedic Surgery, Clinical Oncology, Radiology, and Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Abstract
BACKGROUND Approximately one in five patients with giant cell tumor of bone presents with a pathologic fracture. However, recurrence rates after resection or curettage differ substantially in the literature and it is unclear when curettage is reasonable after fracture. QUESTIONS/PURPOSES We therefore determined: (1) local recurrence rates after curettage with adjuvants or en bloc resection; (2) complication rates after both surgical techniques and whether fracture healing occurred after curettage with adjuvants; and (3) function after both treatment modalities for giant cell tumor of bone with a pathologic fracture. METHODS We retrospectively reviewed 48 patients with fracture from among 422 patients treated between 1981 and 2009. The primary treatment was resection in 25 and curettage with adjuvants in 23 patients. Minimum followup was 27 months (mean, 101 months; range, 27-293 months). RESULTS Recurrence rate was higher after curettage with adjuvants when compared with resection (30% versus 0%). Recurrence risk appears higher with soft tissue extension. The complication rate was lower after curettage with adjuvants when compared with resection (4% versus 16%) and included aseptic loosening of prosthesis, allograft failure, and pseudoarthrosis. Tumor and fracture characteristics did not increase complication risk. Fracture healing occurred in 24 of 25 patients. Mean Musculoskeletal Tumor Society score was higher after curettage with adjuvants (mean, 28; range, 23-30; n = 18) when compared with resection (mean, 25; range, 13-30; n = 25). CONCLUSIONS Our observations suggest curettage with adjuvants is a reasonable option for giant cell tumor of bone with pathologic fractures. Resection should be considered with soft tissue extension, fracture through a local recurrence, or when structural integrity cannot be regained after reconstruction. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
43
|
Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR. Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment. Radiographics 2013; 33:197-211. [DOI: 10.1148/rg.331125089] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
44
|
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: 27] [Impact Index Per Article: 2.3] [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.
Collapse
|
45
|
van der Heijden L, van de Sande MA, Dijkstra PD. Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones. Acta Orthop 2012; 83:401-5. [PMID: 22880716 PMCID: PMC3427632 DOI: 10.3109/17453674.2012.711193] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvants in GCTB. METHODS Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis. RESULTS The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture. INTERPRETATION Curettage with adjuvants is a feasible first-choice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not.
Collapse
Affiliation(s)
- L van der Heijden
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - MA van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - PD Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
46
|
Kim Y, Nizami S, Goto H, Lee FY. Modern interpretation of giant cell tumor of bone: predominantly osteoclastogenic stromal tumor. Clin Orthop Surg 2012; 4:107-16. [PMID: 22662295 PMCID: PMC3360182 DOI: 10.4055/cios.2012.4.2.107] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/22/2012] [Indexed: 02/02/2023] Open
Abstract
Owing to striking features of numerous multinucleated cells and bone destruction, giant cell tumor (GCT) of bone, often called as osteoclastoma, has drawn major attractions from orthopaedic surgeons, pathologists, and radiologists. The name GCT or osteoclastoma gives a false impression of a tumor comprising of proliferating osteoclasts or osteoclast precursors. The underlying mechanisms for excessive osteoclastogenesis are intriguing and GCT has served as an exciting disease model representing a paradigm of osteoclastogenesis for bone biologists. The modern interpretation of GCT is predominantly osteoclastogenic stromal cell tumors of mesenchymal origin. A diverse array of inflammatory cytokines and chemokines disrupts osteoblastic differentiation and promotes the formation of excessive multi-nucleated osteoclastic cells. Pro-osteoclastogenic cytokines such as receptor activator of nuclear factor kappa-B ligand (RANKL), interleukin (IL)-6, and tumor necrosis factor (TNF) as well as monocyte-recruiting chemokines such as stromal cell-derived factor-1 (SDF-1) and monocyte chemoattractant protein (MCP)-1 participate in unfavorable osteoclastogenesis and bone destruction. This model represents a self-sufficient osteoclastogenic paracrine loop in a localized area. Consistent with this paradigm, a recombinant RANK-Fc protein and bisphosphonates are currently being tried for GCT treatment in addition to surgical excision and conventional topical adjuvant therapies.
Collapse
Affiliation(s)
- Yuhree Kim
- Department of Orthopaedic Surgery, Columbia University Medical Center, Columbia University, New York, NY 10032, USA
| | | | | | | |
Collapse
|
47
|
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.
Collapse
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.
| | | | | | | | | | | | | |
Collapse
|
48
|
Lin WH, Lan TY, Chen CY, Wu K, Yang RS. Similar local control between phenol- and ethanol-treated giant cell tumors of bone. Clin Orthop Relat Res 2011; 469:3200-8. [PMID: 21732023 PMCID: PMC3183197 DOI: 10.1007/s11999-011-1962-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 06/22/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Giant cell tumors (GCTs) of bone often are treated with curettage, adjuvant therapy, and cementation. Phenol is a commonly used adjuvant associated with local control rates ranging from 9% to 25%. However, it is corrosive to the eyes, skin, and respiratory tract. Ethanol is readily available and does not cause chemical burns on contact, but it is unclear whether ethanol can achieve similar local control rates as phenol for treating GCTs. QUESTIONS/PURPOSES We evaluated (1) the recurrence rate and recurrence-free Kaplan-Meier survival function, (2) Musculoskeletal Tumor Society (MSTS) functional score (1993 version), and (3) complications of two groups of patients with GCTs treated with extensive curettage, local adjuvant therapy with phenol or ethanol, and cement reconstruction, to determine if ethanol was a reasonable alternative to phenol. PATIENTS AND METHODS We retrospectively reviewed all 26 patients with GCTs in the long bones of extremities treated with curettage, high-speed burring, phenolization, and cementation between May 1995 and November 2001, and 35 patients treated with the same protocol, except phenol was replaced with 95% ethanol, between November 2001 and November 2007. The recurrence rates, Kaplan-Meier recurrence-free survival curves, and MSTS functional scores of these two treatment groups were compared with Fisher's exact test, Tarone-Ware test, and Mann-Whitney U test, respectively. The minimum followup was 36 months (mean, 58 months; range, 36-156 months). RESULTS Local recurrence rates were similar in the two groups: 11% in the ethanol group and 12% in the phenol group. The survival curves (using local recurrence as an endpoint) of the two groups were similar. The mean MSTS functional score was 27.3 (91%) for the ethanol group and 26.9 (90%) for the phenol group. CONCLUSIONS Ethanol is a reasonable alternative to phenol when adjuvant therapy is considered in the treatment of GCTs of long bones. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Wei-Hsin Lin
- Department of Orthopedics, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedics, Far-Eastern Memorial Hospital, Taipei, Taiwan
| | - Chih-Yu Chen
- Department of Orthopedic Surgery, Taipei Medical University Shuang-Ho Hospital, Taipei, Taiwan
| | - Karl Wu
- Department of Orthopedics, Far-Eastern Memorial Hospital, Taipei, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, College of Medicine, National Taiwan University and Hospital, Number7, Chung-Shan South Road, Taipei, Taiwan
| |
Collapse
|
49
|
Giant cell tumour of bone: an analysis of 139 Indian patients. J Orthop Sci 2011; 16:581-8. [PMID: 21833611 DOI: 10.1007/s00776-011-0033-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 06/15/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND Giant cell tumour of bone (GCT) is a benign but locally aggressive lesion. We analysed a series of GCTs of bone to determine whether there was any variation in the incidence and distribution in an Indian population compared to other populations reported in the literature, as well as treatment options applicable in developing countries, and we report the results here. METHODS A total of 139 patients with histologically proven GCT of bone were treated in our referral centre. Of these, 124 cases had a follow-up of more than 2 years (mean 8.3 years). Demographically, 72 were male, 67 were female, and they had a mean age of 29 years (range 15-59 years). The majority of the cases were of Campanacci grade III (n = 72, 51.1%). A total of 157 oncological procedures were performed. RESULTS Incidence of GCT of bone was found to be 20.3% (n = 139/685) among all primary bone tumours. The distal radial involvement amounted to 22.7% (n = 28). There were 14 recurrences (11.1%) and 3 re-recurrences. Functional outcome was evaluated using the MSTS-93 scoring system. Average rating was 89.6% (avg. score 26.9) for upper extremities and 84% (avg. score 25.2) for lower extremities. CONCLUSIONS The incidence of GCT of bone was found to be high in our population, with surprisingly high involvement of the distal radius. Nonvascularised autogenous fibular graft was found to be an effective option for reconstruction. The Indian population, like their South East Asian neighbours, has a higher incidence of GCT compared to Western populations described in the literature.
Collapse
|
50
|
Saikia KC, Bhattacharyya TD, Bhuyan SK, Bordoloi B, Durgia B, Ahmed F. Local recurrences after curettage and cementing in long bone giant cell tumor. Indian J Orthop 2011; 45:168-73. [PMID: 21430873 PMCID: PMC3051125 DOI: 10.4103/0019-5413.77138] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Giant cell tumor of bone (GCT) is a benign lesion with great propensity for local recurrence. This study aimed to analyse the rates of local recurrence and its possible predisposing factors in Campanacci's Grade III and II GCT of long bones following intralesional curettage and bone cementing. MATERIALS AND METHODS 32 cases of either sex with Campanacci's Grade II (n= 14), and Grade III (n=18) with intact articular surface, operated between 1995 and 2007 in form of intralesional curettage and bone cementing were studied. All the cases were followed up for 2.5-12 years (mean, 6.5), after primary treatment. The mean age at operation was 32.4 years (range, 18.5-40 years). The proximal tibia was involved in 13 cases (40.6%), followed by distal femur (n=11)34.4% distal tibia (n=3) 9.4%, proximal femur (n=2) 3.2% and distal radius (n=3) 9.4%. RESULTS Eleven patients (34.4%) had local recurrence, of which eight were of Campanacci's Grade III. The mean recurrence time was 14 months (range, 3-34 months). The two-year recurrence-free survivorship was 71.9% (n=23/32). Post-recurrence mean follow-up was 4.2 years (range, 2-6.5 years). CONCLUSION We observed higher rate of local recurrence with Campanacci's Grade III GCTs. We recommend selective use of this procedure in Grade III lesions, particularly with extensive soft tissue involvement.
Collapse
Affiliation(s)
- Kabul C Saikia
- Department of Orthopaedics, Gauhati Medical College, Guwahati, Assam, India,Address for correspondence: Dr. Kabul C. Saikia, Rajgarh Link Road, Anil Nagar, Bylane No. 5, House No. 7, Guwahati, Assam 781007, India. E-mail:
| | | | - Sanjeev K Bhuyan
- Department of Orthopaedics, Gauhati Medical College, Guwahati, Assam, India
| | - Bikas Bordoloi
- Department of Orthopaedics, Gauhati Medical College, Guwahati, Assam, India
| | - Bharat Durgia
- Department of Orthopaedics, Gauhati Medical College, Guwahati, Assam, India
| | - Firoz Ahmed
- Department of Orthopaedics, Gauhati Medical College, Guwahati, Assam, India
| |
Collapse
|