Giant Cell Tumor of Bone: Risk Factors for Recurrence

• Published in: Clinical orthopaedics and related research Vol. 469; no. 2; pp. 591 - 599
• Main Authors: Klenke, Frank M., Wenger, Doris E., Inwards, Carrie Y., Rose, Peter S., Sim, Franklin H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2011; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adjuvants; Adult; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Bone Cements - therapeutic use; Bone grafts; Bone loss; Bone Neoplasms - drug therapy; Bone Neoplasms - mortality; Bone Neoplasms - pathology; Bone surgery; Bone tumors; Chemotherapy; Chemotherapy, Adjuvant; Clinical Research; Conservative Orthopedics; Curettage; Demography; Disease-Free Survival; 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; Giant cells; Humans; Joints; Lung; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - secondary; Male; Medical sciences; Medicine; Medicine & Public Health; Metastases; Middle Aged; Minnesota - epidemiology; Neoplasm Recurrence, Local - diagnosis; Orthopedics; Phenols; Polymethyl Methacrylate - therapeutic use; polymethylmethacrylate; Radiotherapy; Retrospective Studies; Risk Factors; Sports Medicine; Surgery; Surgical Orthopedics; Survival; Tumor; Tumors; Tumors of striated muscle and skeleton; Young Adult; Minnesota; Local Recurrence; Pathologic Fracture; Polymethylmethacrylate; Giant Cell Tumor; Pulmonary Metastasis; Relapse; Giant cell tumor; Bone tumor; Orthopedics; Diseases of the osteoarticular system; Risk factor
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1501-7

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.