Cement is recommended in intralesional surgery of giant cell tumors: A Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years

Abstract

Background Giant cell tumors of bone rarely metastasize but often recur locally after surgery. There is limited knowledge about the risk of recurrence related to different types of treatment.Patients and methods We analyzed factors affecting the local recurrence rate in 294 patients with giant cell tumors of the extremities using prospectively collected material from 13 centers. The median follow-up time was 5 (0.2-18) years.Results A local recurrence was diagnosed in 57 of 294 patients (19%). The overall 5-year local recurrence rate was 0.22. Univariate analysis identified young age and intralesional surgery to be associated with a higher risk of recurrence. Based on multivariate analysis, the relative risk was 2.4-fold for intralesional surgery compared to more extensive operative methods. There was no correlation between tumor size, tumor extension, sex of the patient, tumor location, or fracture at diagnosis and outcome. In the subgroup of 200 patients treated with intralesional surgery, the method of filling (cement or bone) was known for 194 patients and was statistically highly significant in favor of the use of cement.Interpretation Intralesional surgery should be the first choice in most giant cell tumors, even in the presence of a pathological fracture. After thorough evacuation, the cavity should be filled with cement.

Which Treatment is the Best for Giant Cell Tumors of the Distal Radius? A Meta-analysis

“…Some studies have reported a lower risk of local recurrence with the use of PMMA for curetted cavities [2,4,20,21]. However, we found that tumor recurrence for patients who received PMMA did not differ from patients who underwent a bone graft.…”

“…In addition, delayed recurrence has been reported as much as 20 years after treatment [45]. However, 75% to 80% of patients have experienced recurrence of GCTs within 2 years [14,19,20,26,40]. Sixth, different adjuvants were used (eg, phenol, cryosurgery, high-speed burr) in the curettage group reviewed.…”

Joint Preservation after Extensive Curettage of Knee Giant Cell Tumors

“…Giant cell tumor is difficult to treat, but preservation of the joint through extensive curettage should be considered a priority [11]. This condition usually leaves a large cortical defect originating either by aggressive tumor growth or by the surgeon in an attempt to obtain adequate access to the tumor cavity while performing the curettage.…”

“…The treatment of giant cell tumors (GCTs) remains a difficult problem and surgical options are intralesional excision (curettage) or en bloc resection of the tumor [6,7,9,11,14,16,20,22]. Curettage is the most attractive method because it preserves autologous structures, bone architecture, and native joint cartilage; however, a higher rate of local tumor recurrence has been reported with this method [11].…”

“…Curettage is the most attractive method because it preserves autologous structures, bone architecture, and native joint cartilage; however, a higher rate of local tumor recurrence has been reported with this method [11]. Most surgeons agree that the major factor in the success of local tumor control is how thoroughly the tumor is excised [1,2,18,21]; for this reason, a large cortical window is necessary for appropriate visualization of the entire tumor cavity to obtain extensive curettage.…”