Document Detail


Giant cell tumor of bone: risk factors for recurrence.
MedLine Citation:
PMID:  20706812     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Frank M Klenke; Doris E Wenger; Carrie Y Inwards; Peter S Rose; Franklin H Sim
Publication Detail:
Type:  Journal Article     Date:  2010-08-13
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-11     Completed Date:  2011-02-24     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  591-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antineoplastic Agents / therapeutic use
Bone Cements / therapeutic use
Bone Neoplasms / drug therapy,  mortality,  pathology*
Chemotherapy, Adjuvant
Disease-Free Survival
Female
Giant Cell Tumor of Bone / drug therapy,  mortality,  secondary*
Humans
Lung Neoplasms / drug therapy,  mortality,  secondary*
Male
Middle Aged
Minnesota / epidemiology
Neoplasm Recurrence, Local / diagnosis*
Polymethyl Methacrylate / therapeutic use
Retrospective Studies
Risk Factors
Young Adult
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 0/Bone Cements; 9011-14-7/Polymethyl Methacrylate
Comments/Corrections

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