Treatment options for recurrent giant cell tumors of bone

  • Maurice Balke
  • Helmut Ahrens
  • Arne Streitbuerger
  • Gabriele Koehler
  • Winfried Winkelmann
  • Georg Gosheger
  • Jendrik Hardes
Original Paper



Although the recurrence rate of giant cell tumors of bone (GCTB) is relatively high exact data on treatment options for the recurrent cases is lacking. The possible surgical procedures range from repeated intralesional curettage to wide resection.


Two hundred and fourteen patients with histologically certified GCTB have been treated at the authors department from 1980 to 2007. Sixty-seven patients with at least one local recurrence were included in this study. The mean follow-up was 77.3 months. The data was evaluated according the re-recurrence rate with regard to the surgical procedure for the recurrence.


The mean time until the first local recurrence was 22.0 months; the mean number of recurrences per patient was 1.4. The recurrence occurred in 69.7% (46 out of 66 patients) within the first 2 years. If after intralesional procedures (curettage or intralesional resection) no adjunct was used the re-recurrence rate was 58.8% (10 out of 17 patients) and decreased to 21.7% (5 out of 23 patients) if a combination of all adjuncts (PMMA + burring) was used. The likelihood of re-recurrence was reduced by the factor 5.508 which was clearly significant (P = 0.016). In case of wide resection no re-recurrence occurred. Seven patients (10.5%) developed pulmonary metastases. Fourteen patients (20.9%) finally received an endoprosthesis; 12 due to tumor recurrence, 2 due to secondary arthritis.


Recurrent GCTB can be treated by further curettage with additional burring and cementing with an acceptable re-recurrence rate of 21.7%. The rate of patients finally needing an endoprosthesis is 20.9%. Due to the high rate of pulmonary metastases recurrent GCTB may be considered as a severe disease.


Giant cell tumor Bone tumor Recurrence Bone cement Tumorprosthesis 


  1. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G (2008) Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin OncolGoogle Scholar
  2. Bertoni F, Present D, Enneking WF (1985) Giant-cell tumor of bone with pulmonary metastases. J Bone Joint Surg Am 67(6):890–900PubMedGoogle Scholar
  3. Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M (1988) Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin Orthop Relat Res 237:275–285PubMedGoogle Scholar
  4. Bianchi G, Donati D, Staals EL, Mercuri M (2005) Osteoarticular allograft reconstruction of the distal radius after bone tumour resection. J Hand Surg [Br] 30(4):369–373. doi:10.1016/j.jhsb.2005.04.006 Google Scholar
  5. Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS (1999) Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am 81(6):811–820PubMedGoogle Scholar
  6. Campanacci M (1990) Bone and soft tissue tumors. Springer, New York, pp 117–151Google Scholar
  7. Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69(1):106–114PubMedGoogle Scholar
  8. Carrasco CH, Murray JA (1989) Giant cell tumors. Orthop Clin North Am 20(3):395–405PubMedGoogle Scholar
  9. Chen LH, Niu CC, Lai PL, Fu TS, Chen WJ (2004) Recurrent giant cell tumor of the thoracic spine with bilateral pulmonary metastases. J Formos Med Assoc 103(12):957–961PubMedGoogle Scholar
  10. Cheng JC, Johnston JO (1997) Giant cell tumor of bone. Prognosis and treatment of pulmonary metastases. Clin Orthop Relat Res 338:205–214. doi:10.1097/00003086-199705000-00027 PubMedCrossRefGoogle Scholar
  11. Cheng CY, Shih HN, Hsu KY, Hsu RW (2001) Treatment of giant cell tumor of the distal radius. Clin Orthop Relat Res 383:221–228. doi:10.1097/00003086-200102000-00026 PubMedCrossRefGoogle Scholar
  12. Dominkus M, Ruggieri P, Bertoni F, Briccoli A, Picci P, Rocca M et al (2006) Histologically verified lung metastases in benign giant cell tumours-14 cases from a single institution. Int Orthop 30(6):499–504. doi:10.1007/s00264-006-0204-x PubMedCrossRefGoogle Scholar
  13. Enneking WF (1983) Staging of musculoskeletal tumors. In: Enneking WF (ed) Musculoskeletal tumor surgery, vol 1. Churchill Livingstone, New York, pp 87–88Google Scholar
  14. Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24PubMedGoogle Scholar
  15. Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120PubMedGoogle Scholar
  16. Fidler MW (2001) Surgical treatment of giant cell tumours of the thoracic and lumbar spine: report of nine patients. Eur Spine J 10(1):69–77. doi:10.1007/s005860000206 PubMedCrossRefGoogle Scholar
  17. Frassica FJ, Sim FH, Pritchard DJ, Chao EY (1990) Subchondral replacement: a comparative analysis of reconstruction with methyl methacrylate or autogenous bone graft. Chir Organi Mov 75(Suppl 1):189–190PubMedGoogle Scholar
  18. Freyschmidt J, Ostertag H, Jundt G (1998) Knochentumoren. 2. Auflage. Springer, Berlin, pp 611–649Google Scholar
  19. Gille O, Soderlund C, Berge J, Sacko O, Vital JM (2005) Triple total cervical vertebrectomy for a giant cell tumor: case report. Spine 30(10):E272–E275. doi:10.1097/01.brs.0000162931.80082.04 PubMedCrossRefGoogle Scholar
  20. Goldenberg RR, Campbell CJ, Bonfiglio M (1970) Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am 52(4):619–664PubMedGoogle Scholar
  21. Gruber AW, Sabitzer RJ, Gorzer H, Hainfellner JA, Ungersbock K (1999) Acute symptom transverse laminectomy for a benign osteoclastoma of thethoracic spine–case report and review of the literature. Zentralbl Neurochir 60(2):93–99PubMedGoogle Scholar
  22. Intuwongse CS (1998) Reconstruction following en bloc resection of a giant cell tumor of the distal radius using a vascularized pedicle graft of the ulna. J Hand Surg [Am] 23(4):742–747. doi:10.1016/S0363-5023(98)80064-6 CrossRefGoogle Scholar
  23. Kawahara N, Tomita K, Matsumoto T, Fujita T (1998) Total en bloc spondylectomy for primary malignant vertebral tumors. Chir Organi Mov 83(1–2):73–86PubMedGoogle Scholar
  24. Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ (1994) Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res 302:219–230PubMedGoogle Scholar
  25. Larsson SE, Lorentzon R, Boquist L (1975) Giant-cell tumor of bone. A demographic, clinical, and histopathological study of all cases recorded in the Swedish Cancer Registry for the years 1958 through 1968. J Bone Joint Surg Am 57(2):167–173PubMedGoogle Scholar
  26. Lausten GS, Jensen PK, Schiodt T, Lund B (1996) Local recurrences in giant cell tumour of bone. Long-term follow up of 31 cases. Int Orthop 20(3):172–176. doi:10.1007/s002640050057 PubMedCrossRefGoogle Scholar
  27. Leung PC, Chan KT (1986) Giant cell tumor of the distal end of the radius treated by the resection and free vascularized iliac crest graft. Clin Orthop Relat Res 202:232–236PubMedGoogle Scholar
  28. Malek F, Krueger P, Hatmi ZN, Malayeri AA, Faezipour H, O’Donnell RJ (2006) Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy. Int Orthop 30(6):495–498. doi:10.1007/s00264-006-0146-3 PubMedCrossRefGoogle Scholar
  29. Maloney WJ, Vaughan LM, Jones HH, Ross J, Nagel DA (1989) Benign metastasizing giant-cell tumor of bone. Report of three cases and review of the literature. Clin Orthop Relat Res 243:208–215PubMedGoogle Scholar
  30. Masui F, Ushigome S, Fujii K (1998) Giant cell tumor of bone: a clinicopathologic study of prognostic factors. Pathol Int 48(9):723–729PubMedCrossRefGoogle Scholar
  31. Matsumoto M, Ishii K, Takaishi H, Nakamura M, Morioka H, Chiba K et al (2007) Extensive total spondylectomy for recurrent giant cell tumor in the thoracic spine. Case report. J Neurosurg Spine 6(6):600–605. doi:10.3171/spi.2007.6.6.600 PubMedCrossRefGoogle Scholar
  32. McDonald DJ, Sim FH, McLeod RA, Dahlin DC (1986) Giant-cell tumor of bone. J Bone Joint Surg Am 68(2):235–242PubMedGoogle Scholar
  33. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ (1994) Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 76(12):1827–1833PubMedGoogle Scholar
  34. Oda Y, Miura H, Tsuneyoshi M, Iwamoto Y (1998) Giant cell tumor of bone: oncological and functional results of long-term follow-up. Jpn J Clin Oncol 28(5):323–328. doi:10.1093/jjco/28.5.323 PubMedCrossRefGoogle Scholar
  35. Osaka S, Toriyama M, Taira K, Sano S, Saotome K (1997) Analysis of giant cell tumor of bone with pulmonary metastases. Clin Orthop Relat Res 335:253–261PubMedGoogle Scholar
  36. Ozaki T, Liljenqvist U, Halm H, Hillmann A, Gosheger G, Winkelmann W (2002) Giant cell tumor of the spine. Clin Orthop Relat Res 401:194–201. doi:10.1097/00003086-200208000-00022 PubMedCrossRefGoogle Scholar
  37. Ozalp T, Yercan H, Okcu G, Ozdemir O, Coskunol E (2006) Giant cell tumor at the wrist: a review of 23 cases. Acta Orthop Traumatol Turc 40(2):144–150PubMedGoogle Scholar
  38. Rock MG, Pritchard DJ, Unni KK (1984) Metastases from histologically benign giant-cell tumor of bone. J Bone Joint Surg Am 66(2):269–274PubMedGoogle Scholar
  39. Salzer-Kuntschik M (1998) Differential diagnosis of giant cell tumor of bone. Verh Dtsch Ges Pathol 82:154–159PubMedGoogle Scholar
  40. Samartzis D, Foster WC, Padgett D, Shen FH (2008) Giant cell tumor of the lumbar spine: operative management via spondylectomy and short-segment, 3-column reconstruction with pedicle recreation. Surg Neurol 69(2):138–141. doi:10.1016/j.surneu.2007.01.038 discussion 141–2PubMedCrossRefGoogle Scholar
  41. Sanjay BK, Kadhi SM (1998) Giant cell tumour of bone with pulmonary metastases. A report of three cases. Int Orthop 22(3):200–204. doi:10.1007/s002640050242 PubMedCrossRefGoogle Scholar
  42. Schwartz HS (1998) Update on giant cell tumor of bone. Compr Ther 24(10):488–493PubMedGoogle Scholar
  43. Sheth DS, Healey JH, Sobel M, Lane JM, Marcove RC (1995) Giant cell tumor of the distal radius. J Hand Surg [Am] 20(3):432–440. doi:10.1016/S0363-5023(05)80102-9 CrossRefGoogle Scholar
  44. Siebenrock KA, Unni KK, Rock MG (1998) Giant-cell tumour of bone metastasising to the lungs. A long-term follow-up. J Bone Joint Surg Br 80(1):43–47. doi:10.1302/0301-620X.80B1.7875 PubMedCrossRefGoogle Scholar
  45. Suzuki Y, Nishida Y, Yamada Y, Tsukushi S, Sugiura H, Nakashima H et al (2007) Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone. Knee 14(5):369–374. doi:10.1016/j.knee.2007.05.008 PubMedCrossRefGoogle Scholar
  46. Szalay K, Antal I, Kiss J, Szendroi M (2006) Comparison of the degenerative changes in weight-bearing joints following cementing or grafting techniques in giant cell tumour patients: medium-term results. Int Orthop 30(6):505–509. doi:10.1007/s00264-006-0190-z PubMedCrossRefGoogle Scholar
  47. Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK (1992) Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol 158(2):331–334PubMedGoogle Scholar
  48. Turcotte RE (2006) Giant cell tumor of bone. Orthop Clin North Am 37(1):35–51. doi:10.1016/j.ocl.2005.08.005 PubMedCrossRefGoogle Scholar
  49. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA et al (2002) Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res 397:248–258. doi:10.1097/00003086-200204000-00029 PubMedCrossRefGoogle Scholar
  50. Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jorgensen P et al (2006) Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. J Bone Joint Surg Br 88(4):531–535. doi:10.1302/0301-620X.88B4.17407 PubMedCrossRefGoogle Scholar
  51. Wang HC, Chien SH, Lin GT (2005) Management of grade III giant cell tumors of bones. J Surg Oncol 92(1):46–51. doi:10.1002/jso.20338 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Maurice Balke
    • 1
  • Helmut Ahrens
    • 1
  • Arne Streitbuerger
    • 1
  • Gabriele Koehler
    • 2
  • Winfried Winkelmann
    • 1
  • Georg Gosheger
    • 1
  • Jendrik Hardes
    • 1
  1. 1.Department of Orthopedic SurgeryUniversity of MuensterMunsterGermany
  2. 2.Gerhard-Domagk-Institute of PathologyUniversity of MuensterMunsterGermany

Personalised recommendations