1
|
Apostolopoulos V, Boháč P, Marcián P, Zambo IS, Pazourek L, Mahdal M, Neradil J, Návrat T, Tomáš T. Micro-CT, Mechanical, and Histological Examination of the Effect of Local Adjuvants on Porcine Cortical Bone Following Intralesional Curettage of Bone Tumors. Ann Surg Oncol 2024; 31:6282-6290. [PMID: 38743283 PMCID: PMC11300566 DOI: 10.1245/s10434-024-15397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Curettage is the removal of a tumor from the bone while preserving the surrounding healthy cortical bone, and is associated with higher rates of local recurrence. To lower these rates, curettage should be combined with local adjuvants, although their use is associated with damage to nearby healthy bone. OBJECTIVE The purpose of this analysis is to determine the effect of local adjuvants on cortical porcine bone by using micro-computed tomography (micro-CT) along with histological and mechanical examination. METHODS Local adjuvants were applied to porcine specimens under defined conditions. To assess changes in bone mineral density (BMD), a micro-CT scan was used. The pixel gray values of the volume of interest (VOI) were evaluated per specimen and converted to BMD values. The Vickers hardness test was employed to assess bone hardness (HV). The depth of necrosis was measured histologically using hematoxylin and eosin-stained tissue sections. RESULTS A noticeable change in BMD was observed on the argon beam coagulation (ABC) sample. Comparable hardness values were measured on samples following electrocautery and ABC, and lowering of bone hardness was obtained in the case of liquid nitrogen. Extensive induced depth of necrosis was registered in the specimen treated with liquid nitrogen. CONCLUSION This study determined the effect of local adjuvants on cortical bone by using micro-CT along with histological and mechanical examination. Phenolization and liquid nitrogen application caused a decrease in bone hardness. The bone density was affected in the range of single-digit percentage values. Liquid nitrogen induced extensive depth of necrosis with a wide variance of values.
Collapse
Affiliation(s)
- Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Boháč
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Iva Staniczkova Zambo
- First Department of Pathology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Jakub Neradil
- Laboratory of Tumor Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Tomáš Návrat
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
| |
Collapse
|
2
|
Todi N, Hiltzik DM, Moore DD. Giant cell tumor of bone and secondary osteoarthritis. Heliyon 2024; 10:e30890. [PMID: 38807896 PMCID: PMC11130671 DOI: 10.1016/j.heliyon.2024.e30890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
Giant cell tumor of bone is a commonly encountered aggressive epiphyseal bone tumor, most often treated surgically. The natural history and presentation are classically described but the histopathology is poorly understood. Intralesional curettage is the mainstay of treatment, but there is significant variation in the use of adjuvant and cavity filling modalities. No gold standard has been agreed upon for treatment, and a variety of techniques are currently in use. Given its location, secondary osteoarthritis is a known long-term complication. This review examines the natural history of giant cell tumors, treatment options and complications, and subsequent development of osteoarthritis. Arthroplasty is usually indicated for secondary osteoarthritis although data is limited on its efficacy. Further directions will likely center on improved pharmacological treatments as well as improved arthroplasty techniques.
Collapse
Affiliation(s)
- Niket Todi
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - David M. Hiltzik
- Northwestern University, Department of Orthopaedic Surgery, 303 E Superior St, Chicago, IL, 60611, USA
| | - Drew D. Moore
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, Department of Orthopaedic Surgery, 586 Pioneer Dr, Rochester, MI, 48309, USA
| |
Collapse
|
3
|
Bakarman KA. Diagnosis and Current Treatment of Aneurysmal Bone Cysts. Cureus 2024; 16:e53587. [PMID: 38449944 PMCID: PMC10915701 DOI: 10.7759/cureus.53587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.
Collapse
|
4
|
Schoutens C, Verspoor FG. Heat treatment for giant cell tumors of bone: A systematic review. J Orthop Surg (Hong Kong) 2023; 31:10225536231202157. [PMID: 37726111 DOI: 10.1177/10225536231202157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
This systematic review evaluates the effects of heat treatments in de novo, residual and recurrent giant cell tumors of bone (GCTB). Studies were eligible for inclusion if one of the following treatments was administered: radiofrequency ablation (RFA), microwave ablation, argon cauterization, electrocauterization and hot liquid treatment. The primary outcome was recurrence. Secondary outcomes were complications, pain, function, and quality of life. Recurrence rates for microwave ablation as an adjuvant to intralesional curettage were 0%, 4% and 10% (3 retrospective single-group studies); for argon cauterization 4%, 8% and 26% (3 cohort studies); electrocauterization 0% to 33% (8 cohort studies); and hot liquid 9.5% and 24% (2 cohort studies). Follow-up was generally ≥24 months. Data on pain, function and quality of life were scarce. Complications included infection and secondary osteoarthritis. Current evidence does not demonstrate or exclude an effect of heat treatments on recurrence in GCTB. Further research should objectify if (subgroups of) patients benefit from these treatments.
Collapse
Affiliation(s)
- Carlijn Schoutens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Floortje Gm Verspoor
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Aoude A, Nikomarov D, Perera JR, Ibe IK, Griffin AM, Tsoi KM, Ferguson PC, Wunder JS. Giant cell tumour of bone. Bone Joint J 2023; 105-B:559-567. [PMID: 37121582 DOI: 10.1302/0301-620x.105b5.bjj-2022-1231.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Giant cell tumour of bone (GCTB) is a locally aggressive lesion that is difficult to treat as salvaging the joint can be associated with a high rate of local recurrence (LR). We evaluated the risk factors for tumour relapse after treatment of a GCTB of the limbs. A total of 354 consecutive patients with a GCTB underwent joint salvage by curettage and reconstruction with bone graft and/or cement or en bloc resection. Patient, tumour, and treatment factors were analyzed for their impact on LR. Patients treated with denosumab were excluded. There were 53 LRs (15%) at a mean 30.5 months (5 to 116). LR was higher after curettage (18.4%) than after resection (4.6%; p = 0.008). Neither pathological fracture (p = 0.240), Campanacci grade (p = 0.734), soft-tissue extension (p = 0.297), or tumour size (p = 0.872) affected the risk of recurrence. Joint salvage was possible in 74% of patients overall (262/354), and 98% after curettage alone (262/267). Of 49 patients with LR after curettage, 44 (90%) underwent repeated curettage and joint salvage. For patients treated by curettage, only age less than 30 years (p = 0.042) and location in the distal radius (p = 0.043) predicted higher LR. The rate of LR did not differ whether cement or bone graft was used (p = 0.753), but may have been reduced by the use of hydrogen peroxide (p = 0.069). Complications occurred in 15.3% of cases (54/354) and did not differ by treatment. Most patients with a GCTB can undergo successful joint salvage by aggressive curettage, even in the presence of a soft-tissue mass, pathological fracture, or a large lesion, with an 18.4% risk of local recurrence. However, 90% of local relapses after curettage can be treated by repeat joint salvage. Maximizing joint salvage is important to optimize long-term function since most patients with a GCTB are young adults. Younger patients and those with distal radius tumours treated with joint-sparing procedures have a higher rate of local relapse and may require more aggressive treatment and closer follow-up.
Collapse
Affiliation(s)
- Ahmed Aoude
- Orthopedics Spine and Oncology, Montreal General Hospital, McGill University, Montreal, Canada
| | - David Nikomarov
- Musculoskeletal Oncology Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan R Perera
- Orthopaedic Oncology, Royal National Orthopaedic Hospital, London, UK
| | - Izuchukwu K Ibe
- Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anthony M Griffin
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Kim M Tsoi
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Kumar S, Nandan B, Chauhan R, Dhawan M, Agrawal S, Rivi S. Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases. Rev Bras Ortop 2023; 58:211-221. [PMID: 37252308 PMCID: PMC10212629 DOI: 10.1055/s-0042-1742600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
Objective Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage. Methods We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint. Results Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18-30). Conclusion Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb.
Collapse
Affiliation(s)
- Sumedh Kumar
- Departamento de Ortopedia, Hospital Sir Ganga Ram, Nova Delhi, Índia
| | - Brajesh Nandan
- Departamento de Ortopedia, Hospital Sir Ganga Ram, Nova Delhi, Índia
| | - Ravi Chauhan
- Departamento de Ortopedia, Hospital Sir Ganga Ram, Nova Delhi, Índia
| | - Manish Dhawan
- Departamento de Ortopedia, Hospital Sir Ganga Ram, Nova Delhi, Índia
| | - Siddharth Agrawal
- Departamento de Ortopedia, Hospital Sir Ganga Ram, Nova Delhi, Índia
| | - Sijal Rivi
- Departamento de Ortopedia, Hospital Sir Ganga Ram, Nova Delhi, Índia
| |
Collapse
|
7
|
Wang Y, Shao P, Tian Q, Li H, Li J, Ren P, Lv Z, Lv J, Bai J, Feng Y. 'Triple clear': a systematic and comprehensive surgical process for Campanacci grades II and III giant cell tumors of the bone, with or without pathological fracture and slight joint invasion. World J Surg Oncol 2023; 21:114. [PMID: 36978172 PMCID: PMC10053671 DOI: 10.1186/s12957-023-02982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In recent years, researchers have proposed a number of adjuvant methods for extended curettage of giant cell tumors of the bone. However, various schemes have significant differences in efficacy and safety. Therefore, this article will describe an empirical expanded curettage protocol, 'triple clear', in detail to show the effect of the efficient surgical protocol. METHOD Patients with Campanacci grades II and III primary GCTB who were treated with either SR (n = 39) or TC (n = 41) were included. Various perioperative clinical indicators, including the therapy modality, operation time, Campanacci grade, and filling material were recorded and compared. The pain level was determined by the visual analog scale. Limb function was determined by the Musculoskeletal Tumour Society (MSTS) score. Follow-up time, recurrence rates, reoperation rates, and complication rates were also recorded and compared. RESULT The operation time was 135.7 ± 38.4 min in the TC group and 174.2 ± 43.0 min in the SR group (P < 0.05). The recurrence rates were 7.3% in the TC group and 8.3% in the SR group (P = 0.37). The MSTS scores at three months after surgery were 19.8 ± 1.5 in the TC group and 18.8 ± 1.3 in the SR group. The MSTS scores at two years were 26.2 ± 1.2 in the TC group and 24.3 ± 1.4 in the SR group (P < 0.05). CONCLUSION TC is recommended for patients with Campanacci grade II-III GCTB and for those with a pathological fracture or slight joint invasion. Bone grafts may be more suitable than bone cement in the long term.
Collapse
Affiliation(s)
- Yushan Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Pengfei Shao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Qiaoqiao Tian
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Haoze Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Jian Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Peng Ren
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Zhi Lv
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Jia Lv
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Junjun Bai
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China
| | - Yi Feng
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 of 51 Road, Taiyuan, Shanxi, China.
| |
Collapse
|
8
|
Tuntarattanapong P, Piakong P, Chobpenthai T, Sukanthanak B, Kiatisevi P. Comparing clinical outcomes between extended curettage and wide resection in Enneking stage 3 giant cell tumor of bone. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:135-142. [PMID: 34820742 DOI: 10.1007/s00590-021-03168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Our objectives were (1) to compare the recurrence, metastases, and complication rates of patients with Enneking stage 3 GCTB who underwent extended curettage vs wide resection and (2) examine the factors which might influence surgical options for each patient. METHODS We retrospectively reviewed the records of patients with Enneking stage 3 GCTB from January 2006-December 2015. Extended curettage was performed in patients in whom there was a moderate expansile lesion, minimal/no articular cartilage damage, and less than 50% of cortical deformation compared to its circumference from a CT scan/MRI. The percentages of cortical deformation were collected. Surgical complications, recurrence, and metastatic rates were analyzed. RESULTS There were 28 extended curettage and 41 wide resections. The mean percentages of cortical deformation compared to circumference were 52.6% (range, 23.9-81.9%) and 91.6% (range, 52.1-100%)(P < 0.01) for the curettage and wide resection groups, respectively. There were three recurrences, 2/28 (7.1%) from the curettage group and 1/41 (2.4%) from the resection group (P = 0.56). There were no cases of pulmonary metastasis. There were two complications in the curettage group and five complications in the resection group. CONCLUSION Both extended curettage and wide resection are useful methods to treat Enneking stage 3 GCTB. Extended curettage with proper technique is a viable option showing no difference in local recurrence rate and potentially fewer complications. Preference to do extended curettage in patients in whom when the articular cartilage has minimal or no destruction, a moderate expansile lesion and the cortical deformation is less than 50% of the circumference.
Collapse
Affiliation(s)
- Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pongsiri Piakong
- Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand
| | - Thanapon Chobpenthai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Bhasanan Sukanthanak
- Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand
| | - Piya Kiatisevi
- Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand.
| |
Collapse
|
9
|
Martin JR, Auran RL, Duran MD, de Comas AM, Jacofsky DJ. Management of Primary Aggressive Tumors of the Knee. J Knee Surg 2022; 35:585-596. [PMID: 35181876 DOI: 10.1055/s-0042-1743221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary bone sarcomas and aggressive benign bone tumors are relatively rare. It is essential to recognize features that are concerning for these aggressive tumors based on a patient's history, physical exam, and radiographs. Physicians and other health care providers should have a high suspicion for these tumors and promptly refer these patients to orthopaedic oncologists. A multidisciplinary, team-based approach is required to obtain an accurate diagnosis and provide comprehensive care. This review discussed the appropriate work-up, biopsy principles, relevant peri-operative medical management, and surgical treatment options for patients with aggressive primary bone tumors around the knee. Primary bone sarcomas (osteosarcoma and chondrosarcoma) and aggressive benign bone tumors (giant cell tumor, chondroblastoma, and chondromyxoid fibroma) that have a predilection to the distal femur and proximal tibia are the focus of this review.
Collapse
Affiliation(s)
- John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| |
Collapse
|
10
|
Yenigül AE, Sofulu Ö, Erol B. Treatment of locally aggressive benign bone tumors by means of extended intralesional curettage without chemical adjuvants. SAGE Open Med 2022; 10:20503121221094199. [PMID: 35481245 PMCID: PMC9036382 DOI: 10.1177/20503121221094199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives: The aim of this study is to present the clinical, oncological, and functional results of locally aggressive benign bone tumors treated with extended intralesional curettage without the use of adjuvant in a tertiary orthopedic oncology center. Method: A total of 172 patients treated with surgical curettage and high-speed burrs for the diagnosis of aneurysmal bone cyst, giant cell tumor, osteoblastoma, chondroblastoma, and chondromyxoid fibroma were included in the study. Demographic, radiological, and clinical data of the patients were analyzed. Results: One-hundred seventy two patients (101 (59%) female and 71 (41%) male) with a mean age of 23 years (6–84). The mean follow-up period was 48 months (18–108). In the study, a total of 8 (4.6%) patients had postoperative complications, 17 (9.9%) patients had recurrence in the postoperative period. Diameter greater than 5 cm was found to be a risk factor for recurrence (p < 0.004). The probability of developing complications was found to be significantly higher in patients with recurrence (p < 0.001). There was no significant relationship between recurrence and age, tumor type, and tumor stage. Conclusion: Successful treatment results can be obtained with extended surgical curettage, high-speed burr, and cauterization without the use of chemical adjuvants in locally aggressive bone tumors.
Collapse
Affiliation(s)
- Ali Erkan Yenigül
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ömer Sofulu
- Department of Orthopedics and Traumatology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Bülent Erol
- Department of Orthopedics and Traumatology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
11
|
Nagano A, Urakawa H, Tanaka K, Ozaki T. Current management of giant-cell tumor of bone in the denosumab era. Jpn J Clin Oncol 2022; 52:411-416. [PMID: 35199172 DOI: 10.1093/jjco/hyac018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/14/2022] Open
Abstract
Giant-cell tumor of bone is a rare, locally aggressive and rarely metastasizing primary bone tumor. The mainstay of treatment remains controversial and is decided by the balance between adequate surgical margin and sufficient adjacent joint function. Although curettage with a high-speed burr and local adjuvants can maintain normal joint function, many reports have revealed a high local recurrence rate. Conversely, en bloc resection and reconstruction with prostheses for highly aggressive lesions have reportedly lower local recurrence rates and poorer functional outcomes. Denosumab-a full human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa β ligand-was approved by the Food and Drug Authority in 2013 for use in surgically unresectable or when resection is likely to result in severe morbidity for skeletally mature adolescents and adults with giant-cell tumor of bone. However, subsequent studies have suggested that the local recurrence rate would be increased by preoperative use of denosumab. In systematic reviews of the local recurrence rate after preoperative use of denosumab, conclusions vary due to the small sample sizes of the studies reviewed. Therefore, controversy regarding the treatment of giant-cell tumor of bone is ongoing. Here, this review elucidates the management of giant-cell tumor of bone, especially with the local adjuvant and neoadjuvant use of denosumab, and presents the current, evidence-based treatment for giant-cell tumor of bone.
Collapse
Affiliation(s)
- Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Hospital, Aichi, Japan
| | - Kazuhiro Tanaka
- Department of Endoprosthetic Surgery, Oita University, Yufu, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
12
|
Reconstruction and repair, using mini-plate and bone graft for persons living with HIV with giant cell tumor of long bone: retrospective analysis of a single-center experience. AIDS Res Ther 2021; 18:82. [PMID: 34727929 PMCID: PMC8565052 DOI: 10.1186/s12981-021-00406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the effect of reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone. Methods We conducted a retrospective analysis of 12 HIV positive patients with giant cell tumor of long bone. A non-HIV-positive cohort of patients, matched for age, sex, and disease type, was selected as the control group. From June 2012 to August 2020, curettage by ultrasonic scalpel was performed in all patients, combined with min- plate and bone graft treatment. All patients were followed- up for 18 to 60 months. Limb function was evaluated, using the MSTS93 scoring system, and any examples of postoperative recurrence, distant metastasis, complications, MSTS93 score, and fracture prognosis were recorded. Results The mean age of HIV group was 43.5 years. The ratio of men to women was 11: 1. In all cases the histopathological diagnosis was clear, except the patients with primary malignant giant cell tumor of bone, including five, three, two, and two cases in the proximal tibia, distal femur, distal tibia, and talus, respectively. Following their surgery, all patients were followed up with an average of 31.24 ± 11.84 months. No local recurrence or pulmonary metastases were observed. Post-surgery, all the 12 patients showed good bone morphologic repair and reconstruction, good bone healing, good joint function, and no pathological fractures around their lesion. In the HIV group, one case of giant cell tumor in the proximal tibia showed mild articular surface collapse and mild valgus deformity of the knee joint but retained good joint function. The MSTS scores of excellent or good in the two groups comprised 83.3%, thus, there was no significant difference between them (P > 0.05). Compared with preoperatively, the MSTS scores in the HIV group were significantly improved, ranging from 7 to 11 points preoperatively to 24 to 27 points postoperatively; this difference was statistically significant (P < 0.05). Conclusion Reconstruction and repair, using a mini-plate and bone graft for HIV -positive patients with giant cell tumor of long bone can achieve satisfactory results. The mini- plate requires little space and is flexible during reconstruction and fixation, significantly reducing complications such as surgical site infection, as well as preserving joint function and avoiding amputation; therefore, it is a safe and effective treatment method.
Collapse
|
13
|
Wang Y, Tian Q, Wu C, Li H, Li J, Feng Y. Management of the Cavity After Removal of Giant Cell Tumor of the Bone. Front Surg 2021; 8:626272. [PMID: 34395504 PMCID: PMC8358324 DOI: 10.3389/fsurg.2021.626272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To find out the most appropriate management scheme through the analysis and comparison of different inactivation methods and filling materials. Method: A systematic literature search was performed using the terms, anhydrous ethanol, phenol, hypertonic saline, cryotherapy, thermal therapy, bone reconstruction, GCTB, and etc., Selected articles were studied and summarized. The mechanism, clinical effects, and influence on bone repair of various methods are presented. Recent developments and perspectives are also demonstrated. Recent Findings: Compared to curettage alone, management of the residual cavity can effectively reduce the recurrence of giant cell tumours of bone. It is a complex and multidisciplinary process that includes three steps: local control, cavity filling, and osteogenic induction. In terms of local control, High-speed burring can enlarge the area of curettage but may cause the spread and planting of tumour tissues. Among the inactivation methods, Anhydrous ethanol, and hyperthermia therapy are relatively safe and efficient. The combination of the two may achieve a better inactivation effect. When inactivating the cavity, we need to adjust the approach according to the invasion of the tumour. Filling materials and bone repair should also be considered in management.
Collapse
Affiliation(s)
- Yushan Wang
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiaoqiao Tian
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chenyang Wu
- Department of Computer & Information Technology, Shanxi University, Taiyuan, China
| | - Haoze Li
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Li
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Feng
- Orthopedics Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
14
|
Kellish AS, Qureshi M, Mostello A, Kim TW, Gutowski CJ. "Dry Arthroscopy" is a Valuable Tool in the Excisional Curettage of Chondroblastoma: A Case Series. J Orthop Case Rep 2021; 11:82-86. [PMID: 34141649 PMCID: PMC8046466 DOI: 10.13107/jocr.2021.v11.i01.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Chondroblastomas are benign, locally aggressive bone tumors that occur in the epiphysis of young patients, requiring surgical excision. The anatomic locations of these lesions pose technical challenges to the surgeon; their proximity to the articular surface and the physis make surgical approach and visualization difficult. This case series describes the use of intramedullary arthroscopic assistance during excisional curettage of three distal femoral chondroblastomas. Case Report: Three patients with distal femoral chondroblastomas underwent excisional curettage with intraosseous “dry” arthroscopic assistance. We describe a two-tunnel technique, using medial and lateral windows so the arthroscope and working instruments could be within the lesion simultaneously; as well as two variations of a single-tunnel technique. Conclusion: Achieving adequate exposure and visualization, while protecting the articular surface and physis, during excision of chondroblastomas, is essential for avoiding local recurrence and complications. “Dry” arthroscopic assistance provides the surgeon with an enhanced view of the tumor and tumor cavity, minimizes invasiveness, and has the potential to reduce complications without compromising the completeness of the excision.
Collapse
Affiliation(s)
- Alec S Kellish
- Cooper Medical School of Rowan University, 401 Broadway, Camden, New Jersey
| | - Mahir Qureshi
- Cooper Medical School of Rowan University, 401 Broadway, Camden, New Jersey
| | - Andrew Mostello
- Department of Orthopaedics, University Hospital, Newark, New Jersey
| | - Tae Won Kim
- Department of Orthpaedics, Cooper University Hospital, Camden, New Jersey
| | | |
Collapse
|
15
|
Macwan AA, Nanda SN, Mishra D, Tuteja S, Sandeep B. A Giant Cell Tumor of the Distal Femur Managed by Excision and Knee Arthrodesis Using a Custom Made Long Intramedullary Interlocking Nail: A Case Report and Review of the Literature. Cureus 2021; 13:e14810. [PMID: 34123605 PMCID: PMC8191858 DOI: 10.7759/cureus.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Giant cell tumors (GCTs) are primary bone tumors that occur most commonly in long bones, with half such tumors occurring in the distal femur, proximal tibia, and fibula. Around 12% of patients present with a pathological fracture indicating more aggressive disease. Arthrodesis after tumor resection is a popular choice due to its affordability and early postoperative mobilization, as well as low risks of implant loosening, infections, malignant lesions, or mortality. A free fibular graft is a popular option in limb-sparing surgery for long bone tumors. A bone graft and nail can be used to reconstruct long bones and bridge defects up to 25 cm. In developing countries, the cost of the imported mega prosthesis, around 8,500 US$, means many patients cannot afford the treatment. We describe a case of a GCT of the distal femur treated by excision of the tumor and reconstruction using a fibular bone graft, with knee arthrodesis using a custom-made long intramedullary interlocking nail fixation across the femur to the knee and the tibia. The length was achieved with 1 cm shortening post-surgery. The result was satisfactory, and partial weight-bearing was allowed three months after the surgery. At the one-year follow-up, there was no recurrence, and the patient had the full weight-bearing ability.
Collapse
Affiliation(s)
| | - Saurav N Nanda
- Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Debashish Mishra
- Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Saurabh Tuteja
- Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Bodanapu Sandeep
- Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| |
Collapse
|
16
|
Bombardier B, Haase D, Sweeney K, Friedman E, Poppe T, Hughes N. A comparison of depth of necrosis among adjuvant therapies used for the treatment of benign bone tumors. J Surg Oncol 2021; 123:1299-1303. [PMID: 33524202 DOI: 10.1002/jso.26397] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Benign bone tumors are often treated with extended curettage utilizing an adjuvant therapy to eliminate any remaining tumor cells. The purpose of this study was to explore and compare the histologic depth of necrosis created by various adjuvant therapies used in the treatment of benign bone tumors. METHODS A high-speed burr was utilized to create cortical defects within porcine humeri and femora. Phenol, polymethyl methacrylate (PMMA), argon beam coagulation (ABC), liquid nitrogen, and the Bipolar Hemostatic Sealer (BHS) were each applied to five defects, with an additional five defects left untreated as a control. The maximal depth of necrosis was determined under microscopic examination. RESULTS The phenol, PMMA, ABC, liquid nitrogen, and BHS demonstrated an average histologic depth of necrosis of 0.30, 0.78, 2.54, 2.54, and 0.92 mm, respectively, each of which was significantly increased compared to the control group (p = .001, .003, .003, .01, and <.001). Their respective variances, a measure of reproducibility, were 0.01, 0.09, 0.96, 1.93, and 0.03 mm2 . CONCLUSION This study confirms, through histologic analysis, adjuvant therapies create a rim of cellular necrosis beyond that of burring during extended curettage, supporting their use in the treatment of benign bone tumors. Furthermore, it provides a head-to-head comparison.
Collapse
Affiliation(s)
| | - Douglas Haase
- The University of Kansas Medical Center, Kansas, USA
| | - Kyle Sweeney
- The University of Kansas Medical Center, Kansas, USA
| | | | - Tanner Poppe
- The University of Kansas Medical Center, Kansas, USA
| | - Nicole Hughes
- The University of Kansas Medical Center, Kansas, USA
| |
Collapse
|
17
|
To YH, Orme L, Lewin J. The Role of Systemic Therapies in the Management of Bone Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
18
|
Machak GN, Snetkov AI. The impact of curettage technique on local control in giant cell tumour of bone. INTERNATIONAL ORTHOPAEDICS 2020; 45:779-789. [PMID: 33094400 DOI: 10.1007/s00264-020-04860-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although consensus has been reached regarding the main aspects of intralesional surgery for giant cell tumour of the bone (GCTB), debates continue about the most effective combination of local adjuvants. The purpose of study was to analyze the previous experience and determine the most effective curettage approach for GCTB. METHODS We summarized the findings from 89 papers published from 1962 to 2020 related to this subject. Database consisted of 137 treated groups that included 6441 patients who underwent different curettage techniques without pre-operative administration of bisphosphonates or RANKL inhibitors. RESULTS Recurrence rates after simple curettage ranged between 27 and 82% with a median value at 47%. The use of one or two local adjuvants reduced the incidence of recurrences approximately by 50% when compared with simple curettage. High-speed burring combined with chemical adjuvants or followed by poly(methyl methacrylate) cementation with or without bone grafting further improved the local control leading to good and excellent results; however, these were not documented in all studies. Simultaneous use of burring, chemical adjuvants, and cementation, which we named here as combined curettage, allowed to down local relapses to the range of 0-26%, with a median at 11%. Oncologic outcomes after combined curettage are significantly better when compared with simple curettage (p < 0.0001) and other variants of enhancement (p = 0.001). CONCLUSIONS Combined curettage appears to provide the most potent and comprehensive impact on residual tumour cells located in risk zones. This approach should be considered for locally advanced tumours when function-preserving surgery is planned. Additional comparative studies are required to define the optimal curettage enhancement for each individual patient.
Collapse
Affiliation(s)
- Gennady N Machak
- Priorov Central Institute for Traumatology and Orthopedics, Moscow, Russian Federation.
| | - Andrey I Snetkov
- Priorov Central Institute for Traumatology and Orthopedics, Moscow, Russian Federation
| |
Collapse
|
19
|
Bickels J, Campanacci DA. Local Adjuvant Substances Following Curettage of Bone Tumors. J Bone Joint Surg Am 2020; 102:164-174. [PMID: 31613863 DOI: 10.2106/jbjs.19.00470] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, The Technion, Israel
| | - Domenico A Campanacci
- Unit of Orthopaedic Oncology, Department of Health Sciences, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| |
Collapse
|
20
|
Bisphosphonate-loaded Bone Cement as a Local Adjuvant Therapy for Giant Cell Tumor of Bone: A 1 to 12-Year Follow-up Study. Am J Clin Oncol 2019; 42:231-237. [PMID: 30811352 DOI: 10.1097/coc.0000000000000504] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Historically, nontargeted adjuvant therapies such as liquid nitrogen, phenol, argon beam, and alcohol have been applied locally after curettage of giant cell tumors (GCT) in the extremities. Systemic bisphosphonates (BP) and denosumab have emerged as osteoclast-targeting therapies because osteoclast-like giant cells, responsible for aggressive bone resorption, are susceptible to BP or denosumab. However, such drugs may cause systemic side effects. We examined the effects of an alternative intraoperative local delivery of BP on GCTs. MATERIALS AND METHODS In total, 17 patients with GCTs underwent extended surgical curettage procedures consisting of high-speed burring, traditional adjuvant therapy, and application of BP-loaded polymethylmethacrylate bone cement. Clinical data and follow-up radiographs were reviewed to investigate local recurrence (LR) rate and complications in a retrospective manner. RESULTS There were 6 males and 11 females (mean age, 33.7 y). There were no cases of pulmonary metastases. Patient follow-up ranged from 1 to 12 years. There was 1 LR during the follow-up period for an LR rate of 5.9%. The mean final Musculoskeletal Tumor Society (MSTS) score was 29. There were no systemic or localized avascular necrosis or atypical fractures related to BPs noted. CONCLUSIONS BP-loaded polymethylmethacrylate is a targeted local adjuvant therapy that is feasible, safe, and may reduce LRs while alleviating the risk of systemic side effects of BPs such as avascular necrosis of jaw and atypical femur fractures. Future prospective randomized clinical trials will strengthen the level of evidence of this proposed targeted therapy. LEVEL OF EVIDENCE Therapeutic level IV-see instructions for authors for a complete description of evidence.
Collapse
|
21
|
Gebhart M, Coltofeanu A. PEComa of the talus: a unique case of a soft tissue tumor within bone. Acta Chir Belg 2019; 119:118-122. [PMID: 30774002 DOI: 10.1080/00015458.2017.1394658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Perivascular epithelioid cell tumor (PEComa) is a family of rare mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells (PECs). These tumors have been described at multiple anatomic sites. PEComas presenting in bone are especially rare and they have been reported to be either primary or metastatic lesions. None of them is located at the level of the foot. PATIENT We report on a case of primary bone PEComa of the talus, the first one to be published to the best of our knowledge. Treatment and result: Limb sparing surgical treatment has been done using intralesional tumor removal, burring and application of argon beam at the tumor walls and primary filling of the tumor cavity by bone cement with so far absence of any tumor recurrence documented by multiple histological sections at second look operation nine months after primary surgery, where cement has been replaced by autologous bone graft, and by subsequent follow-up. CONCLUSIONS PEComa is a very rare tumor, and its presence in bone is especially rare. The here reported case of PEComa presenting at the level of the talus is, to the best of our knowledge, the first case to be reported in the literature.
Collapse
Affiliation(s)
- Michael Gebhart
- Service de chirurgie orthopédique, de l’Institut Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Andrei Coltofeanu
- Service de chirurgie orthopédique, Andrei Clinic Hospital, Regina Maria, Medicova, Bucarest, Romania
| |
Collapse
|
22
|
Tsukamoto S, Mavrogenis AF, Tanzi P, Leone G, Righi A, Akahane M, Kido A, Honoki K, Tanaka Y, Donati DM, Errani C. Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation. J Surg Oncol 2019; 119:864-872. [PMID: 30734307 DOI: 10.1002/jso.25391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are conflicting reports for the outcome of the patients with giant cell tumor of bone (GCTB) and pathological fracture at presentation treated with curettage or resection. This study compared local recurrence, complications, and function after curettage versus resection for these patients. MATERIALS AND METHODS We retrospectively studied the files of 46 patients with histologically confirmed GCTB of the extremities admitted and treated from 1982 to 2015. The median follow-up was 79.5 months (57.0-125.5 months). We evaluated local recurrence and type of surgery-related complications with imaging and function with the Musculoskeletal Tumor Society (MSTS) score. RESULTS Overall local recurrence was 6.5%. There were one patient with curettage and two patients with resection; local recurrence rate was similar between the two procedures but the time to local recurrence was shorter after curettage. MSTS score was significantly better after curettage. Complications occurred in two patients after curettage and in five patients after resection; because of the low number of patients with complications, a statistical comparison was not possible; however, by direct comparison of the numbers, complications were more common after resection compared with curettage. CONCLUSION Curettage is recommended for GCTB and pathological fracture at presentation because of similar local recurrence but better function compared with resection. The treating physicians should be aware and inform their patients for a shorter time to local recurrence after curettage and for more complications after resection.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Piergiuseppe Tanzi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Leone
- Department of Orthopaedic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Kido
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
23
|
Management of an Unusual Periprosthetic Giant Cell Tumor of Bone of the Proximal Tibia. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e012. [PMID: 30465034 PMCID: PMC6226298 DOI: 10.5435/jaaosglobal-d-18-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Giant cell tumor of bone is a relatively rare type of bone tumor, accounting for approximately 4.9% to 9% of all primary osseous neoplasms.1 Management options include intralesional curettage, or more uncommonly, wide resection. This process is then followed by reconstruction with bone graft or bone cementation. We present a case of giant cell tumor of bone adjacent to the tibial component of a preexisting total knee arthroplasty, treated with extensive curettage, argon beam coagulation, polymethyl methacrylate cementation with strut reinforcement, and mesh reconstruction of the extensor mechanism. Twenty months after treatment, the patient was recurrence free with a stable prosthesis and had return to functional activity. We report this treatment modality as a potentially effective method of approaching this rare orthopaedic entity.
Collapse
|
24
|
Prabowo Y, Abubakar I. Reconstruction giant cell tumor of the right proximal humerus Campanacci 3 with pedicle and rod system: A case report. Int J Surg Case Rep 2018; 52:67-74. [PMID: 30321828 PMCID: PMC6197710 DOI: 10.1016/j.ijscr.2018.08.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/30/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022] Open
Abstract
Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. GCT were classified by Enneking and later by Campanacci based on radiographic appearance. Wide resection is associated with decreased risk of local recurrence compared to intralesional curettage and may increase the recurrence free survival rate. A 24-years-old male presented with Giant cell tumor (GCT) of the right proximal humerus Campanacci 3 and underwent wide resection and reconstruction type 1B with pedicle screw and rod system. The procedure provided excellent local control as the outcome was good both aesthetically and functionally.
Introduction Giant Cell tumors (GCT) are benign tumors with potential for aggressive behavior and capacity to metastasize. Although considered to be benign tumors of bone, GCT has a relatively high recurrence rate. Tumor often extends to the articular subchondral bone or even abuts the cartilage. The joint and/or its capsule are rarely invaded. Surgical resection is the universal standard of care for the treatment of bone GCT. The key ensuring an adequate surgical treatment with complete removal of tumor is by obtaining adequate exposure of the lesion. Presentation of case We reported a case of 24-years-old male with Giant cell tumor (GCT) of the right proximal humerus. Patient presented with chief complaint of pain on the right shoulder and had a history of fell on the right elbow. Radiographic examination showed a primary bone tumor of the proximal humerus. MRI provided excellent depiction in suggesting the diagnosis of cutaneous GCT Campanacci 3, which was later, affirmed by biopsy. Patient underwent successful wide excision and reconstruction. The limb salvage procedure consisted of shoulder resection type 1B and reconstruction with pedicle screw and rod system. During 5 days post-operative period, there was no major event observed. Patient could do shoulder flexion forward 0–30, shoulder extension 0–20, elbow extension – Flexion, wrist flexion extension, and fingers flexion. Discussion GCT of bone typically shown as an epiphyseal, eccentric, expansive lytic lesion with a ‘soap-bubble appearance’. MRI is useful to assess extracortical spread and intramedullary extension. Surgery is the treatment of choice. Curettage is usually combined with cementing or bone grafting. Hemi-articular and total elbow allografts have been used for reconstruction of the defects following tumor excision, but the complication rates are high, and these techniques are reserved as salvage procedures following failed total elbow arthroplasty. Conclusion Wide resection and total elbow arthroplasty enables good functional outcome and lower risk for recurrence. Pedicle and rod system for shoulder reconstruction is a viable option, as it provides good pain relief and functional improvement with lower complication rates.
Collapse
Affiliation(s)
- Yogi Prabowo
- Musculoskeletal Oncology Division, Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
| | - Irsan Abubakar
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
| |
Collapse
|
25
|
Mostafa MF, Abed YY, Fawzy SI. Shaped graft for aneurysmal bone cyst of upper limb bones. Strategies Trauma Limb Reconstr 2017; 12:151-158. [PMID: 28712047 PMCID: PMC5653600 DOI: 10.1007/s11751-017-0291-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/27/2017] [Indexed: 11/26/2022] Open
Abstract
The optimal treatment of aneurysmal bone cyst remains challenging. The aim of this prospective study was to evaluate the results of using bone grafts shaped to the defects caused by aneurysmal bone cysts of upper limb bones. Fifteen patients (12 males and 3 females) with an average age of 12 years (range 6-16 years) were treated for aneurysmal bone cysts of upper limb bones by intralesional resection, argon beam coagulation and shaped bone graft. The grafts were harvested from 14 patients (11 fibulas and 3 iliac bones) and from the mother of one patient (proximal fibula). Osteosynthesis was required to stabilize the graft in four cases. The modified Enneking's scoring system was used for functional evaluation. One patient developed partial recurrence at 6 months and required reoperation. Superficial wound infection was encountered in one patient. Shortening of the humeral segment was seen in two patients (1 and 1.5 cm) but without angular deformity. After a mean follow-up of 45 months (range 24-68 months), the mean functional score was 97.3%. This technique proved to be reliable in obtaining a well reconstructed and growing bone with no or minimal deformity and good function.
Collapse
Affiliation(s)
- Mohamed F Mostafa
- Orthopedic Oncology Unit, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria Street, P.O. Box 35516, Mansoura, Egypt.
| | - Yasser Y Abed
- Orthopedic Oncology Unit, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria Street, P.O. Box 35516, Mansoura, Egypt
| | - Sallam I Fawzy
- Orthopedic Oncology Unit, Department of Orthopedic Surgery, Mansoura University Hospital, 36 Al-Gomhoria Street, P.O. Box 35516, Mansoura, Egypt
| |
Collapse
|
26
|
Liu C, Tang Y, Li M, Jiao Q, Zhang H, Yang Q, Yao W. Clinical characteristics and prognoses of six patients with multicentric giant cell tumor of the bone. Oncotarget 2016; 7:83795-83805. [PMID: 27823978 PMCID: PMC5347806 DOI: 10.18632/oncotarget.13057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/26/2016] [Indexed: 12/31/2022] Open
Abstract
Multicentric giant cell tumor of the bone (MGCT) is a rare entity whose radiographic, pathological and biological features remain confusing. We retrospectively reviewed six patients (1 male, 5 female; average age, 22.33 years) treated for confirmed MGCT between 2001 and 2015. The patients' clinical information, images from radiographs (n = 14), CT (n = 13), MRI (n = 8), bone scintigraphy (n = 1) and PET-CT (n = 2), as well as histologic features, treatment and prognosis were analyzed. A total of 17 lesions were detected: 4 around the knee joint, 3 in the greater trochanter and head of the femur, 5 in the small bones of the feet, and 2 in flat bones. All these lesions occurred in an ipsilateral extremity. One patient had Paget's disease. On radiographs and CT, 12 lesions exhibited sclerotic margins or patchy sclerosis, 8 showed cortical discontinuity, and 5 showed soft tissue masses. On histopathology, 8 lesions showed signs of sarcomatous transformation and one had transformed into osteosarcoma. Ten lesions in 4 patients were initially treated with surgery, and 3 showed local recurrence. Seven lesions in 3 patients were treated with denosumab. All the patients are currently stable without metastasis. These results suggest MGCT tends to occur in uncommon sites with sclerosis. Because these lesions can be aggressive, patients should be carefully monitored for the recurrence or formation of other lesions, especially in an ipsilateral extremity.
Collapse
Affiliation(s)
- Chenglei Liu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yawen Tang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Mei Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huizhen Zhang
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qingcheng Yang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weiwu Yao
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
27
|
Abstract
Aneurysmal bone cysts (ABCs) are benign bone lesions arising predominantly in the pediatric population that can cause local pain, swelling, and pathologic fracture. Primary lesions, which constitute roughly two thirds of all ABCs, are thought to be neoplastic in nature, with one third of ABCs arising secondary to other tumors. Diagnosis is made with various imaging modalities, which exhibit characteristic features such as "fluid-fluid levels," although biopsy is critical, as telangiectatic osteosarcoma cannot be excluded based on imaging alone. Currently, the standard of care and most widely employed treatment is intralesional curettage. However, tumor recurrence with curettage alone is common and has driven some to propose a multitude of adjuvants with varying efficacy and risk profiles. Historically, therapies such as en bloc resection or radiation therapy were utilized as an alternative to decrease the recurrence rate, but these therapies imposed high morbidity. As a result, modern techniques now seek to simultaneously reduce morbidity and recurrence, the pursuit of which has produced preliminary study into minimally invasive percutaneous treatments and medical management.
Collapse
|
28
|
Abstract
Introduction: Incomplete intralesional curettage remains the most important factor contributing to the recurrence of the GCT tumor. A 360 degree view of the tumor cavity can be achieved with the help of an arthroscope, which can aid complete intralesional curettage. Case Report: This technical note describes the use of arthroscope assisted curettage of the distal femur GCT. Conclusion: Use of an arthroscope can improve the visibility for intralesional curettage 5 of Giant Cell tumor.
Collapse
Affiliation(s)
- Aashay Kekatpure
- Department of Orthopaedics, ADTOOS Clinic And Pimprikar Hospital Nasik. India
| | - Milind Pimprikar
- Department of Orthopaedics, ADTOOS Clinic And Pimprikar Hospital Nasik. India
| | - Aditya Kekatpure
- Department of Orthopaedics, ADTOOS Clinic And Pimprikar Hospital Nasik. India
| |
Collapse
|
29
|
Song M, Dai W, Sun R, Liang H, Liu B, Wu Y, Ma K, Lu M. Giant cell tumor of the patella with a secondary aneurysmal bone cyst: A case report. Oncol Lett 2016; 11:4045-4048. [PMID: 27313738 DOI: 10.3892/ol.2016.4540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/22/2016] [Indexed: 11/06/2022] Open
Abstract
The substance of the patella is an uncommon location for tumor occurrence and development. The present study reports a case of giant cell tumor (GCT) of the patella, combined with an aneurysmal bone cyst (ABC). To the best of our knowledge, this is the second report of GCT with ABC published in English. GCT is the most common type of benign tumor. Secondary ABC is frequently associated with GCT, but this symbiotic tumor rarely occurs in the patella. A 27-year-old male patient was examined at the outpatient clinic, and clinicopathological characteristics of the tumor were observed. X-ray and computed tomography (CT) scans revealed a lytic lesion located in the center of the right patella. Curettage, followed by autogenic and allograft bone grafting, was performed. Histopathologically, the lesion was diagnosed as a GCT with secondary ABC. No recurrence or metastasis was identified during the 1-year follow-up period. The present study reports a case of GCT with secondary ABC, and discusses the rare location and histopathological type of this tumor, in order to improve diagnosis and treatment of patellar tumors in general.
Collapse
Affiliation(s)
- Mingzhi Song
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China; Department of Orthopedics, The Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116200, P.R. China
| | - Wei Dai
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China; Department of Operation Room, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Ran Sun
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China; Department of Operation Room, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Hongfeng Liang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China; Department of Operation Room, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Bingwu Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Yuxuan Wu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China; Department of Orthopedics, The Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116200, P.R. China
| | - Kai Ma
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Ming Lu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| |
Collapse
|
30
|
Traub F, Singh J, Dickson BC, Leung S, Mohankumar R, Blackstein ME, Razak AR, Griffin AM, Ferguson PC, Wunder JS. Efficacy of denosumab in joint preservation for patients with giant cell tumour of the bone. Eur J Cancer 2016; 59:1-12. [PMID: 26990281 DOI: 10.1016/j.ejca.2016.01.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/05/2016] [Accepted: 01/13/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Giant cell tumour of the bone (GCTB) is an aggressive osteolytic primary tumour. GCTB is rich in osteoclast-like giant cells and contains mononuclear cells that express RANK ligand (RANKL), a key mediator of osteoclast activation. The potential therapeutic effect of denosumab was investigated with special reference to its role in joint preservation. METHODS In this prospective non-randomised study patients with GCTB received denosumab for 6-11 months preoperatively. Serial radiographs and biopsy and resection tumour specimens were used to monitor response to denosumab. RESULTS All 20 patients experienced pain relief in the first month of treatment. All patients demonstrated a positive radiographic response with improved subchondral and cortical bone which allowed intralesional tumour resection and preservation of the joint and articular surface in 18 cases. Histological examination following denosumab revealed rarely detectable osteoclast-like giant cells. There was an obvious increase in osteoid matrix and woven bone which showed rare RANK staining amongst the mononuclear cells and only focal RANKL positivity. At median 30 months follow-up after resection, local tumour recurrence occurred in three patients. CONCLUSION Denosumab provides favourable and consistent clinical, radiographic and pathologic responses which facilitates less aggressive surgical treatment, especially joint preservation. However, the local recurrence rate for GCTB following resection does not seem to be affected by denosumab and remains a concern.
Collapse
Affiliation(s)
- Frank Traub
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Janith Singh
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Stephanie Leung
- Musculoskeletal Division, Department of Medical Imaging, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Rakesh Mohankumar
- Musculoskeletal Division, Department of Medical Imaging, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Martin E Blackstein
- Department of Medical Oncology, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Albiruni R Razak
- Department of Medical Oncology, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto M5G 1X5, ON, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto M5G 1X5, ON, Canada.
| |
Collapse
|
31
|
Salunke AA, Chen Y, Chen X, Tan JH, Singh G, Tai BC, Khin LW, Puhaindran ME. Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone?: a meta-analysis. Bone Joint J 2016; 97-B:1566-71. [PMID: 26530662 DOI: 10.1302/0301-620x.97b11.35326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether the presence of a pathological fracture increased the risk of local recurrence in patients with a giant cell tumour (GCT) of bone. We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients with a GCT with and without a pathological fracture at presentation. We computed the odds ratio (OR) of local recurrence in those with and without a pathological fracture. We selected 19 eligible papers for final analysis. This included 3215 patients, of whom 580 (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients with and without a pathological fracture was 1.05 (95% confidence interval (CI) 0.66 to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75 to 2.01, p = 0.417). A post hoc sample size calculation showed adequate power for both comparisons. There is no difference in local recurrence rates between patients who have a GCT of bone with and without a pathological fracture at the time of presentation. The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture.
Collapse
Affiliation(s)
- A A Salunke
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Y Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - X Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - J H Tan
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - G Singh
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - B C Tai
- National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - L W Khin
- National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - M E Puhaindran
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| |
Collapse
|
32
|
Abstract
BACKGROUND CONTEXT Spinal giant cell tumors (SGCT) remain challenging tumors to treat. Although advancements in surgical techniques and adjuvant therapies have provided new options for treatment, evidence-based algorithms are lacking. PURPOSE This study aims to review the peer-reviewed literature that addresses current treatment options and management of SGCT, to produce an evidence-based treatment algorithm. STUDY DESIGN/SETTING A systematic review was performed. METHODS Articles published between January 1, 1970 and March 31, 2015 were selected from PubMed and EMBASE searches using keywords "giant cell tumor" AND "spine" AND "treatment." Relevant articles were selected by the authors and reviewed. RESULTS A total of 515 studies were identified, of which 81 studies were included. Complete surgical resections of SCGT resulted in the lowest recurrence rates. However, morbidity of en bloc resections is high and in some cases, surgery is not possible. Intralesional resection can be coupled with adjuvant therapies, but evidence-based algorithms for use of adjuvants remain elusive. Several recent advancements in adjuvant therapy may hold promise for decreasing SGCT recurrence, specifically stereotactic radiotherapy, selective arterial embolization, and medical therapy using denosumab and interferon. CONCLUSIONS Complete surgical resection of SGCT should be the goal when possible, particularly if neurologic impairment is present. Denosumab holds promise as an adjuvant and perhaps stand-alone therapy for SGCT. Spinal giant cell tumors should be approached as a case-by-case problem, as each presents unique challenges. Collaboration of spine surgeons, radiation oncologists, and medical oncologists is the best practice for treating these difficult tumors.
Collapse
|
33
|
López-Pousa A, Martín Broto J, Garrido T, Vázquez J. Giant cell tumour of bone: new treatments in development. Clin Transl Oncol 2015; 17:419-30. [PMID: 25617146 PMCID: PMC4448077 DOI: 10.1007/s12094-014-1268-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 01/01/2023]
Abstract
Giant cell tumour of bone (GCTB) is a benign osteolytic tumour with three main cellular components: multinucleated osteoclast-like giant cells, mononuclear spindle-like stromal cells (the main neoplastic components) and mononuclear cells of the monocyte/macrophage lineage. The giant cells overexpress a key mediator in osteoclastogenesis: the RANK receptor, which is stimulated in turn by the cytokine RANKL, which is secreted by the stromal cells. The RANK/RANKL interaction is predominantly responsible for the extensive bone resorption by the tumour. Historically, standard treatment was substantial surgical resection, with or without adjuvant therapy, with recurrence rates of 20–56 %. Studies with denosumab, a monoclonal antibody that specifically binds to RANKL, resulted in dramatic treatment responses, which led to its approval by the United States Food and Drugs Administration (US FDA). Recent advances in the understanding of GCTB pathogenesis are essential to develop new treatments for this locally destructive primary bone tumour.
Collapse
Affiliation(s)
- A López-Pousa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,
| | | | | | | |
Collapse
|
34
|
Giacomo GD, Ziranu A, Perisano C, Piccioli A, Maccauro G. Local Adjuvants in Surgical Management of Bone Lesions. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jct.2015.66051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
35
|
|
36
|
Rajani R, Schaefer L, Scarborough MT, Gibbs CP. Giant Cell Tumors of the Foot and Ankle Bones: High Recurrence Rates After Surgical Treatment. J Foot Ankle Surg 2014; 54:1141-5. [PMID: 25441851 DOI: 10.1053/j.jfas.2014.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Indexed: 02/03/2023]
Abstract
Giant cell tumor (GCT) of the bone is a benign primary bone tumor most often treated with intralesional surgery. Most cases occur around the knee; however, rarely, GCT of bone can occur in the foot and ankle. Limited data exist about the outcomes after treatment of GCT in this location. We retrospectively reviewed an orthopedic oncology database from 1970 to 2010 for cases of GCT of the bone, specifically within the foot and ankle bones. After exclusionary criteria were applied, a total of 19 disease sites in 18 patients were included for analysis. Of the 19 disease sites, 10 recurred. Patients, on average, required 1.7 operations per disease site. Of the 18 patients, 10 required ≥2 operations, 3 required ≥3 operations, and 1 required 4 operations. A total of 4 amputations were performed, including 2 below the knee amputations. Of the 10 patients with recurrence, 2 also had evidence of metastatic disease. The recurrence rates of GCT in the foot and ankle bones appear to be greatest after intralesional curettage without the use of cement. Although the recurrence rates are high, intralesional operations with multiple adjuvant therapy can eventually result in cure.
Collapse
Affiliation(s)
- Rajiv Rajani
- Assistant Professor, Department of Orthopaedics, University of Texas Health Sciences Center San Antonio, San Antonio, TX.
| | - Lindsay Schaefer
- Resident, Department of Orthopaedics, University of Texas Health Sciences Center San Antonio, San Antonio, TX
| | - Mark T Scarborough
- Professor, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - C Parker Gibbs
- Professor, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| |
Collapse
|
37
|
Gouin F, Rochwerger AR, Di Marco A, Rosset P, Bonnevialle P, Fiorenza F, Anract P. Adjuvant treatment with zoledronic acid after extensive curettage for giant cell tumours of bone. Eur J Cancer 2014; 50:2425-31. [PMID: 25088085 DOI: 10.1016/j.ejca.2014.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/09/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Giant cell tumours (GCT) of bone are benign neoplasms associated with a high rate of local recurrence after extensive intra-lesional curettage. Recently, understanding of the biological molecular availability of strong anti-osteoclastic drugs has suggested their potential value in reducing local recurrences after curettage. Through a phase II clinical trial, we investigated the effect of a short treatment with zoledronic acid (ZOL) after intra-lesional curettage of GCT, as well as local recurrence and tolerance of the treatment. METHODS AND PATIENTS Twenty-four patients were enrolled in a multicentre, phase 2 study. The patients were treated with extensive intra-lesional curettage followed by five courses of ZOL (4 mg IV every 3 weeks). The clinical and biological tolerance of each patient was assessed. Patients were reviewed clinically and by X-ray every 6 months until the end of the study (36 months). RESULTS Eighteen out of 20 patients reported side-effects with ZOL, mainly grade 1 and 2 effects. The local recurrence rate was 15%; three patients had a recurrence, one at 4 months (huge GCT of the sacrum), one at 24 months (patient who discontinued the treatment after the first course of ZOL), and one after the observational period, at 58 months. Finally, local relapse-free survival was 82 ± 9% at 60 months. CONCLUSION Short adjuvant treatments with ZOL after extensive intra-lesional curettage of GCT were associated with a low rate of recurrence but did not prevent local recurrence in this study. No serious general adverse effects were observed. More studies are needed to evaluate the potential benefit of medical bisphosphonate injections combined with intra-lesional curettage in the treatment of GCTB.
Collapse
Affiliation(s)
- Francois Gouin
- Orthopaedics and Traumatology Department, University Hospital of Nantes CHU, Hôtel-Dieu, 44 093 Nantes Cedex, France; LPRO, Inserm U957, UFR Médecine, Université de Nantes, 1 Rue Gaston Veil, 44000 Nantes, France.
| | | | - Antonio Di Marco
- University Hospital de Hautepierre, Av. Molière, 67 000 Strasbourg, France.
| | - Philippe Rosset
- University Hospital Trousseau, Rue des Loches, 37 004 Tours, France.
| | - Paul Bonnevialle
- University Hospital of Purpan, Place du Dr. Baylac, 31 059 Toulouse, France.
| | - Fabrice Fiorenza
- University Hospital Dupuytren, Av. Martin Luther King, 87 042 Limoges, France.
| | - Philippe Anract
- University Hospital of Cochin-Port Royal, Av. Du Fb Saint Jacques, 75 014 Paris, France.
| |
Collapse
|
38
|
Amanatullah DF, Clark TR, Lopez MJ, Borys D, Tamurian RM. Giant cell tumor of bone. Orthopedics 2014; 37:112-20. [PMID: 24679193 DOI: 10.3928/01477447-20140124-08] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 08/23/2013] [Indexed: 02/03/2023]
Abstract
EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Identify at-risk populations for giant cell tumor of bone. 2. Recognize the biology that drives giant cell tumor of bone. 3. Describe modern surgical and adjuvant techniques to effectively treat giant cell tumor of bone. 4. Recognize the complications associated with radiation therapy, poor resection, and adjuvant treatments. Giant cell tumor of bone (GCT) is a benign, locally aggressive bone tumor. Giant cell tumor of bone primarily affects the young adult patient population. The natural history of GCT is progressive bone destruction leading to joint deformity and disability. Surgery is the primary mode of treatment, but GCT has a tendency to recur locally despite a range of adjuvant surgical options. Pulmonary metastasis has been described. However, systemic spread of GCT rarely becomes progressive, leading to death. This review presents the clinicopathologic features of GCT and a historical perspective that highlights the current rationale and controversies regarding the treatment of GCT.
Collapse
|
39
|
Abstract
Benign bone lesions are a broad category that demonstrates a spectrum of activities from latent to aggressive. Differentiating the various tumors is important in order to properly determine necessary intervention. This chapter focuses on the presentation, imaging, diagnostic features, and treatment of the most common benign bone tumors in order to help guide diagnosis and management.
Collapse
Affiliation(s)
- Robert Steffner
- Orthopaedic Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA,
| |
Collapse
|
40
|
Giant cell tumour of bone: a new evaluating system is necessary. INTERNATIONAL ORTHOPAEDICS 2012; 36:2521-7. [PMID: 23052276 DOI: 10.1007/s00264-012-1664-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 09/11/2012] [Indexed: 12/28/2022]
Abstract
Giant cell tumour (GCT) of bone is still one of the most obscure and intensively studied tumours of bone. The histogenesis of GCT remains unclear. The recommended therapy of GCT evolved during the 20th century. The best treatment should ensure local control and maintain function. Curettage has been the preferred treatment for most GCTs. Good results have also been published on the use of high-speed burr and local adjuvants. Local tumour control can be satisfactorily achieved by wide excision. However, treatment options for GCT have remained fairly static over the past 30 years and there is no widely held consensus regarding the standard treatment selection for all patients. This challenge may result from the fact that there are no single clinical, radiographic, histological or morphological aspects that allow surgeons to accurately predict the trend of a single lesion to recur. In this research, a comprehensive review of the previously described radiographic staging systems by Enneking and Campanacci et al. and the shortfalls associated with them are provided, and then the possible risk factors of predicting local recurrence or evaluating functional outcome of GCT are also discussed. A new preoperative evaluating system of GCT may be necessary and feasible, so that surgeons may accurately assess the aggressiveness or severity of GCT in order to reliably guide treatment decisions and predict outcomes.
Collapse
|
41
|
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 2012; 470:2886-94. [PMID: 22773395 PMCID: PMC3442009 DOI: 10.1007/s11999-012-2464-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 06/19/2012] [Indexed: 01/31/2023]
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 (e.g., 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.
Collapse
Affiliation(s)
- Yu-peng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008 PR China
| | - Kang-hua Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008 PR China
| | - Bu-hua Sun
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008 PR China
| |
Collapse
|
42
|
Sandwich reconstruction technique for subchondral giant cell tumors around the knee. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e3182640f1a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Kim Y, Nizami S, Goto H, Lee FY. Modern interpretation of giant cell tumor of bone: predominantly osteoclastogenic stromal tumor. Clin Orthop Surg 2012; 4:107-16. [PMID: 22662295 PMCID: PMC3360182 DOI: 10.4055/cios.2012.4.2.107] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/22/2012] [Indexed: 02/02/2023] Open
Abstract
Owing to striking features of numerous multinucleated cells and bone destruction, giant cell tumor (GCT) of bone, often called as osteoclastoma, has drawn major attractions from orthopaedic surgeons, pathologists, and radiologists. The name GCT or osteoclastoma gives a false impression of a tumor comprising of proliferating osteoclasts or osteoclast precursors. The underlying mechanisms for excessive osteoclastogenesis are intriguing and GCT has served as an exciting disease model representing a paradigm of osteoclastogenesis for bone biologists. The modern interpretation of GCT is predominantly osteoclastogenic stromal cell tumors of mesenchymal origin. A diverse array of inflammatory cytokines and chemokines disrupts osteoblastic differentiation and promotes the formation of excessive multi-nucleated osteoclastic cells. Pro-osteoclastogenic cytokines such as receptor activator of nuclear factor kappa-B ligand (RANKL), interleukin (IL)-6, and tumor necrosis factor (TNF) as well as monocyte-recruiting chemokines such as stromal cell-derived factor-1 (SDF-1) and monocyte chemoattractant protein (MCP)-1 participate in unfavorable osteoclastogenesis and bone destruction. This model represents a self-sufficient osteoclastogenic paracrine loop in a localized area. Consistent with this paradigm, a recombinant RANK-Fc protein and bisphosphonates are currently being tried for GCT treatment in addition to surgical excision and conventional topical adjuvant therapies.
Collapse
Affiliation(s)
- Yuhree Kim
- Department of Orthopaedic Surgery, Columbia University Medical Center, Columbia University, New York, NY 10032, USA
| | | | | | | |
Collapse
|
44
|
Benevenia J, Patterson FR, Beebe KS, Abdelshahed MM, Uglialoro AD. Comparison of phenol and argon beam coagulation as adjuvant therapies in the treatment of stage 2 and 3 benign-aggressive bone tumors. Orthopedics 2012; 35:e371-8. [PMID: 22385449 DOI: 10.3928/01477447-20120222-22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Argon beam photocoagulation has gained popularity as an adjuvant therapy for the treatment of giant cell tumors of bone and other stage 2 or 3 benign-aggressive bone tumors. Although argon beam photocoagulation has been considered a safe and reasonable adjuvant treatment with acceptable recurrence rates, it has never been directly compared with the commonly described phenol as adjuvant. The purpose of this study was to determine whether argon beam photocoagulation is as effective as phenol in preventing recurrence without affecting functional outcome as an adjuvant to surgical curettage. We retrospectively reviewed 93 consecutive patients with a minimum 10-month follow-up between 1992 and 2007 who were treated with curettage and either phenol or argon beam photocoagulation. Functional outcomes and complications were recorded. Overall, 16 (17.2%) of 93 patients who were initially treated with 1 of the adjuvants had pathologically confirmed recurrences. No additional recurrences were noted after retreatment, leading to an overall recurrence rate of 17.1% with phenol and 14.8% with argon beam photocoagulation (P=.726). While avoiding the toxic effects of phenol, argon beam photocoagulation provides for statistically equivalent recurrence rates, functional outcomes, and complication rates in the treatment of benign-aggressive bone tumors.
Collapse
Affiliation(s)
- Joseph Benevenia
- Department of Orthopaedics, Division of Musculoskeletal Oncology, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, USA
| | | | | | | | | |
Collapse
|
45
|
Piccioli A, Ventura A, Maccauro G, Spinelli MS, Del Bravo V, Rosa MA. Local adjuvants in surgical management of bone metastases. Int J Immunopathol Pharmacol 2011; 24:129-32. [PMID: 21669151 DOI: 10.1177/03946320110241s224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Curettage is one of the most common method for surgical treatment of bone metastasis. Local adjuvant improve most commonly used for improving the effect of curettage in local cancer surgery may exerted their effects either chemically either physically; in Orthopedic Oncology the most common are phenol, liquid nitrogen, laser, and cement. This article reviewed the main characteristics of the most common chemical and physical agents used in bone oncology, emphasizing the toxic effects of some of them, especially phenol and liquid nitrogen.
Collapse
Affiliation(s)
- A Piccioli
- Orthopedic Oncology University La Sapienza, Rome, Italy
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Bone tumors are uncommon clinical entities that are often a source of diagnostic and therapeutic uncertainty. Evaluating these lesions starts with a patient history and physical examination Imaging then begins with radiographs, followed by advanced imaging modalities, such as magnetic resonance imaging, computed tomography, or bone scan. Biopsy can be performed to establish histologic diagnosis by either closed or open means. Treatment options range from observation to wide resection with reconstruction or amputation. Surveillance schedules vary depending on the type of tumor that is being treated. An algorithm for the evaluation, work-up, and diagnosis of bone tumors is presented.
Collapse
Affiliation(s)
- Tessa Balach
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-5456, USA
| | | | | |
Collapse
|
47
|
Adams ML, Steinberg JS. Argon beam coagulation in foot and ankle surgery. J Foot Ankle Surg 2011; 50:780-2. [PMID: 21907597 DOI: 10.1053/j.jfas.2011.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 06/13/2011] [Indexed: 02/03/2023]
Abstract
In this brief report, we introduce the principles, indications, advantages, disadvantages, and surgical techniques involved in the use of argon beam coagulation in foot and ankle surgery.
Collapse
|
48
|
Gortzak Y, Kandel R, Deheshi B, Werier J, Turcotte RE, Ferguson PC, Wunder JS. The efficacy of chemical adjuvants on giant-cell tumour of bone. An in vitro study. ACTA ACUST UNITED AC 2010; 92:1475-9. [PMID: 21089702 DOI: 10.1302/0301-620x.92b10.23495] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Various chemicals are commonly used as adjuvant treatment to surgery for giant-cell tumour (GCT) of bone. The comparative effect of these solutions on the cells of GCT is not known. In this study we evaluated the cytotoxic effect of sterile water, 95% ethanol, 5% phenol, 3% hydrogen peroxide (H(2)O(2)) and 50% zinc chloride (ZnCI(2)) on GCT monolayer tumour cultures which were established from six patients. The DNA content, the metabolic activity and the viability of the cultured samples of tumour cells were assessed at various times up to 120 hours after their exposure to these solutions. Equal cytotoxicity to the GCT monolayer culture was observed for 95% ethanol, 5% phenol, 3% H(2)O(2) and 50% ZnCI(2). The treated samples showed significant reductions in DNA content and metabolic activity 24 hours after treatment and this was sustained for up to 120 hours. The samples treated with sterile water showed an initial decline in DNA content and viability 24 hours after treatment, but the surviving cells were viable and had proliferated. No multinucleated cell formation was seen in these cultures. These results suggest that the use of chemical adjuvants other than water could help improve local control in the treatment of GCT of bone.
Collapse
Affiliation(s)
- Y Gortzak
- Mount Sinai Hospital, Toronto, Canada.
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Level of Evidence: V, Expert Opinion
Collapse
Affiliation(s)
- Christopher Bibbo
- Foot & Ankle Section, Department of Orthopaedics, Marshfield Clinic, Marshfield, WI 54449, USA.
| |
Collapse
|
50
|
High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis. Sarcoma 2010; 2010. [PMID: 20706639 PMCID: PMC2913811 DOI: 10.1155/2010/586090] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 06/24/2010] [Indexed: 11/30/2022] Open
Abstract
Local control rates for Giant Cell Tumor of Bone (GCT) have been reported in a large number of retrospective series. However, there remains a lack of consensus with respect to the need for a surgical adjuvant when intralesional curettage is performed. We have systematically reviewed the literature and identified six studies in which two groups from the same patient cohort were treated with intralesional curettage and high-speed burring with or without a chemical or thermal adjuvant. Studies were evaluated for quality and pooled data was analyzed using the fixed effects model. Data from 387 patients did not indicate improved local control with the use of surgical adjuvants. Given the available data, we conclude that surgical adjuvants are not required when meticulous tumor removal is performed.
Collapse
|