Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Wysocki, Robert; Soni, Emily E. Carmody; Virkus, Walter W.; Scarborough, Mark T.; Leurgans, Sue E.; Gitelis, Steven

doi:10.1007/s11999-014-4054-3

Cited by 55 publications

(68 citation statements)

References 38 publications

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“…and Chadha et al . reported one recurrence in 12 and 9 patients, respectively, and Murray and Schlafly reported a recurrence rate of 27.7% in 18 patients. Compared with this last result, our relatively lower recurrence rate is likely attributable to the relatively short duration of follow‐up: our mean follow‐up was 3.5 years, whereas that of Murray's was 7.1 years.…”

Section: Discussioncontrasting

confidence: 45%

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Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor

Wang

et al. 2016

Orthopaedic Surgery

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Section: Discussioncontrasting

confidence: 45%

“…Many techniques have been used to reconstruct the defects, including vascularized/non‐vascularized fibular grafts, osteoarticular allografts, partial/total wrist arthrodesis and custom‐made prostheses. Each technique has its own unique possible advantages and disadvantages, which has been thoroughly discussed and debated .…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor

Wang

et al. 2016

Orthopaedic Surgery

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“…The present study suggested that en bloc resection and reconstruction can be used as the standard initial treatment method for Campanacci's grade II and III GCT. Wysocki et al (12) suggested that curettage can be considered for the initial treatment for Campanacci's grade II and III GCT of the distal radius, since en bloc resection can be performed if tumor recurrence occurred. However, secondary surgery not only increases the expense of the patients, it also increases the risk of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2016

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to assess the curative effects of three surgical approaches for a giant cell tumor (GCT) of the distal radius and ulna. A total of 27 patients with GCT on distal radius and ulnas (7 and 20, respectively), confirmed by biopsy, were treated with individualized treatment regimens, according to the Campanacci's grade system: i) Curettage plus inactivated tumor bed and allogeneic bone graft/bone cement augmentation for Campanacci's grade I GCT of the distal radius and ulna (Group A); ii) simple en bloc resection for Campanacci's grade II and III GCT of the distal ulna (Group B); iii) en bloc resection and reconstruction with non-vascularized fibular autograft/allogeneic bone graft for Campanacci's II and III GCT of the distal radius (Group C). Postoperative recurrence and complications were recorded. The Musculoskeletal Tumor Society Score was used to assess functional results. The mean follow-up time was 25 months (range, 9-125 months). A total of 3 patients exhibited tumor recurrence at 9, 11 and 15 months following surgery (1 case succumbed to pulmonary metastasis at 27 months). Overall, the incidence of the postoperative recurrence of the GCT of the distal ulna and radius were 14.3 (1/7) and 10% (2/20), respectively, with a statistical P-value of 0.762. No statistically significant difference was observed regarding the incidence of the postoperative recurrence, postoperative complications and MSTS results among the three surgical approaches for the GCT on distal ulna and radius (all P>0.05). However, statistically significant differences were noted when the incidence of the postoperative recurrence of curettage (Group A) was compared with that of en bloc resection (Groups B and C) (P=0.024). In conclusion, in order to achieve the best clinical effects for patients with GCT on distal radius and ulna, individualized treatment regimens must be designed according to the different Campanacci's grades and tumor locations.

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“…For patients with Campanacci Grades I and II lesions, intralesional curettage and cementation is the most common treatment. However, there is a high risk of local recurrence after this treatment method for patients with moreaggressive (Grade III) GCTs [1,33]. En bloc resection of Campanacci Grade III tumors with reconstruction is associated with a lower risk of local recurrence than curettage for these aggressive lesions [6,9,32,34].…”

Section: Introductionmentioning

confidence: 99%

What are the Functional Results, Complications, and Outcomes of Using a Custom Unipolar Wrist Hemiarthroplasty for Treatment of Grade III Giant Cell Tumors of the Distal Radius?

Wang

Liu

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Purpose A giant cell tumor (GCT) of bone presenting in the distal radius is rare, however, when they occur, Campanacci Grade III tumors can present formidable reconstructive challenges. They are associated with a high local recurrence rate with intralesional treatment, therefore approaches to reconstruct the wrist after en bloc resection warrant study. Questions We asked: (1) What are the functional outcomes after en bloc resection and reconstruction of the wrist with a unipolar prosthesis in patients with Grade III GCT of the distal radius? (2) What complications occur with use of a unipolar prosthesis in these patients? (3) What are the oncologic outcomes with using en bloc resection and reconstruction with a custom unipolar wrist hemiarthroplasty for Grade III GCTs of the distal radius? Methods We retrospectively analyzed 10 patients with Campanacci Grade III GCTs of the distal radius treated by a unipolar prosthesis after wide resection of the tumor between January 2008 and October 2013. During that period, all patients at our medical group who presented with a Grade III GCT of the distal radius were treated with wide resection and reconstruction using a custom unipolar implant. Pre-and postoperative pain at rest were assessed according to a 10-cm VAS score. The functional outcomes of the wrist were assessed using the modified Mayo wrist score, and the degenerative changes were evaluated radiographically by a new rating system based on the Knirk and Jupiter scale. We also analyzed tumor recurrence, metastases, and complications associated with the reconstruction procedure. All patients were available for followup at a mean of 52 months (range, 24-90 months). Results Although the complication rate associated with prosthetic arthroplasty was relatively high (six of 10), none of our patients experienced severe complications. Two patients reported having occasional pain of the involved wrist at the time of final followup (VAS, preoperative versus postoperative: 0 versus 3; 5 versus 2, respectively). The mean modified Mayo wrist score was 68 (range, 45-90). Degenerative changes were found in three wrists (Grade 1, two patients; Grade 2, one patient). Aseptic loosening occurred in one patient and wrist subluxation occurred in two patients. Lung metastases or local tumor recurrence were not observed. Conclusions Because of the proportion of patients who had complications and progressive degeneration with this approach, we recommend first exploring alternatives to reconstruction with custom unipolar wrist hemiarthroplasty after resection of Grade III GCTs of the distal radius, such as fibular autografting. However, this technique provides an alternative for patients with concerns regarding possible morbidity associated with autografting, and for situations when allograft is not available.

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Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Cited by 55 publications

References 38 publications

Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor

Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor

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

What are the Functional Results, Complications, and Outcomes of Using a Custom Unipolar Wrist Hemiarthroplasty for Treatment of Grade III Giant Cell Tumors of the Distal Radius?

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