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Different MRI findings between bone grafts and bone cement group after agreessive curettage during follow up. The coronal T 1 WI (A) and coronal fat-suppressed T 2 WI (B) showed that the band signal around the area filled with bone cement. No similar
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Background
Aggressive curettage has been well established for the treatment of giant cell tumors (GCTs) of the bone. The purpose of this study was to review our experience and evaluate the role of different implant materials in patients with GCTs of the extremities after aggressive curettage.
Methods
A total of 119 patients with GCTs of the long b...
Similar publications
Giant cell tumors (GCTs) are benign bone lesions which are treated with curettage and bone grafting. Infrequently, GCTs show local site recurrences which are then treated with either surgical excision or radiation therapy. Radiation-induced sarcoma is rarely seen as a late complication of radiation therapy which needs to be differentiated from recu...
Background
Malignant transformation of giant cell tumors of bones, that is, secondary malignant giant cell tumor of bone, is rare. The most common symptoms are local pain and swelling. There are no prior reports of giant cell tumor of bone with fever of unknown origin at the onset. Here we present a case of a secondary malignant giant cell tumor of...
Background and objective
There is scarce data on demography and different surgical treatment modalities for giant cell tumor of bone (GCTB) from eastern India. In light of this, the present study aimed to examine the demographic characteristics, different surgical treatment modalities, and recurrence rate of GCTB at a tertiary care institute in Bih...
The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore...
Citations
... A further nine studies reported 0 complications in their respective cohorts (altogether 436 patients) [17,21,23,24,32,43,49,54,63]. In the remaining 40 studies (involving 2296 patients), at least one complication had been observed [7][8][9][10]12,15,16,18,20,[25][26][27][29][30][31]33,34,37,38,[40][41][42]45,46,48,[50][51][52][53]55,[57][58][59][60][61][64][65][66][67][68]. Thus, 263 complications occurred in 2732 patients with information on adverse events available, amounting to an overall complication rate of 9.6%. ...
Local adjuvants are used upon intralesional resection of benign/intermediate bone tumours, aiming at reducing the local recurrence (LR) rate. However, it is under debate whether, when and which local adjuvants should be used. This PRISMA-guideline based systematic review aimed to analyse studies reporting on the role of adjuvants in benign/intermediate bone tumours. All original articles published between January 1995 and April 2020 were potentially eligible. Of 344 studies identified, 58 met the final inclusion criteria and were further analysed. Articles were screened for adjuvant and tumour type, follow-up period, surgical treatment, and development of LR. Differences in LR rates were analysed using chi-squared tests. Altogether, 3316 cases (10 different tumour entities) were analysed. Overall, 32 different therapeutic approaches were identified. The most common were curettage combined with high-speed burr (n = 774; 23.3%) and high-speed burr only (n = 620; 18.7%). The LR rate for studies with a minimum follow-up of 24 months (n = 30; 51.7%) was 12.5% (185/1483), with the highest rate found in GCT (16.7%; 144/861). In comparison to a combination of curettage, any adjuvant and PMMA, the sole application of curettage and high-speed burr (p = 0.015) reduced the LR rate in GCT. The overall complication rate was 9.6% (263/2732), which was most commonly attributable to postoperative fracture (n = 68) and osteoarthritis of an adjacent joint during follow-up (n = 62). A variety of adjuvants treatment options are reported in the literature. However, the most important step remains to be thorough curettage, ideally combined with high-speed burring.
... While polymethylmethacrylate cement is widely used with good outcomes, it has been associated with growth arrest in immature skeletons [14]. Conversely, benign orthopaedic tumour recurrence can be higher in bone graft compared to cement filler [18]. Other studies show no difference in outcomes based on filling material [17]. ...
Introduction and importance:
Chondroblastoma is a benign cartilaginous tumour that usually presents in the epiphysis of long bones in patients aged 10-20 years old. Only 4 % of primary chondroblastoma occur in the talus. Recurrence is rare, especially in the foot and ankle and there is no consensus regarding how it is best managed. This unique case and literature review add to a limited evidence base.
Case presentation:
A 21-year-old male was referred to our elective orthopaedic clinic with persistent anterior ankle pain exacerbated by weight-bearing. Radiographs and MRI revealed a 2.5 cm non-homogenous mass in the anteromedial talus with expansion of overlying bone consistent with chondroblastoma-ABC. Our patient was initially managed by intralesional curettage and autologous bone grafting but had recurrence 4.5 months postoperatively. Subsequent en bloc resection of the talar neck with talonavicular and calcaneocuboid joint fusion resulted in excellent functional outcomes and disease-free survival at 2 years follow-up.
Clinical discussion:
There are few reports discussing treatment options for recurrence in the foot and ankle. Successful treatment of primary and recurrent lesions depends on complete local resection. Repeat curettage or en bloc resection are effective options depending on tumour size and location. Type of bone graft or void filler should be considered on a case-by-case basis. Novel therapies (e.g. phenol instillation) may be beneficial.
Conclusion:
This case details successful management of recurrent chondroblastoma with en bloc resection of the talar neck and hindfoot reconstruction. We review the efficacy and outcomes of all previously reported recurrent chondroblastoma in the foot and ankle. We highlight multiple potential treatment options.
... Other similar studies are mostly based on a single histological diagnosis, most frequently the diagnosis of a giant cell tumour of bone (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Predictive factors of recurrence after intralesional excision were sometimes only identified, and other times also statistically evaluated. ...
... Predictive factors, researched in other studies, include tumour localization (31), the occurrence of another bone tumour simultaneously with a giant cell tumour of bone (32), usage of different surgical adjuvants (bone cement (33,34), phenol (35)), occurrence of pathological fractures (36) and microscopic characteristics of surrounding tissue (37). Other histological diagnoses to be more frequently found in similar studies are chondroblastoma (38)(39)(40)(41), aneurismal bone cyst (42), osteoblastoma (43), and enchondroma (44). ...
Background: Most aggressive benign bone tumours are treated surgically by an intralesional excision and bone defect filling. The primary aim of our study was to evaluate prognostic factors of recurrence after an intralesional excision of a benign bone tumour in the peripheral skeleton. We asked whether patient age and gender, maximal tumour diameter, histological diagnosis, and the tumour’s location statistically significantly impact postoperative tumour recurrences. The secondary aim was to evaluate preoperative differences between different histopathological groups of benign bone tumours and the impact of age and gender, maximal tumour diameter, histological diagnosis, and the tumour location on the number of diagnostic biopsies and curative surgical procedures.
Methods: Retrospective analysis of prospectively collected data included a cohort of patients operated on at a single tertiary tumour centre between 2010 and 2020 with at least one-year follow-up. Ordinal logistic regression was used to assess the influence of input variables on the number of diagnostic/curative surgical procedures and postoperative recurrences.
Results: The cohort analysis included 261 patients with 61 local recurrences. The risk of tumour recurrence was significantly lower with higher patient age (p = 0.001) and tumour location in the distal femur (p = 0.033). Higher number of diagnostical procedures correlated with higher patient age (p = 0.028), larger maximal tumour diameter (p = 0.035) and connective tissue tumour diagnosis (p = 0.027). Higher number of curative procedures correlated with larger maximal tumour diameter (p = 0.008) and lower patient age (p = 0.001).
Conclusions: Preoperative features of benign bone tumours significant impact the number of surgical procedures needed to treat the tumour and the risk of postoperative recurrence. Although most of these factors are nonmodifiable, they represent an incentive to create evidence-based guidelines for biopsy indications, surgical techniques and consistent postoperative follow-up.
... The standard therapy for resectable GCTB without possible postoperative large bone defect has been curettage with local adjuvant treatment, and its local recurrence proportion has been as high as 24.6-30.8% of patients (3)(4)(5)(6), whereas distant recurrence has been reported in 2% of patients after curettage (7,8) usually occurring in lung. Surgical treatment remains the mainstay of treatment for GCTB, and both elimination of tumor cells and joint preservation are major goals of GCTB treatment. ...
Objectives
The aim of JCOG1610 (randomized controlled phase III trial) was to confirm the superiority of preoperative denosumab to curettage with adjuvant local therapy for patients with giant cell tumor of bone without possible post-operative large bone defect.
Methods
The primary endpoint was relapse-free survival and the total sample size was set at 106 patients. Patient accrual began in October 2017. However, the accrual was terminated in December 2020 due to a recommendation from the Data and Safety Monitoring Committee because of poor patient accrual. Now, we report the descriptive results obtained in this study.
Results
A total of 18 patients had been registered from 13 Japanese institutions at the time of termination on December 2020. Eleven patients were assigned to Arm A (curettage and adjuvant local therapy) and 7 to Arm B (preoperative denosumab, curettage and adjuvant local therapy). Median follow-up period was 1.6 (range: 0.5–2.8) years. Protocol treatment was completed in all but one patient in Arm A who had a pathological fracture before surgery. All patients in Arm B were treated with five courses of preoperative denosumab. Relapse-free survival proportions in Arm A and B were 90.0% (95% confidence interval: 47.3–98.5) and 100% (100–100) at 1 year, and 60.0% (19.0–85.5) and 62.5% (14.2–89.3) at 2 years, respectively [hazard ratio (95% confidence interval): 1.51 (0.24–9.41)].
Conclusion
In terms of relapse-free survival, the superiority of preoperative denosumab was not observed in patients with giant cell tumor of bone without possible post-operative large bone defect.
... 25 Klenke et al. 26 evaluated 41 patients submitted to intralesional curettage treatment, and observed a recurrence rate of 25% and a mean interval of recurrence of 16 AE 12 months; subjects treated with local methyl methacrylate and phenol had a better recurrence-free survival rate (85%) compared to those submitted to a bone graft with the application of phenol (66%); as such, the use of phenol did not improve the recurrence-free rate. 26 Lackman et al. 27 29 reported local recurrence in 12.9% of the cases treated with curettage and cementation, including 81.3% within the first 2 years of follow-up. ...
Resumen
Objetivo Identificar la tasa de recurrencia de tumor de células gigantes (TCG) en pacientes tratados con curetaje y cementación con seguimiento mínimo de tres años.
Material y métodos Cohorte retrospectiva y observacional de pacientes con diagnóstico de TCG en estadios 1 y 2 de Enneking tratados con curetaje intralesional y cementación entre 1981 y 2011. Se registraron edad, sexo, región anatómica, y tiempo de recurrencia. Se utilizó estadística descriptiva con medidas de tendencia central y medidas de dispersión (desviación estándar) para variables cuantitativas, y porcentajes para variables cualitativas.
Resultados Entre 1981 y 2011, se identificaron 375 casos de TCG, de los cuales 141 (37,6%) fueron tratados con este método. El seguimiento fue de 48 a 240 meses, y la edad, de 27 ± 9 años; 45% de los pacientes eran mujeres, y 55%, varones, con una relación mujer:hombre de 1,2:1. El hueso más afectado fue la tibia (38%), seguida del fémur (32%), del húmero (16%), y del radio (10%). En 88,6%, la resección fue curetaje intralesional, y el resto, marginal. Hubo 15,7% de casos de TCG con fractura, y recidiva en 12,7%.
Discusión Se ha demostrado que este método de tratamiento reduce el riesgo de recurrencia por los efectos adyuvantes locales de la cementación acrílica. La recurrencia ocurre en los dos primeros años de seguimiento. Sin embargo, hay autores que respaldan que el margen quirúrgico es el único factor que influencia el riesgo de recurrencia local. La extensión extraósea del TCG no es contraindicación para curetaje intralesional y adyuvante con metilmetacrilato.
Conclusiones Reportamos tasa una de recurrencia similar a la de la literatura, siendo un recurso factible de reconstrucción de miembros.
... Arbeitsgemeinshaft et al. reported local recurrence rates of 22 and 49%, respectively, for GCTB treated with curettage with and without PMMA (14). Similarly, Balke et al. (46). However, several reports indicated no statistical impact of PMMA use on the recurrence risk (12,17,47). ...
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.
... The more aggressive curettage is recommended for locally aggressive tumors to achieve better local control (Gao et al., 2014;Machak and Snetkov, 2021). The more aggressive curettage causes the bone defects to increase, and increased bone defects cause the bone to become weaker under compressive loads (Ghouchani et al., 2020). ...
Background
Ideal treatment method based on the size of the defect in local aggressive bone tumors is yet to be described. We evaluated the mechanical behavior of different fixation methods for various defect sizes located in the proximal tibia.
Methods
Ninety-one sheep tibiae were distributed in five groups. Each study group was further divided into three subgroups, forming 25%, 50%, and 75% metaphyseal defects. The five groups were divided as follows: 1) control group where tibiae remained intact (n = 7); 2) isolated defect created, without filling (n = 21); 3) filling with cement (n = 21); 4) application of two subchondral cortical screws in addition to cement (n = 21); and 5) application of plate-screw fixation in addition to cement (n = 21). A loading test simulating the axial load applied by the distal femur to the tibia plateau was performed. The maximum failure load was compared between groups according to the defect size and fixation method.
Findings
In 25% defects, group 5 had significantly higher failure load than other groups. However, in 50% and 75% defects, additional fixation did not increase the failure load. Also, additional screw fixation did not increase failure load in all defect sizes. There was a significant positive correlation between fracture morphology and defect size, fixation method, and failure load.
Interpretation
Additional plate-screw fixation would increase the stability in defects ≤25%. In defects ≥50%, additional fixation does not increase stability. Screw fixation in addition to cementing does not increase stability in all defect sizes.
... In this study an intralesional curettage was performed in 90 cases, combined with the use of a high-speed burr, hydrogen peroxide and bone cement for defect reconstruction. Gao et al. [18] reported about a local recurrence rate of 13% after Fig. 3. a-e: case of a 39-year-old female patient with GCTB of the proximal tibia: 3a: radiographs (left and middle) and MRI-scan (middle and right) of the proximal tibia showing an osteolysis; 3b: postoperative radiograph after intralesional curettage and defect reconstruction with bone cement; 3c radiographs of first local recurrence 18 months after surgery; 3d: radiographs (left and middle) and MRI-scan (middle and right) of second local recurrence 9 months after second curettage; 3e: radiographs of a modular tumor endoprosthesis which had to be implanted due to massive bone defect. ...
... The authors reported a recurrence rate of 41% after intralesional curettage with the use of hydrogen peroxide. In other studies, the local recurrence rate of GCTB after intralesional curettage ranged from 13% À 50% [8,[18][19][20]. In the present study the local recurrence rate after the standard treatment of intralesional curettage with the use of a high-speed burr, hydrogen peroxide as adjuvant and defect filling with bone cement was 42.2% (38/90 cases) and thus comparably high. ...
Background
Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor that represents about 4-5% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and may include intralesional curettage with adjuvants or, in rare cases, wide resection. In recent years the monoclonal antibody denosumab has been introduced as a potential (neo-)adjuvant systemic treatment option for patients with borderline resectable or unresectable lesions. Currently several studies reported that the use of denosumab prior to curettage possibly increase the risk of local recurrence
Methods
In this retrospective study we reviewed 115 cases of GCT with a mean follow-up of 65.6 (24-404) months who underwent a surgical treatment with or without preoperative denosumab therapy in our institution. Potential risk factors for LR and complications were analyzed.
Results
The study includes 47 male (40.9%) and 68 female (59.1%) patients with a mean age of 33.9 (10-77) years and a mean follow-up of 65.6 (24-404) months. Denosumab was used in 33 (28.7%) cases, in 14 cases (12.2%) in a neoadjuvant setting and in 17 cases preoperatively before re-curettage (14.8%) after LR. In 105 cases (91.3%) an intralesional curettage was performed. The overall LR rate was 47.8% (55 cases). Patients who underwent intralesional curettage and bone cement augmentation without neoadjuvant denosumab treatment had LR in 42.2% (38/90) of the cases. Patients who underwent neoadjuvant denosumab treatment prior to curettage had LR in 28.6% (4/14). Re-recurrence was frequent in patients with neoadjuvant denosumab treatment who had LR after initial curettage (50%, 8/16). After wide resection and endoprosthetic replacement one case (20%) of local recurrence was detectable (1/5 cases).
Conclusions
GCTB recurs frequently after intralesional curettage and cement augmentation. While denosumab is a potential (neo-)adjuvant treatment option that might be used for lesions that are difficult to resect, surgeons should be aware that LR is still frequent.
... There is no consensus about the follow-up, but these patients must be periodically checked on with imaging exams [53][54][55][56]. Metastases affect 2-3% of GCTB and develop almost exclusively from the lungs (especially if the primary tumor arises from the spine). ...
Nonmalignant bone tumors represent a wide variety of different entities but maintain many common features. They usually affect young patients, and most can be diagnosed through imaging exams. Often asymptomatic, they can be discovered incidentally. Due to their similarities, these tumors may be challenging to diagnose and differentiate between each other, thus the need for a complete and clear description of their main characteristics. The aim of this review is to give a picture of the benign bone tumors that clinicians can encounter more frequently in their everyday work.
... Shows eccentric epiphyseal and purely lytic. Soft tissue extension can be determined by MRI may reveal secondary aneurysmal bone cyst (20%) [6], [7]. Histologically GCT are multinucleated giant cells (typically 40 to 60 nuclei per cell) in a sea of mononuclear stromal cells. ...
Introduction: Giant cell tumor (GCT) is a distinctive lesion characterized by the proliferation of multinucleate giant cells in a stroma of mononuclear cells; it is generally seen in skeletally mature individuals. GCT is usually found in the long bones around the knee or in the distal radius but distal end of tibia, proximal humerus, vertebrae of young adults are unusual location. We report a case of GCT of the distal end of tibia, with a secondary aneurysmal bone cyst, in a 26-year-old female. Based on our review of the medical literature, it appears that the occurrence of a GCT along with a secondary aneurysmal bone cyst (ABC) in distal end of tibia is less typical with challenging task for full tumor resection and restoration of ankle function to normal. Case Summary: 26 year old female presented with pain&swelling over left ankle since last six month. Biopsy was suggestive of GCT with ABC of lower third tibia. We managed this case with intralesional curettage using phenol and burr and bone graft harvested from left iliac crest for reconstruction of defect along with kwire fixation to achieve optimum anatomical restoration. Conclusion: In cases of GCT, the management depends upon the various factors such as site, age, involvement of the bone, extent of bone involvement and whether there is articular involvement or not. Here Intra-articular GCT is managed with extended intralesional curettage with phenol. Bone graft plays a role of agent for reconstruction of the defect and kwire for anatomical reduction.
