Skip to main content
SpringerLink
Log in

Salvaging the Unsalvageable Giant Cell Tumors of Bone: The ‘Longitudinal Sandwich Technique’

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Management of Campanacci Grade III Giant Cell Tumors of bone (GCT) is challenging. Although selected cases of Grade III GCTs can still be managed with intralesional extended curettage, wide excision of the lesion is usually recommended when there is extensive cortical destruction. This study describes the outcome of ‘longitudinal sandwich technique’ for extended curettage of Grade III GCTs with more than 50% cortical destruction. Here, the deficiency of cortex was made up for by using bone graft/graft substitute, used alongside cement placed in a longitudinal fashion. Twelve patients operated with this technique between Jan 2012 and Jan 2018 were reviewed. Majority of the lesions involved the lower limbs. Bone graft was used in eight whereas commercial bone graft substitute was used in the remaining four, along with bone cement in all. On follow-up ranging from 38 to 84 months (median follow-up 59 months), there were 4 local recurrences (33.33%). All recurrences were managed successfully with repeat surgery without the need for bony resection. Mean MSTS score during the last follow-up was 25.08 ± 2.31 and all patients were disease-free during the last follow-up. ‘Longitudinal sandwich technique’ helps to expand the indications of extended curettage even for aggressive Grade III GCTs, with satisfactory outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

Available from corresponding author on reasonable request.

References

  1. Sobti A, Agrawal P, Agarwala S, Agarwal M (2016) Giant cell tumor of bone - an overview. Arch Bone Jt Surg 4(1):2–9

    PubMed  PubMed Central  Google Scholar 

  2. Zheng K, Yu XC, Hu YC, Wang Z, Wu SJ, Ye ZM, Giant Cell Tumor Group of China (GTOC), (2017) How to fill the cavity after curettage of giant cell tumors around the knee? A multicenter analysis. Chin Med J (Engl) 130 (21) 2541–2546

  3. Radev BR, Kase JA, Askew MJ, Weiner SD (2009) Potential for thermal damage to articular cartilage by PMMA reconstruction of a bone cavity following tumor excision: a finite element study. J Biomech 42(8):1120–1126

    Article  Google Scholar 

  4. Kundu ZS, Gogna P, Singla R, Sangwan SS, Kamboj P, Goyal S (2015) Joint salvage using sandwich technique for giant cell tumors around knee. J Knee Surg 28(2):157–164

    Article  Google Scholar 

  5. Saibaba B, Chouhan DK, Kumar V, Dhillon MS, Rajoli SR (2014) Curettage and reconstruction by the sandwich technique for giant cell tumours around the knee. J Orthop Surg (Hong Kong) 22(3):351–355

    Article  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. Kang L, Manoso MW, Boland PJ, Healey JH, Athanasian EA (2010) Features of grade 3 giant cell tumors of the distal radius associated with successful intralesional treatment. J Hand Surg Am 35(11):1850–1857

    Article  Google Scholar 

  8. Ward WG Sr, Li G 3rd (2002) Customized treatment algorithm for giant cell tumor of bone: report of a series. Clin Orthop Relat Res 397:259–270

    Article  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. Liu YP, Li KH, Sun BH (2012) Which treatment is the best for giant cell tumors of the distal radius? A meta-analysis Clin Orthop Relat Res 470(10):2886–2894

    Article  Google Scholar 

  11. Eckardt JJ, Grogan TJ (1986) Giant cell tumor of bone. Clin Orthop Relat Res 204:45–58

    Article  Google Scholar 

  12. Labs K, Perka C, Schmidt RG (2001) Treatment of stages 2 and 3 giant-cell tumor. Arch Orthop Trauma Surg 121(1–2):83–86

    Article  CAS  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. Wang HC, Chien SH, Lin GT (2005) Management of grade III giant cell tumors of bones. J Surg Oncol 92(1):46–51

    Article  Google Scholar 

  15. 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):811–820

    Article  CAS  Google Scholar 

  16. Mankin HJ, Hornicek FJ (2005) Treatment of giant cell tumors with allograft transplants: a 30-year study. Clin Orthop Relat Res 439:144–150

    Article  Google Scholar 

  17. Salunke AA, Pathak S, Shah J, Pandit J, Naneria V (2018) Wide resection versus curettage in giant cell tumor with pathological fracture? A systematic review and meta-analysis. J Clin Orthop Trauma 9(Suppl 1):S15–S18

    Article  Google Scholar 

  18. Puri A, Gulia A, Hegde P, Verma V, Rekhi B (2019) Neoadjuvant denosumab: its role and results in operable cases of giant cell tumour of bone. Bone Joint J 101-B(2):170–177

    Article  CAS  Google Scholar 

  19. 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(1):68–73

    Article  CAS  Google Scholar 

  20. Henderson ER, Groundland JS, Pala E et al (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429

    Article  Google Scholar 

  21. Pala E, Trovarelli G, Calabrò T, Angelini A, Abati CN, Ruggieri P (2015) Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res 473(3):891–899

    Article  Google Scholar 

  22. Dahlin DC, Cupps RE, Johnson EW Jr (1970) Giant-cell tumor: a study of 195 cases. Cancer 25(5):1061–1070

    Article  CAS  Google Scholar 

  23. Ghert MA, Rizzo M, Harrelson JM, Scully SP (2002) Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res 400:201–210

    Article  Google Scholar 

  24. Shi W, Indelicato DJ, Reith J et al (2013) Radiotherapy in the management of giant cell tumor of bone. Am J Clin Oncol 36(505–508):119

    Google Scholar 

  25. Bhatia S, Miszczyk L, Roelandts M et al (2011) Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study. Rare Tumors 3:e48

    Article  Google Scholar 

  26. Puri A, Gupta SM, Gulia A, Shetty N, Laskar S (2021) Giant cell tumors of the sacrum: is non-operative treatment effective? Eur Spine J 30(10):2881–2886

    Article  Google Scholar 

  27. van der Heijden L, Dijkstra PD, van de Sande MA, Kroep JR, Nout RA, van Rijswijk CS, Bovée JV, Hogendoorn PC, Gelderblom H (2014) The clinical approach toward giant cell tumor of bone. Oncologist 19(5):550–561

    Article  Google Scholar 

  28. Ibe IK, Alder KD, Henderson SE, Yu KE, Lee FY (2019) Excisional curettage of benign cystic lesions. JBJS Essent Surg Tech 9(3):e24

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal Oncology, Department of Surgical Oncology, Nepal Cancer Hospital & Research Center, Lalitpur, Nepal

    Rishi Ram Poudel

  2. Division of Musculoskeletal Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India

    Akshay Tiwari, Aakriti Jain & Vivek Verma

Authors
  1. Rishi Ram Poudel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akshay Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aakriti Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vivek Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akshay Tiwari.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poudel, R.R., Tiwari, A., Jain, A. et al. Salvaging the Unsalvageable Giant Cell Tumors of Bone: The ‘Longitudinal Sandwich Technique’. Indian J Surg Oncol 13, 316–321 (2022). https://doi.org/10.1007/s13193-022-01545-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-022-01545-3

Keywords

Search

Navigation