Clinical outcomes of giant cell tumor of bone treated with bone cement filling and internal fixation, and oral bisphosphonates

Abstract

Giant cell tumor (GCT) of the bone is a relatively common primary bone tumor. Treatment with simple curettage often results in a high local recurrence rate. Tumor resection and reconstruction with prosthesis or an allograft has a low rate of local recurrence; however, the patient’s native joint function becomes significantly impaired. With the development and usage of aggressive curettage, it is a priority to treat GCT with a method that reduces the local recurrence rate and preserves the native joint. To evaluate the feasibility of treating GCT with aggressive curettage and cement filling using internal fixation and oral bisphosphonates, 16 patients with GCT of the bone located in the distal femur and treated in our department from January 2008 to June 2011, were followed up. The patients had received aggressive curettage, bone cement filling, internal fixation and oral administration of bisphosphonates.There were seven males and nine females in total, with a mean age of 38 years. All patients were carefully assessed prior to surgery in order to determine the integrity of the tumor cavity. Subsequently, patients were treated with aggressive curettage by high-speed burring and cementation with internal fixation, and were administered postoperative oral alendronate sodium tablets (10 mg/day) for two years. The median follow-up time was 25 months. None of the patients were lost to follow-up. No local recurrence or metastasis was observed in the last follow-up. The Enneking limb function score range of the affected limb was 24–29 (average, 26.7). At the last follow-up, all patients exhibited solid fixation without fracture of the subchondral bone in plain radiographs. Based on these data, we suggest that patients with distal femoral GCT may be treated with aggressive curettage and cement filling, with internal fixation and oral bisphosphonates. The advantages of this method are its safety and efficacy. However, the long-term outcomes require further investigation.

Bortezomib Inhibits Giant Cell Tumor of Bone through Induction of Cell Apoptosis and Inhibition of Osteoclast Recruitment, Giant Cell Formation, and Bone Resorption

“…Bisphosphonates, the frequently used drugs for treating osteoporosis by encouraging osteoclasts to undergo apoptosis, or cell death, have already been used for treating GCTB in China and France (15)(16)(17). Denosumab, the human mAb against RANKL, also is a proven agent for treating osteoporosis and solid tumor bone metastases by inhibiting osteoclast differentiation.…”

“…2A). However, the bisphosphonate, zoledronic acid, which has been used for treating GCTB in China and France (15)(16)(17), had little effect on GCTB cell growth ( Fig. 2A).…”

“…Bisphosphonates, which are standard drugs for treating osteoporosis, have been used for treating GCTB in China (15,16) and France (17). Recently, denosumab has been approved by the FDA for the treatment of unresectable GCTB (18).…”

Surgical treatment for pelvic giant cell tumor: a multi-center study

“…It is widely accepted that intralesional surgery can spare nerve roots, pelvic support, and the hip and visceral structures, whereas it has a high risk of local recurrence, even for a recurrent GCT. Various adjuvant modalities have been used to supplement intralesional surgery in order for a low recurrence rate, which include the use of cytotoxic agents such as phenol [16], zinc chloride [26], ethanol [14], and physical adjuvants such as polymethylmethacrylate [13, 14, 27], cryosurgery [13], microwave inactivation [28], and a high-speed burr drill [13, 14]. Besides, a study shows that curettage based on CT classification can also lower the recurrence rate [29].…”

Management of cystic bony lesions at a tertiary health centre in North-West Nigeria

“…The use of oral bisphosphonase and denosumab have been use in addition to the sandwich technique to reduce the incidence of recurrence. Bisphosphonase treatment is said to reduce tumour size, induce apoptosis of osteoclast and neoplastic cells [22,23]. Denosumab is being tried due to its effects as a receptor activator of nuclear factor-KB ligand [24].…”