Conservative Treatment of Campanacci Grade III Proximal Humerus Giant Cell Tumors

Lackman, Richard D.; Crawford, Eileen A.; King, Joseph J.; Ogilvie, Christian M.

doi:10.1007/s11999-008-0583-y

Cited by 36 publications

(19 citation statements)

References 39 publications

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“…However, to our knowledge, there is no clear definition of "more," "extensive" or "severe" destruction" in grade III GCTs and the reported indications of wide resection for GCT are also heterogeneous [5,7,22,23,30,38]. Furthermore, another dilemma of the application of the system of Campanacci et al is that some authors declared that conservative treatments instead of wide resection should be recommended for grade III GCTs [44,45]. Therefore, the role of the classifications of Enneking and Campanacci et al in planning the initial surgical treatment is limited.…”

Section: The Clinicoradiological System Of Gctmentioning

confidence: 99%

Giant cell tumour of bone: a new evaluating system is necessary

Wang

Wan

2012

International Orthopaedics (SICOT)

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Giant cell tumour (GCT) of bone is still one of the most obscure and intensively studied tumours of bone. The histogenesis of GCT remains unclear. The recommended therapy of GCT evolved during the 20th century. The best treatment should ensure local control and maintain function. Curettage has been the preferred treatment for most GCTs. Good results have also been published on the use of high-speed burr and local adjuvants. Local tumour control can be satisfactorily achieved by wide excision. However, treatment options for GCT have remained fairly static over the past 30 years and there is no widely held consensus regarding the standard treatment selection for all patients. This challenge may result from the fact that there are no single clinical, radiographic, histological or morphological aspects that allow surgeons to accurately predict the trend of a single lesion to recur. In this research, a comprehensive review of the previously described radiographic staging systems by Enneking and Campanacci et al. and the shortfalls associated with them are provided, and then the possible risk factors of predicting local recurrence or evaluating functional outcome of GCT are also discussed. A new preoperative evaluating system of GCT may be necessary and feasible, so that surgeons may accurately assess the aggressiveness or severity of GCT in order to reliably guide treatment decisions and predict outcomes.

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Section: The Clinicoradiological System Of Gctmentioning

confidence: 99%

Giant cell tumour of bone: a new evaluating system is necessary

Wang

Wan

2012

International Orthopaedics (SICOT)

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“…The preoperative and postoperative MSTS scores were 80.04% ± 24.09% (6.67%-100.00%) and 93.19% ± 17.39% (16.67%-100.00%), respectively. Curettage is one of the most common treatment options for benign lytic bone tumors and tumorlike lesions [1][2][3][4][17][18][19]. However, after intralesional curettage of these lesions, highspeed burring, electrocautery, phenol, hydrogen peroxide, liquid nitrogen and absolute alcohol are generally advocated by many surgeons as several adjuvant treatment methods to reduce the rate of local recurrence [4,8,20,21].…”

Section: Fig6 Case 18 a 38-year-old Female Originally Was Diagnosedmentioning

confidence: 99%

“…Giant cell tumor (GCT) is known as one of the most common benign bone tumors. It is locally aggressive and sometimes may metastasize to lungs [19,24,25]. Rock et al had reported a sixfold higher risk of lung metastasis in patients who experienced local recurrence of GCT compared with patients with no history of local recurrence [24].…”

Section: Table1．clinical Details Of Patientsmentioning

confidence: 99%

“…Rock et al had reported a sixfold higher risk of lung metastasis in patients who experienced local recurrence of GCT compared with patients with no history of local recurrence [24]. Local recurrence of GCT is considered as a risk factor for lung metastasis in many studies [19].…”

Section: Table1．clinical Details Of Patientsmentioning

confidence: 99%

“…Some scholars advocate wide resection of GCT affected segment and prosthetic reconstruction to prevent local recurrence in the patients with higher risk. Wide resection of the entire tumor theoretically offers an advantage of lower recurrence risk, but it is usually associated with poor long-term outcome [7,11,[19][20][21]26]. It is reported that local recurrence rate of GCT could be as high as 20% after intralesional curettage, but curettage has advantages of joint preservation and excellent functions [21,27].…”

Section: Table1．clinical Details Of Patientsmentioning

confidence: 99%

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Vascularized Fibular Graft Reconstructing Large Bone Defects after Extended Curettage of Osteolytic Lesions in Lower Extremities

2019

ARC Journal of Clinical Case Reports

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Background: Benign lytic lesions of bone encompass a group of neoplasm or disorders of human skeleton. Planning a treatment protocol for patients with osteolyic lesions of lower extremity involves many concerns of different risks. Especially, the reconstruction of large bony defects following surgical resection of the lesions presents a challenge for the operating surgeon. Materials and Methods: Twenty-three cases of benign bone tumors or tumor-like lesions in the lower extremities treated between April 2013 to March 2016 were retrospectively analyzed. Lesion was scooped out with extended curettage technique and the tumor wall was treated by zinc chloride. Vascularized fibular grafting with or without plate fixation were performed to reconstruct bone defect. The patients were followed up and assessed with the MSTS score (Musculoskeletal Tumor Society score) and radiological images. Results: The mean follow-up term is for 43.1 months, ranging from 24 to 77 months. One patient of giant cell tumor developed recurrence at 12-month follow-up, who finally died from lung metastasis. The other 22 patients showed no sign of recurrence. Overall, there was no evidence of avascular necrosis of fibular graft in any case. The average time of bony union between vascularized fibular graft and the receipt site was 4.3 months (rang, 2-7 months). The mean MSTS scores of pre-operation and post-operation were (80.87 ± 23. 49) % and (93.19 ± 17. 39) %, respectively, which showed that the functional outcomes of affected limbs were averagely restored to excellent level at the final follow-up. Conclusions: The outcomes showed that vascularized fibular grafting following extended curettage and zinc chloride treating is a reliable and effective surgical option in the management of benign bone tumors or tumorlike lesions in the lower extremities.

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How safe and effective is denosumab for bone giant cell tumour?

Errani

Tsukamoto

Mavrogenis

2017

International Orthopaedics (SICOT)

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Recent clinical studies have suggested that denosumab is associated with beneficial tumour response, surgical down-staging, and reduced surgical morbidity in patients with giant cell tumour of bone. However, these studies reported results of patients still on denosumab treatment, or patients after denosumab treatment but with a short follow-up. Other studies reported that the new osseous tumour matrix and thickened cortical bone that develop with denosumab treatment does not allow the surgeon to delineate the true extent of the tumour, and probably increases the risk for local recurrence. A study showed that cell proliferation is only diminished by denosumab; the cells continue to proliferate in vitro, albeit at a slower rate. More importantly, nine cases of malignant transformation of GCT during denosumab therapy without previous radiation exposure have been reported; inhibition of RANKL may increase the risk of new malignancies due to immunosuppression. With these concerns in mind, this article is an attempt to put essential information in one place, creating a comprehensive review that the curious reader would find interesting and informative.

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Conservative Treatment of Campanacci Grade III Proximal Humerus Giant Cell Tumors

Abstract: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 36 publications

References 39 publications

Giant cell tumour of bone: a new evaluating system is necessary

Giant cell tumour of bone: a new evaluating system is necessary

Vascularized Fibular Graft Reconstructing Large Bone Defects after Extended Curettage of Osteolytic Lesions in Lower Extremities

How safe and effective is denosumab for bone giant cell tumour?

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