CLINICAL OBSERVATION OF SURGICAL MANAGEMENT FOR RECURRENT GIANT CELL TUMOR OF BONE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

KONG Qingquan , YANG Jin , XING Rong , TU Chongqi , ZHOU Yong , ZHANG Hui , DUAN Hong.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: TU Chongqi, E-mail: tuchongqi@163.com;

Corresponding author：

Keywords：

Bone giant cell tumor; Tumor recurrence; Surgical treatment; Pulmonary metastasis

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Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.

Citation： KONG Qingquan,YANG Jin,XING Rong,TU Chongqi,ZHOU Yong,ZHANG Hui,DUAN Hong.. CLINICAL OBSERVATION OF SURGICAL MANAGEMENT FOR RECURRENT GIANT CELL TUMOR OF BONE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 36-40. doi: Copy

1.	Balke M, Schremper L, Gebert C, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol, 2008, 134(9): 969-978.
2.	Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res, 2011, 469(2): 591-599.
3.	Gupta R, Seethalakshmi V, Jambhekar NA, et al. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol, 2008, 12(4): 239-248.
4.	Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res, 1995, (321): 245-250.
5.	Balke M, Ahrens H, Streitbuerger A, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol, 2009, 135(1): 149-158.
6.	Pietschmann MF, Dietz RA, Utzschneider S, et al. The influence of adjuvants on local recurrence rate in giant cell tumour of the bone. Acta Chir Belg, 2010, 110(6): 584-589.
7.	Wan R, Zhang W, Xu J, et al. The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton. J Orthop Sci, 2012, 17(4): 464-469.
8.	Balke M, Campanacci L, Gebert C, et al. Bisphosphonate treatment of aggressive primary, recurrent and metastatic Giant Cell Tumour of Bone. BMC Cancer, 2010, 10: 462.
9.	Kriz J, Eich HT, Mücke R, et al. Radiotherapy for giant cell tumors of the bone: a safe and effective treatment modality. Anticancer Res, 2012, 32(5): 2069-2073.
10.	Bhatia S, Miszczyk L, Roelandts M, et al. Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study. Rare Tumors, 2011, 3(4): e48.
11.	Tse LF, Wong KC, Kumta SM, et al. Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case-control study. Bone, 2008, 42(1): 68-73.
12.	Klenke FM, Wenger DE, Inwards CY, et al. Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res, 2011, 469(4): 1181-1187.
13.	Yu XC, Xu M, Song RX, et al. Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis. Orthop Surg, 2010, 2(3): 211-217.
14.	Lv C, Tu C, Min L, et al. Allograft arthrodesis of the knee for giant cell tumors. Orthopedics, 2012, 35(3): e397-402.
15.	毕郑钢, 潘琦, 付春江, 等. 吻合血管腓骨小头移植重建腕关节治疗桡骨远端骨巨细胞瘤. 中国修复重建外科杂志, 2010, 24(12): 1416-1418.
16.	Arredondo-Gómez E, Pasos Novelo FJ, Vargas Mena R. Treatment of recurrent giant cell tumor of the tibia with en bloc resections, bone transport and arthrodesis using an AO type external fixations system. A case report. Acta Ortop Mex, 2009, 23(2): 98-102.
17.	Kim H, Lee SK, Kim KJ, et al. Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop, 2009, 33(3): 835-841.
18.	Anract P, De Pinieux G, Cottias P, et al. Malignant giant-cell tumours of bone. Clinico-pathological types and prognosis: a review of 29 cases. Int Orthop, 1998, 22(1): 19-26.
19.	Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer, 2003, 97(10): 2520-2529.
20.	Takeuchi A, Tsuchiya H, Niu X, et al. The prognostic factors of recurrent GCT: a cooperative study by the Eastern Asian Musculoskeletal Oncology Group. J Orthop Sci, 2011, 16(2): 196-202.

1. Balke M, Schremper L, Gebert C, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol, 2008, 134(9): 969-978.
2. Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res, 2011, 469(2): 591-599.
3. Gupta R, Seethalakshmi V, Jambhekar NA, et al. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol, 2008, 12(4): 239-248.
4. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res, 1995, (321): 245-250.
5. Balke M, Ahrens H, Streitbuerger A, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol, 2009, 135(1): 149-158.
6. Pietschmann MF, Dietz RA, Utzschneider S, et al. The influence of adjuvants on local recurrence rate in giant cell tumour of the bone. Acta Chir Belg, 2010, 110(6): 584-589.
7. Wan R, Zhang W, Xu J, et al. The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton. J Orthop Sci, 2012, 17(4): 464-469.
8. Balke M, Campanacci L, Gebert C, et al. Bisphosphonate treatment of aggressive primary, recurrent and metastatic Giant Cell Tumour of Bone. BMC Cancer, 2010, 10: 462.
9. Kriz J, Eich HT, Mücke R, et al. Radiotherapy for giant cell tumors of the bone: a safe and effective treatment modality. Anticancer Res, 2012, 32(5): 2069-2073.
10. Bhatia S, Miszczyk L, Roelandts M, et al. Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study. Rare Tumors, 2011, 3(4): e48.
11. Tse LF, Wong KC, Kumta SM, et al. Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case-control study. Bone, 2008, 42(1): 68-73.
12. Klenke FM, Wenger DE, Inwards CY, et al. Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res, 2011, 469(4): 1181-1187.
13. Yu XC, Xu M, Song RX, et al. Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis. Orthop Surg, 2010, 2(3): 211-217.
14. Lv C, Tu C, Min L, et al. Allograft arthrodesis of the knee for giant cell tumors. Orthopedics, 2012, 35(3): e397-402.
15. 毕郑钢, 潘琦, 付春江, 等. 吻合血管腓骨小头移植重建腕关节治疗桡骨远端骨巨细胞瘤. 中国修复重建外科杂志, 2010, 24(12): 1416-1418.
16. Arredondo-Gómez E, Pasos Novelo FJ, Vargas Mena R. Treatment of recurrent giant cell tumor of the tibia with en bloc resections, bone transport and arthrodesis using an AO type external fixations system. A case report. Acta Ortop Mex, 2009, 23(2): 98-102.
17. Kim H, Lee SK, Kim KJ, et al. Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop, 2009, 33(3): 835-841.
18. Anract P, De Pinieux G, Cottias P, et al. Malignant giant-cell tumours of bone. Clinico-pathological types and prognosis: a review of 29 cases. Int Orthop, 1998, 22(1): 19-26.
19. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer, 2003, 97(10): 2520-2529.
20. Takeuchi A, Tsuchiya H, Niu X, et al. The prognostic factors of recurrent GCT: a cooperative study by the Eastern Asian Musculoskeletal Oncology Group. J Orthop Sci, 2011, 16(2): 196-202.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL OBSERVATION OF SURGICAL MANAGEMENT FOR RECURRENT GIANT CELL TUMOR OF BONE

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