Skip to main content
SpringerLink
Log in

Management of Giant Cell Tumor of Distal Radius—Does Curettage Work?

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

Abstract

Giant cell tumor affecting distal radius has been considered more aggressive, as compared to its counterparts in other locations. While resection has been advocated as the treatment of choice with lower rates of recurrence, curettage has reportedly led to superior functional outcomes. This retrospective study aimed to evaluate the functional and oncological outcomes of patients managed for GCT distal radius by either extended intralesional curettage (EIC) or resection and arthrodesis with radialisation of ulna (RRU), with respect to rates of local recurrence and function. Twenty-four patients operated for giant cell tumor of distal radius by a single surgeon from 2011 to 2021, were included in the study. The demographic, clinico-radiological, and surgical details were recorded and analyzed, as were the functional and oncological outcomes. At a median (IQR) follow-up of 6.3 years (range 2 years to 15.9 years), the rate of recurrence in curettage was found to be higher than that in resection but was not statistically significant (35.7% vs 20%, p > 0.05). Patients managed elsewhere and then presented to us for recurrence had a higher rate of local recurrence (66.6%, p = 0.01). Average time to recurrence was 14 months (range 2–24 months). On final follow-up, patients in curettage group had better functional outcomes in terms of grip strength and range of motion. Mean Modified Mayo Wrist score and MSTS score were 78.2 and 25.63, respectively, for EIC group and 69.6 and 25.75, respectively, for RRU group. Extended intralesional curettage resulted in an earlier rehabilitation with a mobile wrist and acceptable disease control when compared with resection and arthrodesis with radialisation of ulna.

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

Similar content being viewed by others

References

  1. Cao H, Lin F, Hu Y, Zhao L, Yu X, Wang Z et al (2017) Epidemiological and clinical features of primary giant cell tumors of the distal radium: a multicenter retrospective study in China. Sci Reports 71 [Internet]. 2017 Aug 22 [cited 2022 May 14];7(1):1–6

  2. Puri A, Agarwal M, Anchan C, Shah M, Panchwagh Y (2007) Giant cell tumor - distal end radius: do we know the answer? Indian J Orthop 41(2):139

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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 [Internet]. [cited 2022 Jun 13];76(12):1827–33

  4. Wysocki RW, Soni E, Virkus WW, Scarborough MT, Leurgans SE, Gitelis S (2015) Is intralesional treatment of giant cell tumor of the distal radius comparable to resection with respect to local control and functional outcome? Clin Orthop Relat Res. 473(2):706–715

    Article  PubMed  Google Scholar 

  5. Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res. (214):136–47.

  6. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246

    Article  Google Scholar 

  7. Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69(1):106–14

    Article  CAS  PubMed  Google Scholar 

  8. Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr (2013) Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics 33(1):197–211

    Article  PubMed  Google Scholar 

  9. Verschoor AJ, Bovée JVMG, Mastboom MJL, Sander Dijkstra PD, Van De Sande MAJ, Gelderblom H (2018) Incidence and demographics of giant cell tumor of bone in The Netherlands: First nationwide Pathology Registry Study. Acta Orthop 89(5):570–574. https://doi.org/10.1080/17453674.2018.1490987

    Article  PubMed  PubMed Central  Google Scholar 

  10. Saikia KC, Borgohain M, Bhuyan SK, Goswami S, Bora A, Ahmed F (2010) Resection-reconstruction arthroplasty for giant cell tumor of distal radius. Indian J Orthop 44(3):327–332

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mohaidat ZM, Al-Jamal HZ, Bany-Khalaf AM, Radaideh AM, Audat ZA (2019) Giant cell tumor of bone: unusual features of a rare tumor. Rare Tumors 11:2036361319878894

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hu Y, Zhao L, Zhang H, Yu X, Wang Z, Ye Z et al (2016) Sex Differences in the Recurrence rate and risk factors for primary giant cell tumors around the knee in China. Sci Rep [Internet] 20:6

    Google Scholar 

  13. 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):331–334

    Article  CAS  PubMed  Google Scholar 

  14. 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):43–7

    Article  CAS  PubMed  Google Scholar 

  15. Puri A, Gulia A, Agarwal MG, Reddy K (2010) Ulnar translocation after excision of a Campanacci grade-3 giant-cell tumour of the distal radius: an effective method of reconstruction. J Bone Joint Surg Br 92(6):875–9

    Article  CAS  PubMed  Google Scholar 

  16. 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):2886–94. https://doi.org/10.1007/s11999-012-2464-7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Barik S, Jain A, Ahmad S, Singh V (2020) Functional outcome in giant cell tumor of distal radius treated with excision and fibular arthroplasty: a case series. Eur J Orthop Surg Traumatol 30(6):1109–1117

    Article  PubMed  Google Scholar 

  18. Fang Y, Zhang Y (2019) Wrist arthroplasty using an autogenous iliac crest for giant cell tumors of the distal radius: 9 cases of giant cell tumors (Campanacci grade III) of the distal radius. Int J Clin Exp Med 12(7):9413–9417

    Google Scholar 

  19. Gokaraju K, Sri-Ram K, Donaldson J, Parratt MTR, Blunn GW, Cannon SR et al (2009) Use of a distal radius endoprosthesis following resection of a bone tumour: a case report. Sarcoma 2009:1–5

    Article  Google Scholar 

  20. Yang YF, Wang JW, Huang P, Xu ZH (2016) Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord [Internet] 17(1):1–6

    CAS  Google Scholar 

  21. Gulia A, Puri A, Prajapati A, Kurisunkal V (2019) Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma 10(6):1033–1037

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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):2886–94. https://doi.org/10.1007/s11999-012-2464-7

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pazionis TJ, Alradwan H, Deheshi BM, Turcotte R, Farrokhyar F, Ghert M (2013) A systematic review and meta-analysis of en-bloc vs intralesional resection for giant cell tumor of bone of the distal radius. Open Orthop J 7(1):103–108

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cheng CY, Shih HN, Hsu KY, Hsu RWW (2001) Treatment of giant cell tumor of the distal radius. Clin Orthop Relat Res [Internet]. [cited 2022 Jun 3];383(383):221–8

  25. Khan MT, Gray JM, Carter SR, Grimer RJ, Tillman RM (2004) Management of the giant-cell tumours of the distal radius. Ann R Coll Surg Engl 86(1):18–24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Poudel RR, Tiwari A, Jain A, Verma V (2022) Salvaging the unsalvageable giant cell tumors of bone: the ‘longitudinal sandwich technique.’ Indian J Surg Oncol 6:1–6

    Google Scholar 

  27. Abuhejleh H, Wunder JS, Ferguson PC, Isler MH, Mottard S, Werier JA et al (2020) Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. Eur J Orthop Surg Traumatol 30(1):11–17

    Article  PubMed  Google Scholar 

  28. Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A et al (2008) Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Jt Surg 90(5):1060–1067

    Article  Google Scholar 

  29. 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(435):211–218

    Article  Google Scholar 

  30. Guedes A, Baptista PPR, Santili C, Yonamine ES, Garcia HRP, Martinez EC (2009) Wide resection and fibular transposition in the treatment of GCT on radius distal end. Acta Ortop Bras 17(3):171–181

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pushpanjali Cancer Care Institute, Agra, India

    Aakriti Jain

  2. Musculoskeletal Oncology Division, Department of Surgical Oncology, Max Institute of Cancer Care, Max Super Specialty Hospital, Press Enclave Road, Saket, New Delhi, India

    Anu Aggrawal & Akshay Tiwari

  3. Department of Radiology, Max Institute of Cancer Care, Max Super Specialty Hospital, Saket, New Delhi, India

    Amit Sahu

  4. Department of Pathology, Max Institute of Cancer Care, Max Super Specialty Hospital, Saket, New Delhi, India

    Riti Agarwal

Authors
  1. Aakriti Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anu Aggrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Sahu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Riti Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akshay Tiwari
    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

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, A., Aggrawal, A., Sahu, A. et al. Management of Giant Cell Tumor of Distal Radius—Does Curettage Work?. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-01952-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13193-024-01952-8

Keywords

Search

Navigation