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Giant Cell Tumor of Bone: Risk Factors for Recurrence
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Journal Article
Giant Cell Tumor of Bone: Risk Factors for Recurrence
2011
Overview
Background
Many surgeons treat giant cell tumor of bone (GCT) with intralesional curettage. Wide resection is reserved for extensive bone destruction where joint preservation is impossible or when expendable sites (eg, fibular head) are affected. Adjuvants such as polymethylmethacrylate and phenol have been recommended to reduce the risk of local recurrence after intralesional surgery. However, the best treatment of these tumors and risk factors for recurrence remain controversial.
Questions/purposes
We evaluated the recurrence-free survival after surgical treatment of GCT to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence.
Methods
We retrospectively reviewed 118 patients treated for benign GCT of bone between 1985 and 2005. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum followup was 36 months (mean, 108.4 ± 43.7; range, 36–233 months).
Results
Wide resection had a lower recurrence rate than intralesional surgery (5% versus 25%). Application of polymethylmethacrylate decreased the risk of local recurrence after intralesional surgery compared with bone grafting; phenol application alone had no effect on the risk of recurrence. Pulmonary metastases occurred in 4%; multidisciplinary treatment including wedge resection, chemotherapy, and radiotherapy achieved disease-free survival or stable disease in all of these patients.
Conclusion
We recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. Because pulmonary metastases are rare and aggressive treatment of pulmonary metastases is usually successful, we believe the potential for metastases should not by itself create an indication for wide resection of primary tumors.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Publisher
Springer-Verlag,Springer,Lippincott Williams & Wilkins Ovid Technologies
Subject
/ Adult
/ Antineoplastic Agents - therapeutic use
/ Biological and medical sciences
/ Bone Cements - therapeutic use
/ Bone Neoplasms - drug therapy
/ Diseases of the osteoarticular system
/ Female
/ Giant Cell Tumor of Bone - drug therapy
/ Giant Cell Tumor of Bone - mortality
/ Giant Cell Tumor of Bone - secondary
/ Humans
/ Joints
/ Lung
/ Lung Neoplasms - drug therapy
/ Male
/ Medicine
/ Neoplasm Recurrence, Local - diagnosis
/ Phenols
/ Polymethyl Methacrylate - therapeutic use
/ Surgery
/ Survival
/ Tumor
/ Tumors
