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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 2/2011

01-02-2011 | Clinical Research

Giant Cell Tumor of Bone: Risk Factors for Recurrence

Authors: Frank M. Klenke, MD, PhD, Doris E. Wenger, MD, Carrie Y. Inwards, MD, Peter S. Rose, MD, Franklin H. Sim, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2011

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Abstract

Background

Many surgeons treat giant cell tumor of bone (GCT) with intralesional curettage. Wide resection is reserved for extensive bone destruction where joint preservation is impossible or when expendable sites (eg, fibular head) are affected. Adjuvants such as polymethylmethacrylate and phenol have been recommended to reduce the risk of local recurrence after intralesional surgery. However, the best treatment of these tumors and risk factors for recurrence remain controversial.

Questions/purposes

We evaluated the recurrence-free survival after surgical treatment of GCT to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence.

Methods

We retrospectively reviewed 118 patients treated for benign GCT of bone between 1985 and 2005. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum followup was 36 months (mean, 108.4 ± 43.7; range, 36–233 months).

Results

Wide resection had a lower recurrence rate than intralesional surgery (5% versus 25%). Application of polymethylmethacrylate decreased the risk of local recurrence after intralesional surgery compared with bone grafting; phenol application alone had no effect on the risk of recurrence. Pulmonary metastases occurred in 4%; multidisciplinary treatment including wedge resection, chemotherapy, and radiotherapy achieved disease-free survival or stable disease in all of these patients.

Conclusion

We recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. Because pulmonary metastases are rare and aggressive treatment of pulmonary metastases is usually successful, we believe the potential for metastases should not by itself create an indication for wide resection of primary tumors.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Giant Cell Tumor of Bone: Risk Factors for Recurrence
Authors
Frank M. Klenke, MD, PhD
Doris E. Wenger, MD
Carrie Y. Inwards, MD
Peter S. Rose, MD
Franklin H. Sim, MD
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 2/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1501-7

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