Abstract
Background
Giant-cell tumor (GCT) of bone is a common primary benign tumor with high local recurrence and potential distant metastasis or malignant transformation. We have investigated the clinical behavior of recurrent GCT of bone in the extremities.
Methods
We retrospectively reviewed 110 patients with recurrent GCTs of bone in the extremities treated by the Eastern Asian Musculoskeletal Oncology Group. The factors that affected the number of recurrences and distant metastasis were analyzed.
Results
The median interval between initial surgery and the first recurrence of GCT was 16 months (2–180 months). All patients received additional surgery for first recurrence. Twenty-five patients had a second recurrence and 6 patients had a third recurrence. The mean interval between the initial surgery and the first recurrence correlated with the eventual number of recurrences—14.1 months for the repeated recurrence groups (two and three recurrences) and 28.3 months for the single recurrence group (p = 0.016). Campanacci grade did not correlate with repeated recurrence (p = 0. 446). The venue of the initial surgery did not correlate with recurrence but did affect preservation of the adjacent joint (chi-squared test; p = 0.046). Campanacci grade II and III also correlated with sacrifice of the adjacent joint (p = 0.020). The incidence of lung metastasis and malignant transformation were 7.5% (8 out of 107 patients) and 2.7% (3 out of 110 patients), respectively. Repeat recurrence was associated with lung metastasis (p = 0.018).
Conclusions
Early local recurrence of GCT is a risk factor for repeat recurrence. Repeat recurrence also correlates with lung metastasis. Recurettage with meticulous adjuvant treatment to completely preclude recurrent lesions is a reasonable method for preserving the adjacent joint. However, a continuous careful follow-up is mandatory.
Similar content being viewed by others
References
Dahlin DC. Caldwell lecture. Giant cell tumor of bone: highlights of 407 cases. AJR Am J Roentgenol. 1985;144:955–60.
Eckardt JJ, Grogan TJ. Giant cell tumor of bone. Clin Orthop Relat Res. 1986;204:45–58.
Marcove RCA. 17-year review of cryosurgery in the treatment of bone tumors. Clin Orthop Relat Res. 1982;163:231–4.
Malawer MM, Dunham W. Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop Relat Res. 1991;262:42–57.
McDonald DJ, Sim FH, McLeod RA, Dahlin DC. Giant-cell tumor of bone. J Bone Jt Surg Am. 1986;68:235–42.
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Jt Surg Am. 1987;69:106–14.
Capanna R, Fabbri N, Bettelli G. Curettage of giant cell tumor of bone. The effect of surgical technique and adjuvants on local recurrence rate. Chir Organi Mov. 1990;75:206.
O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Jt Surg Am. 1994;76:1827–33.
Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res. 1995;321:245–50.
Ghert MA, Rizzo M, Harrelson JM, Scully SP. Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res. 2002;400:201–10.
Ward WG Sr, Li G 3rd. Customized treatment algorithm for giant cell tumor of bone: report of a series. Clin Orthop Relat Res. 2002;397:259–70.
Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002;397:248–58.
Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Jt Surg Am. 1970;52:619–64.
Larsson SE, Lorentzon R, Boquist L. 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 Jt Surg Am. 1975;57:167–73.
Rock MG, Pritchard DJ, Unni KK. Metastases from histologically benign giant-cell tumor of bone. J Bone Jt Surg Am. 1984;66:269–74.
Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res. 1994;302:219–30.
Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ. Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res. 2005;435:211–8.
Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK. Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. Am J Roentgenol. 1992;158:331–4.
Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jorgensen P, Follerås G, Rydholm A. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. J Bone Jt Surg Br. 2006;88:531–5.
Balke M, Ahrens H, Streitbuerger A, Koehler G, Winkelmann W, Gosheger G, Hardes J. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol. 2009;135:149–58.
Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Jt Surg Am. 2008;90:1060–7.
McGough RL, Rutledge J, Lewis VO, Lin PP, Yasko AW. Impact severity of local recurrence in giant cell tumor of bone. Clin Orthop Relat Res. 2005;438:116–22.
Campanacci M. Giant-cell tumor and chondrosarcomas: grading, treatment and results (studies of 209 and 131 cases). Recent Results Cancer Res. 1976;54:257–61.
Rock M. Curettage of giant cell tumor of bone. Factors influencing local recurrences and metastasis. Chir Organi Mov. 1990;75:204–5.
Tyler W, Barrett T, Frassica F, McCarthy E. Skin metastasis from conventional giant cell tumor of bone: conceptual significance. Skeletal Radiol. 2002;31:166–70.
Present DA, Bertoni F, Springfield D, Braylan R, Enneking WF. Giant cell tumor of bone with pulmonary and lymph node metastases. A case report. Clin Orthop Relat Res. 1986;209:286–91.
Brien EW, Mirra JM, Kessler S, Suen M, Ho JK, Yang WT. Benign giant cell tumor of bone with osteosarcomatous transformation (“dedifferentiated” primary malignant GCT): report of two cases. Skeletal Radiol. 1997;26:246–55.
Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer. 2003;97:2520–9.
Sakkers RJ, van der Heul RO, Kroon HM, Taminiau AH, Hogendoorn PC. Late malignant transformation of a benign giant-cell tumor of bone. A case report. J Bone Jt Surg Am. 1997;79:259–62.
Acknowledgments
The authors greatly appreciate Patrick P. Lin MD, for his valuable criticism and advice.
Conflict of interest
The authors indicate no potential conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Takeuchi, A., Tsuchiya, H., Niu, X. et al. The prognostic factors of recurrent GCT: a cooperative study by the Eastern Asian Musculoskeletal Oncology Group. J Orthop Sci 16, 196–202 (2011). https://doi.org/10.1007/s00776-011-0030-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-011-0030-x