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Which Treatment is the Best for Giant Cell Tumors of the Distal Radius? A Meta-analysis

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Clinical Orthopaedics and Related Research®

Abstract

Background

Intralesional excision and en bloc resection are used to treat giant cell tumors (GCTs) of the distal radius. However, it is unclear whether one provides lower rates of recurrences and fewer complications, and whether the use of polymethylmethacrylate (PMMA) after curettage reduces the risk of recurrence.

Questions/Purposes

We examined whether curettage was associated with lower rates of recurrence and fewer major complications compared with en bloc excision, and whether PMMA resulted in lower rates of recurrence compared with a bone graft.

Methods

We systematically searched the literature using the criteria, “giant cell tumor” AND “curettage” OR “intralesional excision” OR “resection”. Six relevant articles were identified that reported data for 80 curettage cases (PMMA, n = 49; bone graft, n = 26; no PMMA or bone grafts, n = 5) and 59 involving en bloc excision. A meta-analysis was performed using these data.

Results

Overall, patients in the intralesional excision group had a higher recurrence rate (relative risk [RR], 2.80; 95% CI, 1.17–6.71), especially for Campanacci Grade 3 GCTs (RR, 4.90; 95% CI, 1.36–17.66), yet fewer major complications (RR, 0.21; 95% CI, 0.09–0.54) than the en bloc resection group. The use of PMMA versus bone graft did not affect the recurrence rate (RR, 0.98; 95% CI, 0.44–2.17).

Conclusions

Based on data obtained from the limited number of studies available, intralesional excision appears to be more appropriate for the treatment of local lesions (eg, Grades 1 and 2) than Grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant.

Level of Evidence

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

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Acknowledgments

We thank Jie Ding MD and Mai Xu MD, who offered valuable support and help in the writing and revising this article.

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Authors and Affiliations

  1. Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China

    Yu-peng Liu MD, PhD, Kang-hua Li MD & Bu-hua Sun MD, PhD

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  1. Yu-peng Liu MD, PhD
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  2. Kang-hua Li MD
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  3. Bu-hua Sun MD, PhD
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Corresponding author

Correspondence to Kang-hua Li MD.

Additional information

This work was supported by the National 863 project of China (2011AA030101), the freedom explore program of Central South University (2012QNZT103), and National Clinical Key Department Construction Projects of China.

Each author certifies that he or she, or a member of their immediate family, 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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

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Liu, Yp., Li, Kh. & Sun, Bh. Which Treatment is the Best for Giant Cell Tumors of the Distal Radius? A Meta-analysis. Clin Orthop Relat Res 470, 2886–2894 (2012). https://doi.org/10.1007/s11999-012-2464-7

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  • DOI: https://doi.org/10.1007/s11999-012-2464-7

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