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Giant Cell Tumor of Bone: Risk Factors for Recurrence

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Many surgeons treat giant cell tumor of bone (GCT) with intralesional curettage. Wide resection is reserved for extensive bone destruction where joint preservation is impossible or when expendable sites (eg, fibular head) are affected. Adjuvants such as polymethylmethacrylate and phenol have been recommended to reduce the risk of local recurrence after intralesional surgery. However, the best treatment of these tumors and risk factors for recurrence remain controversial.

Questions/purposes

We evaluated the recurrence-free survival after surgical treatment of GCT to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence.

Methods

We retrospectively reviewed 118 patients treated for benign GCT of bone between 1985 and 2005. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum followup was 36 months (mean, 108.4 ± 43.7; range, 36–233 months).

Results

Wide resection had a lower recurrence rate than intralesional surgery (5% versus 25%). Application of polymethylmethacrylate decreased the risk of local recurrence after intralesional surgery compared with bone grafting; phenol application alone had no effect on the risk of recurrence. Pulmonary metastases occurred in 4%; multidisciplinary treatment including wedge resection, chemotherapy, and radiotherapy achieved disease-free survival or stable disease in all of these patients.

Conclusion

We recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. Because pulmonary metastases are rare and aggressive treatment of pulmonary metastases is usually successful, we believe the potential for metastases should not by itself create an indication for wide resection of primary tumors.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Frank M. Klenke MD, PhD, Peter S. Rose MD & Franklin H. Sim MD

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Doris E. Wenger MD

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Carrie Y. Inwards MD

Authors
  1. Frank M. Klenke MD, PhD
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  2. Doris E. Wenger MD
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  3. Carrie Y. Inwards MD
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  4. Peter S. Rose MD
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  5. Franklin H. Sim MD
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Correspondence to Franklin H. Sim MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Klenke, F.M., Wenger, D.E., Inwards, C.Y. et al. Giant Cell Tumor of Bone: Risk Factors for Recurrence. Clin Orthop Relat Res 469, 591–599 (2011). https://doi.org/10.1007/s11999-010-1501-7

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  • DOI: https://doi.org/10.1007/s11999-010-1501-7

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