A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius

Abstract

Introduction: Surgical management of Giant Cell Tumor of Bone of the distal radius (GCTDR) remains controversial due to risk of local recurrence (LR) offset by functional limitations which result from en-bloc resection. This study aims to determine the oncologic and functional outcomes of wide excision (WE) vs intralesional curettage (IC) of GCTDR.Methods: A complete search of the applicable literature was done. Included studies reported on patients from the same cohort who were surgically treated for GCTDR with WE or IC. Two reviewers independently assessed all papers. The primary outcome measure was LR.Results: One-hundred-forty-one patients from six studies were included: 60 treated with WE, and 81 with IC. Five WE patients (8%) suffered LR whereas 25 IC patients (31%) did. The odds of LR were three times less in the WE group vs the IC group. MSTS1993 scores, where available, were on average 'good' with WE and 'excellent' with IC.Conclusions: Within statistical limitations the data support an attempt, where feasible, at wrist joint preservation and superior function with IC. Intralesional curettage is reasonable when the functional benefit outweighs the risk of recurrence as is the case in many cases of GCT of the distal radius.

Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

“…A total of 11% (three of 27) of our patients experienced a local recurrence, which is comparable to that published in other studies and analyzed in recent meta-analyses [23,34]. In contrast, local recurrence after intralesional excision is as high as 31% [23,34].…”

“…As such the defects created are particularly amenable to reconstruction with autogenous structural ICBG. Some authors favor the use of vascularized fibula grafts for the benefits of prompt bony union, the option to include skin to address soft tissue defects, and durability of the reconstruction [8,25,34]. On the other hand, the use of nonvascularized fibular grafts has the advantage of being less technically demanding.…”

“…In contrast, local recurrence after intralesional excision is as high as 31% [23,34]. In a series of 15 patients with Grade III GCT of the distal radius, Kang et al [19] used limited intralesional excision and cementation for nine patients with limited volar cortical involvement that was contained by the overlying pronator quadratus; 22% of them experienced recurrences.…”

Clinical effects of three surgical approaches for a giant cell tumor of the distal radius and ulna

“…Liu et al (10) reported that patients in the intralesional excision group exhibited a higher recurrence rate, particularly for Campanacci's III Grade GCT compared with the en bloc resection group (10). Pazionis et al (11) reported that the odds of local recurrence were three times less in the en bloc resection group (n=60) compared with the intralesional excision group (n=81). Considering the high local recurrence risk of curettage, the 23 patients with Campanacci's grade II and III GCT of the distal radius and ulna were all treated with en bloc resection, and only one patient (1/23; 4.3%) relapsed.…”

“…Numerous previous studies have identified the distal radius and ulna as being particularly prone to recurrence. To date, the ideal treatment methods for GCTs of the distal ulna and radius remain controversial (10)(11)(12). En bloc resection of GCT provides lower rates of recurrences, which also sacrifices the joint, results in a major reconstruction, and the functional outcomes are questionable.…”