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Zhou L, Zhu H, Lin S, Jin H, Zhang Z, Dong Y, Yang Q, Zhang C, Yuan T. Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage. INTERNATIONAL ORTHOPAEDICS 2021; 46:381-390. [PMID: 34783889 PMCID: PMC8782792 DOI: 10.1007/s00264-021-05260-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Background Extended curettage has increasingly become the preferred treatment for giant cell tumour of bone (GCTB), but the high recurrence rate after curettage poses a major challenge for orthopaedic surgeons. Computed tomography (CT) is valuable in the evaluation of GCTB. Our aim was to identify specific features of GCTB around the knee in pre-operative CT images that might have prognostic value for local recurrence. Methods We retrospectively analyzed data from 124 patients with primary GCTB around the knee who underwent extended curettage from 2010 through 2019. We collected demographic, clinical, and therapeutic data along with several CT-derived tumour characteristics. CT-derived tumor characteristics included tumour size, the distance between the tumour edge and articular surface (DTA), and destruction of posterior cortical bone (DPC). Akaike information criterion (AIC) was used to select which variables to enter into multivariate logistic regression models and to determine significant factors affecting recurrence. Results The total recurrence rate was 21.0% (26/124), and the average follow-up time was 69.5 ± 31.2 months (24–127 months). Age, DTA (< 2 mm), and DPC were significantly related to recurrence, as determined by multivariate logistic regression. The C-index of the final model was 0.79 (95% CI: 0.71 to 0.88), representing a good model for predicting recurrence. Conclusion Identifying certain features of GCTB around the knee on CT has prognostic value for patients treated with extended curettage. A three-factor model predicts tumour recurrence well after extended curettage. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05260-6.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hongyi Zhu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shanyi Lin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Hanqiang Jin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhaoyuan Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yang Dong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
- Institute of Microsurgery On Extremities, Shanghai Jiaotong University Affiliated Sixth, People's Hospital, Shanghai, 200233, China.
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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In Vitro Study of the Effects of Denosumab on Giant Cell Tumor of Bone: Comparison with Zoledronic Acid. Pathol Oncol Res 2017; 25:409-419. [PMID: 29159783 DOI: 10.1007/s12253-017-0362-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/08/2017] [Indexed: 12/21/2022]
Abstract
Giant cell tumor of bone (GCTB) is a locally aggressive primary bone tumor that contains numerous osteoclasts formed from marrow-derived precursors through receptor activator of nuclear factor κ-B ligand (RANKL), an osteoclast differentiation factor expressed in neoplastic cells of GCTB. Denosumab, a fully human monoclonal antibody targeting RANKL, has recently been used for the treatment of GCTB, and superior treatment effects have been reported. The aim of this work was to elucidate the mechanism of action of denosumab, and the differences between denosumab and zoledronic acid at the level of GCTB cells. We isolated GCTB cells from 3 patients and separated them into osteoclasts, osteoclast precursors and proliferating spindle-shaped stromal cells (the true neoplastic component), and examined the action of denosumab on differentiation, survival and bone resorption activity of osteoclasts. Denosumab and zoledronic acid inhibited osteoclast differentiation from mononuclear cells containing osteoclast precursors. Zoledronic acid inhibited osteoclast survival, whereas an inhibitory effect of denosumab on osteoclast survival was not observed. The inhibitory effect on bone resorption by both agents was confirmed in culture on dentin slices. Furthermore, zoledronic acid showed dose-dependent inhibition of cell growth of neoplastic cells whereas denosumab had no inhibitory effect on these cells. Denosumab has an inhibitory effect on osteoclast differentiation, but no inhibitory effects on survival of osteoclasts or growth of neoplastic cells in GCTBs.
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Epidemiological and Clinical Features of Primary Giant Cell Tumors of the Distal Radium: A Multicenter Retrospective Study in China. Sci Rep 2017; 7:9067. [PMID: 28831106 PMCID: PMC5567356 DOI: 10.1038/s41598-017-09486-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/27/2017] [Indexed: 11/08/2022] Open
Abstract
Giant cell tumors of the distal radius are challenging for surgeons because they are associated with high recurrence rates and poor functional outcomes. Between June 2005 and October 2015, patients with primary giant cell tumors of the distal radius were recruited from seven orthopedic centers in China. The patients’ clinical features and demographic characteristics were obtained from medical records and reviewed retrospectively. Overall, 48 cases of giant cell tumors of the distal radius were assessed in this study. These patients were more likely to be between 20 and 40 years of age, to have a Campanacci grade of III, and to undergo a surgical style of resection. The prevalence of pathological fractures was 12.5% overall (20.0% in men and 4.3% in women). The prevalence of local recurrence was 30.0% overall (38.1% in men and 21.1% in women) during the average follow-up period of 62.5 months, with a pulmonary metastasis rate of 5.0%. Giant cell tumors of the distal radius were predominant in men and were more likely to recur locally than around the knee. These findings suggest that it is crucial to evaluate the optimal surgical approach for balancing local recurrence control and functional outcomes to reduce the disease burden.
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Hu P, Zhao L, Zhang H, Yu X, Wang Z, Ye Z, Wu S, Guo S, Zhang G, Wang J, Ning X, Hu Y, Zhang Y. Recurrence Rates and Risk Factors for Primary Giant Cell Tumors around the Knee: A Multicentre Retrospective Study in China. Sci Rep 2016; 6:36332. [PMID: 27827384 PMCID: PMC5101496 DOI: 10.1038/srep36332] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/13/2016] [Indexed: 12/01/2022] Open
Abstract
Giant cell tumors of the bone (GCTBs) are commonly diagnosed in Asian populations, usually around the knee. Herein, we aimed to determine the clinical characteristics, local recurrence rates, and relevant risk factors of primary GCTB around the knee. Univariate and multivariate survival analyses were used to identify the risk factors for local recurrence. Four hundred ten patients with primary GCTB around the knee, treated between March 2000 and June 2014, were recruited from 7 institutions in China. The overall local recurrence rate was 23.4%, but was higher in patients aged 20–39 years (28.5%; P = 0.039). The local recurrence rate was the highest in patients treated with intralesional curettage (53.4%), and the lowest in those treated with resection (4.9%). We found a higher risk of tumor recurrence in the proximal fibula compared to the distal femur (hazard ratio: 28.52, 95% confidence interval: 5.88–138.39; P < 0.0001), and in patients treated with curettage compared to those treated with resection (hazard ratio: 12.07, 95% confidence interval: 4.99–29.18; P < 0.0001). Thus, the tumor location must be considered when selecting the optimal surgical treatment approach to reduce the risk of local recurrence and preserve joint function, especially in young patients.
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Affiliation(s)
- Pan Hu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liming Zhao
- Department of Oncology of Bone, Tianjin Hospital, Tianjin, China.,The Graduate School, Tianjin Medical University, Tianjin, China
| | - Huilin Zhang
- Department of Oncology of Bone, Tianjin Hospital, Tianjin, China.,The Graduate School, Tianjin Medical University, Tianjin, China
| | - Xiuchun Yu
- Department of Orthopedics, Jinan Military General Hospital, Jinan, China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Forth Military Medical University, Xi'an, China
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Sujia Wu
- Department of Orthopaedics, Nanjing Military General Hospital, Nanjing, China
| | - Shibing Guo
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Guochuan Zhang
- Department of Oncology of Bone, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China
| | - Yongcheng Hu
- Department of Oncology of Bone, Tianjin Hospital, Tianjin, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Hu Y, Zhao L, Zhang H, Yu X, Wang Z, Ye Z, Wu S, Guo S, Zhang G, Wang J, Ning X. Sex Differences in the Recurrence Rate and Risk Factors for Primary Giant Cell Tumors Around the Knee in China. Sci Rep 2016; 6:28173. [PMID: 27321308 PMCID: PMC4913301 DOI: 10.1038/srep28173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022] Open
Abstract
Although giant cell tumor of bone (GCTB) is more common in women in Western countries, it tends to be more common in men in Asian countries. We aimed to determine the sex differences in clinical characteristics, local recurrence rate, and relevant risk factors for local recurrence in primary GCTB around the knee. Between March 2000 and June 2014, patients with primary GCTB around the knee were recruited from 7 institutions in China, and 410 patients were included. The age at diagnosis was younger in women than in men (34.0 vs 37.2 years). The local recurrence rates were 23.4% overall, 25.8% in men, and 20.7% in women. Lower local recurrence rates were observed with en-bloc marginal resection in both men (6.9%) and women (3.1%). With tumors located in the distal femur, the local recurrence rate was higher for men than for women (29.1% vs 14.3%, P = 0.025). Local recurrence was significantly associated with the tumor location and surgical operation in men and only surgical operation in women. These findings suggest that more aggressive operations should be considered in men with GCTB in the proximal fibula.
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Affiliation(s)
- Yongcheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China
| | - Liming Zhao
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China.,The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300071, China
| | - Huilin Zhang
- Department of Orthopedic Oncology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, China.,The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300071, China
| | - Xiuchun Yu
- Department of Orthopedics, The General Hospital of Jinan Military Commanding Region, 25 Shifan Road, Jinan, Shandong 250031, China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Forth Military Medical University, No. 15 West Changle Road, Xincheng District, Xi'an, Shaanxi, 710032, China
| | - Zhaoming Ye
- Centre for Orthopaedic Research, Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310008, China
| | - Sujia Wu
- Department of Orthopaedics, Jin Ling Hospital, 305 Zhong Shan East Road, Nanjing 210002, Jiangsu Province, China
| | - Shibing Guo
- Orthopedics Department, Second Affiliated Hospital of Inner Mongolia Medical University, 1 Yingfang Road, Huimin District, Hohhot, 010050, P.R. China
| | - Guochuan Zhang
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute &Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute &Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
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Zheng K, Yu X, Hu Y, Wang Z, Wu S, Ye Z. Surgical treatment for pelvic giant cell tumor: a multi-center study. World J Surg Oncol 2016; 14:104. [PMID: 27044392 PMCID: PMC4820864 DOI: 10.1186/s12957-016-0862-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to discuss the clinical results which related to the location of giant cell tumors (GCTs) in the pelvis so as to determine the ideal surgical treatment protocol. Methods We report 29 cases who accepted surgical treatment from five clinical centers during the last 12 years. All patients were divided into three groups according to tumor locations, and they were also classified into two groups in light of surgical treatments. The parameters for outcome evaluation consisting of general condition, surgical complications, local disease control, and Musculoskeletal Tumor Society (MSTS) 93 functional score had been analyzed, respectively. Results Surgical treatment in the acetabular area usually resulted in postoperative complications and poor function. One patient who accepted intralesional surgery and two who accepted wide resection had local recurrence. The mean functional score was 25.4 for the 8 patients who received intralesional surgery and 21.9 for the 21 patients who received wide resection. Surgical complications occurred in 1 patient who underwent intralesional surgery and the other 6 patients who underwent wide resection. Conclusions We conclude that surgical treatment of pelvic GCTs in the acetabular area is difficult to select as it is always accompanied by complications and poor function. Compared to wide resection, intralesional surgery combined with a meticulous preoperative planning may lower the recurrence rate and obtain favorable postoperative functional results.
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Affiliation(s)
- Kai Zheng
- Second Military Medical University, Shanghai, China.,Department of Orthopaedics, The General Hospital of Jinan Military Commanding Region, Jinan, Shandong, China.,Giant Cell Tumor Group of China (GTOC), Beijing, China
| | - Xiuchun Yu
- Second Military Medical University, Shanghai, China. .,Department of Orthopaedics, The General Hospital of Jinan Military Commanding Region, Jinan, Shandong, China. .,Giant Cell Tumor Group of China (GTOC), Beijing, China.
| | - Yongcheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China. .,Giant Cell Tumor Group of China (GTOC), Beijing, China.
| | - Zhen Wang
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xian, Shannxi, China.,Giant Cell Tumor Group of China (GTOC), Beijing, China
| | - Sujia Wu
- Department of Orthopaedics, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China.,Giant Cell Tumor Group of China (GTOC), Beijing, China
| | - Zhaoming Ye
- Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Giant Cell Tumor Group of China (GTOC), Beijing, China
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Lin F, Hu Y, Zhao L, Zhang H, Yu X, Wang Z, Ye Z, Wu S, Guo S, Zhang G, Wang J. The epidemiological and clinical features of primary giant cell tumor around the knee: A report from the multicenter retrospective study in china. J Bone Oncol 2016; 5:38-42. [PMID: 26998425 PMCID: PMC4782016 DOI: 10.1016/j.jbo.2016.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives We aimed to determine the demographic characteristics of giant cell tumor around the knee in China. Methods Between March 2000 and June 2014, patients with primary giant cell tumor around the knee were recruited from 6 institutions located in different regions of China, and were reviewed retrospectively the clinical features according to gender and age. Results 334 qualified patients were included in this study. The sex ratio was 1.14:1 (178/156), with mean ages of 36.9 years in men and 33.1 years in women, constituting a significant difference (P=0.007). The prevalence of pathological fracture was 32.9% overall (28.7% in men and 37.8% in women). The prevalence of simple fracture was significantly higher in women (26.3%) than in men (15.2%), P=0.042. Tumor location and staging did not differ significantly according to sex (P>0.05). However, comparing with >40 years old, those patients aged ≤40 were more likely to have a right knee tumor (56.7% vs. 44.7%, P=0.042), less likely to have Enneking stage 3 disease (18.6% vs. 35.0%, P=0.005), and less likely to have both soft-tissue extension and a mass (18.6% vs. 34.0%, P=0.009). Conclusions Giant cell tumor around the knee was more common in men than in women, although female patients were younger on average. Further, cases among patients ≤40 years old were observed to be milder than cases among older patients. The results suggest that efficient treatment and preservation of function should both be valued for young patients with giant cell tumor around the knee. This is the first report of primary GCT around the knee in China. Women are youngerand have a a higher rate of simple pathological fracture than men. Young patients are more likely to have tumor at right knee and to be mild.
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Affiliation(s)
- Fengsong Lin
- Department of Traumatology, Tianjin Hospital, 406 Jiefang South Road, Tianjin 300210, PR China
| | - Yongcheng Hu
- Department of Bone Tumor, Tianjin Hospital, 406 Jiefang South Road, Hexi District, Tianjin 300210, PR China
- Corresponding author.
| | - Liming Zhao
- The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300071, PR China
| | - Huilin Zhang
- The Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300071, PR China
| | - Xiuchun Yu
- Department of Orthopedics, The General Hospital of Jinan Military Commanding Region, 25 Shifan Road, Jinan, Shandong 250031, PR China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Forth Military Medical University, No. 15 West Changle Road, Xincheng District, Xi'an, Shaanxi 710032, PR China
| | - Zhaoming Ye
- Centre for Orthopaedic Research, Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou 310008, PR China
| | - Sujia Wu
- Department of Orthopredics, Jin Ling Hospital, 305 Zhong Shan East Road, Nanjing 210002, Jiangsu Province, PR China
| | - Shibing Guo
- Orthopedics Department, Second Affiliated Hospital of Inner Mongolia Medical University, 1 Yingfang Road, Huimin District, Hohhot 010050, PR China
| | - Guochuan Zhang
- Department of Oncology of Bone, The Third Hospital of Hebei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, PR China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin 300052, PR China
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Chen G, Li J, Li X, Fan H, Guo Z, Wang Z. Giant cell tumor of axial vertebra: surgical experience of five cases and a review of the literature. World J Surg Oncol 2015; 13:62. [PMID: 25889981 PMCID: PMC4340120 DOI: 10.1186/s12957-015-0438-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Due to the complex anatomy of the upper cervical spinal column region and the variable aggressiveness of giant cell tumors (GCTs), there exists no standard treatment for GCTs of axial vertebra. To the best of our knowledge, there are only a few case reports in the literature and no large sum numbers of clinical trials about the treatment of, or research into, axial vertebra GCTs. Methods Between 2009 and 2013, five patients pathologically diagnosed with axial vertebra GCTs were treated at our hospital. We performed intralesional excision and odontoid process reconstructive surgery to preserve the odontoid process, followed with adjuvant radiation therapy after surgery. Results For those with an intact bone shell, part of the β-TCP (beta tricalcium phosphate) artificial bone could be seen clearly after surgery and became blurred three months after surgery, as seen on a radiograph. One year later, the part of β-TCP artificial bone was fused as a block. Subsequently, autogenous bone regenerated successfully and artificial bone degraded thoroughly. For those with a defective cortical bone, partial fusion of the odontoid process, autograft ilium and third vertebra body could be seen three months after surgery, and complete fusion was seen nine months later. The odontoid process was preserved successfully, and the upper cervical spine was reconstructed effectively, without implant failure or infection. Conclusions In this study, the odontoid process and function of upper cervical vertebra was preserved successfully through lesion curettage, combined with reconstruction with bone grafting, and adjuvant radiation therapy after surgery. During the follow-up periods, no recurrence or complications was observed.
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Affiliation(s)
- Guojing Chen
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Xiangdong Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Hongbin Fan
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Zheng Guo
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Changle Road, Xi'an, 710032, People's Republic of China.
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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.
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