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Giant Cell Tumor of Bone: Are We Stratifying Results Appropriately?

  • Symposium: 2010 Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There is no consensus as to which surgical approach to the treatment of giant cell tumor of bone is most appropriate or which patients are at a higher risk for recurrence or metastasis.

Questions/purposes

Therefore, we asked: (1) Are there subsets of patients who are associated with a more recalcitrant disease course? And (2) are surgeons appropriately stratifying patients by identifying risk factors for increased local recurrence and pulmonary metastases?

Methods

We retrospectively reviewed the records of 230 patients with giant cell tumor of bone treated from 1980 to 2010, stratifying them by primary versus recurrent disease and by surgical treatment. From the records, we determined local recurrence, metastatic disease, and complications of treatment. The median follow up was 47 months (range, 0.1–312 months).

Results

Overall incidence of local recurrence was 10% and pulmonary metastasis was 2%. When stratified by surgical treatment, the incidence of local recurrence among patients undergoing intralesional curettage (12%) was greater than in those undergoing resection (2%). The incidence of local recurrence among primary tumors, independent of treatment, was 9%, whereas the incidence of local recurrence after treatment of recurrent lesions was 16%. The incidence of pulmonary metastases was similar, regardless of treatment or whether primary or recurrent.

Conclusions

Our observations suggest there are subsets of patients with giant cell tumor of bone who are at higher risk of recurrence and should be clinically followed more closely. This should allow surgeons to provide patients with more informed expectations.

Level of Evidence

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

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Acknowledgements

The authors thank the UCLA Mathematics Department for their assistance with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California Los Angeles Medical Center, Box 956902, 76-143 CHS, Los Angeles, CA, USA

    Thomas J. Kremen Jr MD, Nicholas M. Bernthal MD & Jeffrey J. Eckardt MD

  2. Department of Hematology and Oncology, University of California, Los Angeles, CA, USA

    Mark A. Eckardt BS

Authors
  1. Thomas J. Kremen Jr MD
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  2. Nicholas M. Bernthal MD
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  3. Mark A. Eckardt BS
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  4. Jeffrey J. Eckardt MD
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Corresponding author

Correspondence to Thomas J. Kremen Jr 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, and that informed consent for participation in the study was obtained.

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Kremen, T.J., Bernthal, N.M., Eckardt, M.A. et al. Giant Cell Tumor of Bone: Are We Stratifying Results Appropriately?. Clin Orthop Relat Res 470, 677–683 (2012). https://doi.org/10.1007/s11999-011-2172-8

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  • DOI: https://doi.org/10.1007/s11999-011-2172-8

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