Abstract
Giant cell tumour (GCT) of bone is still one of the most obscure and intensively studied tumours of bone. The histogenesis of GCT remains unclear. The recommended therapy of GCT evolved during the 20th century. The best treatment should ensure local control and maintain function. Curettage has been the preferred treatment for most GCTs. Good results have also been published on the use of high-speed burr and local adjuvants. Local tumour control can be satisfactorily achieved by wide excision. However, treatment options for GCT have remained fairly static over the past 30 years and there is no widely held consensus regarding the standard treatment selection for all patients. This challenge may result from the fact that there are no single clinical, radiographic, histological or morphological aspects that allow surgeons to accurately predict the trend of a single lesion to recur. In this research, a comprehensive review of the previously described radiographic staging systems by Enneking and Campanacci et al. and the shortfalls associated with them are provided, and then the possible risk factors of predicting local recurrence or evaluating functional outcome of GCT are also discussed. A new preoperative evaluating system of GCT may be necessary and feasible, so that surgeons may accurately assess the aggressiveness or severity of GCT in order to reliably guide treatment decisions and predict outcomes.
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Fletcher CDM, Unni KK, Mertens F (2002) Pathology and genetics of tumours of soft tissue and bone. International Agency for Research on Cancer Press, Lyon, pp 309–313
Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, Liu W (2012) Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am 94(5):461–467
Jeys LM, Suneja R, Chami G, Grimer RJ, Carter SR, Tillman RM (2006) Impending fractures in giant cell tumours of the distal femur: incidence and outcome. Int Orthop 30:135–138
Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C, Walloe A, Bauer HC, Jorgensen PH, Bergh P, Follerås G (2008) Cement is recommended in intralesional surgery of giant cell tumors: a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop 79(1):86–93
Rooney RJ, Asirvatham R, Lifeso RM, Ali MA, Parikh S (1993) Giant cell tumour of bone. A surgical approach to grade III tumours. Int Orthop 17(2):87–92
Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM (1982) Giant cell tumor of bone: analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am 64:755–761
Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M (2010) Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 36(1):1–7
Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ (2005) Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res 435:211–218
Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM, Canadian Sarcoma Group (2002) Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res 397:248–258
Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ (2005) Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res 438:123–127
Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP (2006) Giant cell tumor of bone. Am J Clin Oncol 29(1):96–99
Turcotte RE (2006) Giant cell tumor of bone. Orthop Clin North Am 37(1):35–51
Szendröi M (2004) Giant-cell tumour of bone. J Bone Joint Surg Br 86(1):5–12
Algawahmed H, Turcotte R, Farrokhyar F, Ghert M (2010) High-speed burring with and without the use of surgical adjuvants in the intralesional management of giant cell tumor of bone: a systematic review and meta-analysis. Sarcoma 2010
Shih HN, Hsu RW, Sim FH (1998) Excision curettage and allografting of giant cell tumours. World J Surg 22:432–437
Trieb K, Bitzan P, Dominkus M, Kotz R (2000) Giant-cell tumors of long bone. J Bone Joint Surg 82A:1360–1361
Karpik M (2010) Giant cell tumor (tumor gigantocellularis, osteoclastoma)—epidemiology, diagnosis, treatment. Ortop Traumatol Rehabil 12(3):207–215
Yu XC, Xu M, Song RX, Fu ZH, Liu XP (2010) Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis. Orthop Surg 2(3):211–217
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-A:811–820
Malek F, Krueger P, Hatmi ZN, Malayeri AA, Faezipour H, O’Donnell RJ (2006) Local control of long bone giant cell tumor using curettage, burring and bone grafting without adjuvant therapy. Int Orthop 30:495–498
Labs K, Perka C, Schmidt GR (2001) Treatment of stages 2 and 3 giant-cell tumor. Arch Orthop Traum Surg 121:83–86
O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ (1994) Recurrence of giant-cell tumors of long bones after curettage and packing with cement. J Bone Joint Surg Am 76-A:1827–1833
Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH (2011) Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res 469(2):591–599
Masui F, Ushigome S, Fujii K (1998) Giant cell tumor of bone: a clinicopathological study of prognostic factors. Pathol Int 48:723–729
Puthoor DK, Puthezhath K (2012) Management of giant cell tumor of bone: computerized tomography based selection strategy and approaching the lesion through the site of cortical break. Orthop Surg 4(2):76–82
Gitelis S, Mallin BA, Piasecki P, Turner F (1993) Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am 75:1648–1655
Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jörgensen P, Follerås G, Rydholm A, Scandinavian Sarcoma Group (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 88:531–535
Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM, Canadian Sarcoma Group (2002) Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res (397):248–258
McDonald DJ, Weber KL (2007) Giant cell tumor of bone. In: Schwartz HS (ed) Musculoskeletal tumors, 2nd edn. American Academy of Orthopaedic Surgeons, Rosemont, IL, pp 133–140
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 Oncol 134(9):969–978
Werner M (2006) Giant cell tumour of bone: morphological, biological and histogenetical aspects. Int Orthop 30(6):484–489
Jaffe HL, Lichtenstein L, Portis RB (1940) Giant cell tumor of bone: its pathological appearance, grading, supposed variants and treatment. Arch Pathol 30:993–1031
Sanerkin NG (1980) Malignancy, aggressiveness, and recurrence in giant cell tumor of bone. Cancer 46:1641–1649
Lausten GS, Jensen PK, Schiødt 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
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):167–173
Dahlin DC (1985) Giant cell tumor of bone: highlights of 407 cases. Am J Roentgenol 144:955–960
Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 9–24
Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69(1):106–114
Rock M (1990) Curettage of giant cell tumor of bone: Factors influencing local recurrences and metastasis. Chir Organi Mov 75(Suppl1):204–205
Wuismann P, Härle A, Nommensen B (1989) Giant-cell tumour of bone: an analysis of 69 cases. Z Orthop 127:392–395
Szendroi M, Kiss J, Antal I (2003) Surgical treatment and prognostic factors in giant-cell tumor of bone. Acta Chir Orthop Traumatol Cech 70(3):142–150
Thomas DM, Skubitz KM (2009) Giant cell tumour of bone. Curr Opin Oncol 21(4):338–344
Ward WG Sr, Gird L (2002) Customized treatment algorithm for giant cell tumor of bone: report of a series. Clin Orthop Relat Res 397:259–270
Lackman RD, Crawford EA, King JJ, Ogilvie CM (2009) Conservative treatment of Campanacci grade III proximal humerus giant cell tumors. Clin Orthop Relat Res 467(5):1355–1359
Deheshi BM, Jaffer SN, Griffin AM, Ferguson PC, Bell RS, Wunder JS (2007) Joint salvage for pathological fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res 459:96–104
Tse LF, Wong KC, Kumta SM, Huang L, Chow TC, Griffith JF (2008) Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case–control study. Bone 42:68–73
Weber KL, Peabody T, Frassica FJ, Mott MP, Parsons TW (2010) Tumors for the general orthopedist: how to save your patients and practice. Instr Course Lect 59:579–591
Hirn M, de Silva U, Sidharthan S, Grimer RJ, Abudu A, Tillman RM, Carter SR (2009) Bone defects following curettage do not necessarily need augmentation. A retrospective study of 146 patients. Acta Orthop 80(1):4–8
Miszczyk L, Wydmanski J, Spindel J (2001) Efficacy of radiotherapy for giant cell tumor of bone: given either postoperatively or as sole treatment. Int J Radiat Oncol Biol Phys 49:1239–1242
Knochentumouren A, Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU (2008) Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 90:1060–1067
Lewis VO, Wei A, Mendoza T, Primus F, Peabody T, Simon MA (2007) Argon beam coagulation as an adjuvant for local control of giant cell tumor. Clin Orthop Relat Res 454:192–197
Dreinhöfer KE, Rydholm A, Bauer HC, Kreicbergs A (1995) Giant-cell tumours with fracture at diagnosis: curettage and acrylic cementing in ten cases. J Bone Joint Surg Br 77(2):189–193
Chen TH, Su YP, Chen WM (2005) Giant cell tumors of the knee: subchondral bone integrity affects the outcome. Int Orthop 29(1):30–34
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Wang, H., Wan, N. & Hu, Y. Giant cell tumour of bone: a new evaluating system is necessary. International Orthopaedics (SICOT) 36, 2521–2527 (2012). https://doi.org/10.1007/s00264-012-1664-9
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DOI: https://doi.org/10.1007/s00264-012-1664-9