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Recurrent Giant Cell Tumor of Long Bones: Analysis of Surgical Management

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

Abstract

Background

Treatment of giant cell tumor of bone (GCT) often is complicated by local recurrence. Intralesional curettage is the standard of care for primary GCTs. However, there is controversy whether intralesional curettage should be preferred over wide resection in recurrent GCTs.

Questions/purposes

We investigated the rerecurrence-free survival after surgical treatment of recurrent GCTs to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of further recurrence.

Patients and Methods

We retrospectively reviewed the medical records of 46 patients with recurrent GCTs of long bones treated with wide resection or intralesional curettage and compared these cohorts. Recurrence rates, risk factors for recurrence, and the development of pulmonary metastases were determined. The minimum followup was 37 months (mean, 134 months; range, 37–337 months).

Results

The rate of rerecurrence after wide resection was 6%. Intralesional curettage showed an overall rerecurrence rate of 32%. Implantation of polymethylmethacrylate (PMMA) instead of bone grafting was associated with a lower risk of subsequent recurrence in intralesional procedures (14% versus 50%). Extracompartmental disease did not increase the risk of rerecurrence. Pulmonary metastases occurred in seven patients and appeared independent of the surgical treatment modality chosen.

Conclusions

Intralesional curettage with methylmethacrylate for recurrent GCT provided equivalent tumor control compared with resection in this retrospective study. If joint salvage is possible, we advocate this treatment over resection in recurrent GCTs to preserve the native joint articulation.

Level of Evidence

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

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Acknowledgments

We thank Krishnan K. Unni (KKU) for work on the histologic evaluation of the surgical specimens.

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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 Anatomical 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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Corresponding author

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 approved the human protocol for this investigation, 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. Recurrent Giant Cell Tumor of Long Bones: Analysis of Surgical Management. Clin Orthop Relat Res 469, 1181–1187 (2011). https://doi.org/10.1007/s11999-010-1560-9

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  • DOI: https://doi.org/10.1007/s11999-010-1560-9

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