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Spierenburg G, Staals EL, Palmerini E, Randall RL, Thorpe SW, Wunder JS, Ferguson PC, Verspoor FGM, Houdek MT, Bernthal NM, Schreuder BHWB, Gelderblom H, van de Sande MAJ, van der Heijden L. Active surveillance of diffuse-type tenosynovial giant cell tumors: A retrospective, multicenter cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107953. [PMID: 38215550 DOI: 10.1016/j.ejso.2024.107953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a mono-articular, soft-tissue tumor. Although it can behave locally aggressively, D-TGCT is a non-malignant disease. This is the first study describing the natural course of D-TGCT and evaluating active surveillance as possible treatment strategy. METHODS This retrospective, multicenter study included therapy naïve patients with D-TGCT from eight sarcoma centers worldwide between 2000 and 2019. Patients initially managed by active surveillance following their first consultation were eligible. Data regarding the radiological and clinical course and subsequent treatments were collected. RESULTS Sixty-one patients with primary D-TGCT were initially managed by active surveillance. Fifty-nine patients had an MRI performed around first consultation: D-TGCT was located intra-articular in most patients (n = 56; 95 %) and extra-articular in 14 cases (24 %). At baseline, osteoarthritis was observed in 13 patients (22 %) on MRI. Most of the patients' reported symptoms: pain (n = 43; 70 %), swelling (n = 33; 54 %). Eight patients (13 %) were asymptomatic. Follow-up data were available for 58 patients; the median follow-up was 28 months. Twenty-one patients (36 %) had radiological progression after 21 months (median). Eight of 45 patients (18 %) without osteoarthritis at baseline developed osteoarthritis during follow-up. Thirty-seven patients (64 %) did not clinically deteriorate during follow-up. Finally, eighteen patients (31 %) required a subsequent treatment. CONCLUSION Active surveillance can be considered adequate for selected therapy naïve D-TGCT patients. Although follow-up data was limited, almost two-thirds of the patients remained progression-free, and 69 % did not need treatment during the follow-up period. However, one-fifth of patients developed secondary osteoarthritis. Prospective studies on active surveillance are warranted.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - Eric L Staals
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuela Palmerini
- Osteooncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Robert Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA, USA
| | - Jay S Wunder
- Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Floortje G M Verspoor
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Matthew T Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, CA, USA
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
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