Results of Giant Cell Tumor of Bone Treated With Intralesional Excision

Author(s): Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S

Source: Clinical Orthop 221-226, 2004.

Summary:

This article reviews the results of treatment of giant cell tumor of bone with intralesional excision, adjunctive, phenol and polymethylmethacrylate (PMMA). Forty-four consecutive patients treated by 1 surgeon between 1985 and 1999 were reviewed.  There were 19 males and 21 females with a mean age of 34 years (range, 14 to 56 years).  The distal femur was involved in 17 patients, proximal tibia in 11 patients, distal radius in 5 patients, distal tibia in 3 patients, metatarsal in 2 patients, proximal humerus in 1 patient, and talus in 1 patient.  Thirty-six patients had Stage II giant cell tumors which is an active lesion showing growth confined within bone as per the system of Enneking and 4 patients had Stage III disease defined as locally aggressive with soft tissue extension.  Recurrence occurred in 5 patients (12.5%) at a mean of 19 months postoperatively (range, 10 to 38 months).  Two recurrences occurred in the proximal tibia followed by the distal femur, talus and distal radius each with one recurrence.  Although the recurrence rate (12.5%) and complication rate (7.5%) were low for the entire group, when evaluating  the 5 patients with distal radius giant cell tumors, there was 1 recurrence (20%) and 2 complications including a fracture and development of degenerative joint disease for essentially a 60% combined recurrence and/complication rate making the distal radius the most problematic area for treatment of giant cell tumors.

Considering that giant cell tumor of bone is a benign but locally aggressive neoplasm, this article confirms the current recommendation for treatment of distal radius giant cell tumors with intralesional excision with adjunctive cautery, phenol and PMMA for lesions which are contained to bone without soft tissue extension.  However, there is a high complication/recurrence rate which may ultimately require end block excision and intercalary allograft placement which was the treatment in 2 of the 3 patients with a complication or recurrence in this series.

 

 

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Clinical Orthop 221-226, 2004.