Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

Tsukamoto, Shinji; Mavrogenis, Andreas F.; Tanzi, Piergiuseppe; Leone, Giulio; Righi, Alberto; Akahane, Manabu; Kido, Akira; Honoki, Kanya; Tanaka, Yasuhito; Donati, Davide María; Errani, Costantino

doi:10.1002/jso.25391

Cited by 25 publications

(29 citation statements)

References 45 publications

(93 reference statements)

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“…Only five patients were found to have secondary early osteoarthritis during follow-up, and surgical treatment was not required. Therefore, we have also proven that subchondral bone grafting can avoid the direct damage of cement to cartilage and reduce the incidence of postoperative complications without affecting the recurrence rate, which was consistent with that reported in previous studies (7, 29, 30).…”

Section: Discussionsupporting

confidence: 92%

“…SR, as an excellent surgical method for oncological prognosis, was recommended for GCTB of the proximal fibula (31), distal radius (32), and part of Campanacci grade III (Figure 5) (5, 29, 30). Medellin et al (5) reported a lower recurrence rate in patients with Campanacci grade III using SR than using EC through a comparative study, and the results were further confirmed by Renard et al (33).…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection?

Zeng

Luo

et al. 2019

Front. Oncol.

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Aims: This study aimed to compare and evaluate the oncological and functional prognosis of two surgical approaches for giant cell tumor of the bone (GCTB) around the knee joint and provide worthy suggestion for clinical treatment.Patients and Methods: This study included 93 patients, who were divided into the extended curettage (EC) group and segmental resection (SR) group. Relevant preoperative and postoperative data were collected, oncological and functional prognosis were evaluated, and postoperative complications of the two groups were analyzed. Local recurrence was assessed via clinical and radiological tests. Functional prognosis was evaluated using the Musculoskeletal tumor Society (MSTS) scoring system.Results: The EC group had 69 patients; it included 57 primary cases and 12 recurrent cases. The SR group had 24 patients (12 men and 12 women; mean age, 34.9 years), including 15 primary cases and 9 recurrent cases. In this study, six cases (6.5%; EC group, 5 cases; SR group 1 case) recurred within 18 months postoperatively. There was a significant difference in the mean MSTS score between the two groups (p < 0.001). Nononcologic complications occurred frequently in the EC group than in the SR group (28.0 vs. 16.7%), but no complications had serious consequences, and the functional prognosis was not affected.Conclusion: EC and SR for GCTB around the knee joint can achieve satisfactory oncological prognosis, but we should individually select the most suitable surgical method according to Campanacci grade, age, and long-term complications of patients and consider the functional prognosis to ensure excellent oncological prognosis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection?

Zeng

Luo

et al. 2019

Front. Oncol.

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“…Tsukamato et al . reported that the rate of local recurrence for these patients was 22.0% after curettage and 8.8% after resection, demonstrating the superior effects of en bloc resection in reducing the recurrence rate of GCTB 39 . Tumor prosthesis replacement is the common method for reconstruction after en bloc resection.…”

Section: Discussionmentioning

confidence: 96%

Novel Strategy of Curettage and Adjuvant Microwave Therapy for the Treatment of Giant Cell Tumor of Bone in Extremities: A Preliminary Study

Cheng

Yao

et al. 2021

Orthopaedic Surgery

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Objectives To evaluate whether curettage with adjuvant microwave therapy was successful in the treatment of giant cell tumor of the bone (GCTB) in extremities, especially for GCTB with pathological fractures and GCTB of the distal radius. Methods This was a retrospective study of 54 cases of GCTB of the extremities treated by curettage with adjuvant microwave therapy between 2007 and 2019. Five patients were lost to follow up and excluded from the study. A total of 33 male and 21 female patients were included in this study. Patients were aged 15–57 years (mean 29.72 ± 10.48 years). Among these patients, there were 10 cases of GCTB with pathological fractures and eight cases of GCTB of the distal radius; one of these cases was combined with a pathological fracture. Comprehensive imaging examinations (X‐rays [including lesion site and chest], CT, MRI, emission computed tomography, and pathology examination) of all patients were reviewed. The clinical staging of these patients were evaluated radiologically using the Campanacci classification system based on the extent of spread of the tumor. All patients underwent curettage with adjuvant microwave therapy. Clinical and imaging evaluations were performed in all cases to check for recurrence or metastasis. Lower limb and upper limber function were assessed using the Musculoskeletal Tumor Society score (MSTS), and wrist function was assessed according to the disabilities of the arm, shoulder and hand (DASH) score. Data on surgical‐related complications were recorded. Results All cases were followed up for 24–126 months (mean 60.69 ± 29.61 months). There were 24 patients with a Campanacci grade of 3 and 30 with a Campanacci grade of 2. The 52 patients were continuously disease‐free. The local recurrence rate was 3.70% (2 patients). One patient had recurrence in the proximal femur, and the other developed in soft tissue of the calf muscle. No recurrence occurred for GCTB of the distal radius. One recurrence occurred in a GCTB with pathological fractures. The intervals were 9 and 28 months, respectively. The cases of recurrence all had a Campanacci grade of 3 (8.33%). The median MSTS among the 54 patients was 27.67 ± 3.81. The mean wrist function DASH score was 8.30 ± 2.53. The mean MSTS was 28.67 ± 1.63 and 26.71 ± 5.49 for patients with GCTB of the distal radius and for those with pathological fractures, respectively. In comparing patients with and without pathological fractures, there was no significant difference in the MSTS functional score. Five patients had complications after the surgery. Conclusion Curettage with adjuvant microwave ablation therapy provided favorable local control and satisfactory functional outcomes in the treatment of GCTB, especially for cases with pathological fractures and those with GCTB of the distal radius.

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“…The difference between curettage and wide resection is always one of the hotspots in the treatment of GCT of bone with pathological fracture [16,18]. Recent studies have shown that curettage can achieve local tumor control rates similar to resection while reducing the incidence of complications [2]. At the same time, other recent studies have also shown that pathological fractures are not a risk factor for recurrence, and the presence of a pathological fracture should not preclude the decision to perform curettage [18].…”

Section: Discussionmentioning

confidence: 99%

“…Giant cell tumor (GCT) of bone accounts for approximately 5% of all primary bone tumors [1]. The rate of pathological fracture at presentation in these patients is 4% to 50% [2], with 12% of the fracture located at the distal end of the femur [2]. Pathological fracture of distal femur giant cell tumor (GCT) frequently leads to joint surface defect, which is challenging to be repaired.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Articular Surface Defect Cases Caused by Pathological Fracture of Giant Cell Tumor of Distal Femur Treated With Three-Dimension-Printed Custom-Made Prostheses Versus Conventional Endoprosthesis Replacement: Three-Dimension-Printed Custom-Made Prostheses Have Better Function Outcome

Ji¹,

Wu²,

Yang³

et al. 2020

Preprint

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Background: Pathological fracture of the distal femur giant cell tumor (GCT) occasionally leads to articular surface defect. The conventional endoprosthesis replacement needs to remove the both condyles, and then the patients probably face lower prosthesis survival rate and multiple joint replacement, especially in young patients. The aims of this study were to evaluate the feasibility of 3D-printed custom-made prosthesis in repairing the articular surface defect at a short-term follow-up.Methods: We retrospectively reviewed fourteen patients admitted and treated from January 2012 to January 2018 with mean age of 43.9 years (range 29 to 69 years). Diagnoses were primary pathological fracture of distal femur giant cell tumor (GCT) which articular surface of one condyle is defect. 10 lesions were located in medial femoral condyle and 16 in Lateral femoral condyle. Twelve patients were treated with three-dimension-printed custom-made prosthesis to repaired of articular surface defect (3D-printed group), and the other Fourteen patients were treated with endoprosthesis replacement (EPR group). Operation time, blood loss was compared between the groups. Functional results were assessed with MSTS score. The range of motion (ROM), local recurrences and complications were statistically compared.Results: Mean Follow-up is 33.5 months (range 26 to 43 months). In the 3D-printed group, operation time and blood loss were significantly less (p < 0.05). Differences in functional outcomes of the MSTS were observed between the two groups from three-month follow-up (p < 0.05) to twenty-four-month follow-up (p < 0.05), and the score were higher in the 3D-printed group than the EPR group. The ROM of the 3D-printed group was statistically better than the EPR group at 6 and 9 months after operation (p < 0.05). Local recurrence and complication rates were similar in the two groups (p = 1).Conclusion: 3D-printed custom-made prosthesis represent a promising reconstructive technique in articular surface defect caused by pathological fracture of GCT of distal femur. It could be able to achieve satisfactory oncological and better short-term functional results compared with endoprosthesis replacement. Further studies are needed to evaluate the stability of the implants and the wear of the articular surface with larger samples at long-term.

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Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

Cited by 25 publications

References 45 publications

Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection?

Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection?

Novel Strategy of Curettage and Adjuvant Microwave Therapy for the Treatment of Giant Cell Tumor of Bone in Extremities: A Preliminary Study

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