Epidemiologic Characteristics, Clinical Behavior, and Outcome of the Giant Cell Tumor of the Bone: A Retrospective Single-center Study

Document Type : RESEARCH PAPER

Authors

Bone and Joint Reconstruction Research Center, Shafa Ortopaedic Hospital, Iran University of Medical Science, Tehran, Iran

Abstract

Background: Giant cell tumor of bone (GCTB) is a locally aggressive lesion with an unpredictable behavior. Herein,
the aim of this study was to evaluate the epidemiological characteristics, as well as clinical and functional outcomes of
GCTB in a relatively large series of patients.
Methods: Patients with the diagnosis of GCTB were included in this retrospective study. Whenever the preservation
of the articular surface was possible, surgical options included extended curettage; otherwise, wide resection was
implemented. In case of extended curettage, the cavity was filled with cement or bone graft. In addition, the functional
and oncologic outcomes of these surgical strategies were compared. The functional outcome of the patients was
assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.
Results: A total of 120 GCTB patients, including 55 males (45.8%) and 65 females (54.2%), were evaluated. The
three involved locations with highest frequency included distal femur (26%), distal radius (22%), and proximal tibia
(19%). At a mean follow-up of 125.5±49.2 months, two pulmonary metastases (1.6%) and 12 (10%) local recurrences
were observed. In addition, 6 out of 12 (50%) local recurrences occurred in distal radius (P=0.04). The recurrence rate
was significantly higher in extended curettage than in wide resection (P=0.05), and the same pattern was observed
for allograft, compared to cement filling (P=0.05). The mean MSTS scores for extended curettage and wide resection
were 94.7 and 89.1, respectively (P=0.04). Furthermore, the mean MSTS scores for bone graft filling and cement
augmentation were obtained as 96 and 93.1, respectively (P=0.07).
Conclusion: Based on the findings, wide resection of GCTB was associated with superior oncologic outcome, as well
as inferior functional outcome. In extended curettage, cement augmentation resulted in superior oncologic outcome
when compared with allograft filling.
Level of evidence: IV

Keywords

Main Subjects


1. Cooper A, Travers B. Surgical essays. London: Cox &
Son and Longman & Co; 1818. P. 195.
2. Beebe-Dimmer JL, Cetin K, Fryzek JP, Schuetze SM,
Schwartz K. The epidemiology of malignant giant
cell tumors of bone: an analysis of data from the
surveillance, epidemiology and end results program
(1975–2004). Rare Tumors. 2009; 1(2):e52.
3. Jaffe HL. Giant cell tumor of bone: its pathologic
appearance, grading, supposed variants and
treatment. Arch Pathol. 1940; 30(5):993-1031.
4. Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH.
Giant cell tumor of bone: risk factors for recurrence.
Clin Orthop Relat Res. 2011; 469(2):591-9.
5. Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell
tumor of bone-an overview. Arch Bone Jt Surg. 2016;
4(1):2-9.
6. Turcotte RE. Giant cell tumor of bone. Orthop Clin
North Am. 2006; 37(1):35-51.
7. Lopez-Pousa A, Broto JM, Garrido T, Vázquez J. Giant
cell tumour of bone: new treatments in development.
Clin Transl Oncol. 2015; 7(6):419-30.
8. Singh AS, Chawla NS, Chawla SP. Giant-cell tumor
of bone: treatment options and role of denosumab.
Biologics. 2015; 9(1):69-74.
9. Campanacci M. Bone and soft tissue tumors. New
York: Springer; 2013.
10. Campanacci M. Giant-cell tumor and chondrosarcomas:
grading, treatment and results (studies of 209 and 131
cases). Recent Results Cancer Res. 1976; 54(1):257-61.
11. Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C,
Walloe A, Bauer HC, et al. Cement is recommended
in intralesional surgery of giant cell tumors: a
Scandinavian Sarcoma Group study of 294 patients
followed for a median time of 5 years. Acta Orthop.
2008; 79(1):86-93.
12. Gupta A, Nath R, Mishra M. Giant cell tumor of
bone: multimodal approach. Indian J Orthop. 2007;
41(2):115-20.
13. Dahlin DC, Cupps RE, Johnson EW Jr. Giant‐cell tumor:
a study of 195 cases. Cancer. 1970; 25(5):1061-70.
14. Goldenberg RR, Campbell CJ, Bonfiglio M. Giantcell
tumor of bone: an analysis of two hundred
and eighteen cases. J Bone Joint Surg Am. 1970;
52(4):619-64.
15. Júnior RC, Pereira MG, Garcia PB, Santos PA,
Cavalcanti Ados A, Meohas W. Epidemiological
study on giant cell tumor recurrence at the Brazilian
National Institute of Traumatology and Orthopedics.
Rev Bras Ortop. 2016; 51(4):459-65.
16. Donthineni R, Boriani L, Ofluoglu O, Bandiera S.
Metastatic behaviour of giant cell tumour of the
spine. Int Orthop. 2009; 33(2):497-501.
17. Jeys L, Suneja R, Chami G, Grimer R, Carter S, Tillman
R. Impending fractures in giant cell tumours of the
distal femur: incidence and outcome. Int Orthop.
2006; 30(2):135-8.
18. Zorlu F, Selek U, Soylemezoglu F, Oge K. Malignant
giant cell tumor of the skull base originating from
clivus and sphenoid bone. J Neurooncol. 2006;
76(2):149-52.
19. Dahlin DC. Caldwell lecture. Giant cell tumor of bone:
highlights of 407 cases. Am J Roentgenol. 1985;
144(5):955-60.
20. O’Donnell RJ, Springfield DS, Motwani HK, Ready
JE, Gebhardt MC, Mankin HJ. Recurrence of giantcell
tumors of the long bones after curettage and
packing with cement. J Bone Joint Surg Am. 1994;
76(12):1827-33.
21. Teixeira L, Vilela J, Miranda RH, Gomes AH, Costa
FA. Giant cell tumors of bone: nonsurgical factors
associated with local recurrence. Acta Orthop
Traumatol Turc. 2014; 48(2):136-40.
22. Miszczyk L, Wydmański J, Spindel J. Efficacy of
radiotherapy for giant cell tumor of bone: given
either postoperatively or as sole treatment. Int J
Radiat Oncol Biol Phys. 2001; 49(5):1239-42.
23. Dreinhofer K, Rydholm A, Bauer H, Kreicbergs
A. Giant-cell tumours with fracture at diagnosis.
Curettage and acrylic cementing in ten cases. J Bone
Joint Surg Br. 1995; 77(2):189-93.
24. Cheng DD, Hu T, Zhang HZ, Huang J, Yang QC. Factors
affecting the recurrence of giant cell tumor of bone
after surgery: A clinicopathological study of 80 cases
from a single center. Cell Physiol Biochem. 2015;
36(5):1961-70.
25. Gao ZH, Yin JQ, Xie XB, Zou CY, Huang G, Wang J,
et al. Local control of giant cell tumors of the long
bone after aggressive curettage with and without
bone cement. BMC Musculoskelet Disord. 2014;
15(1):330.
26. Fraquet N, Faizon G, Rosset P, Phillipeau JM, Waast
D, Gouin F. Long bones giant cells tumors: treatment
by curretage and cavity filling cementation. Orthop
Traumatol Surg Res. 2009; 95(6):402-6.
27. Kafchitsas K, Habermann B, Proschek D, Kurth A,
Eberhardt C. Functional results after giant cell tumor
operation near knee joint and the cement radiolucent
zone as indicator of recurrence. Anticancer Res.
2010; 30(9):3795-9.
28. Liu H, Wang J. Treatment of giant cell tumor of bone:
a comparison of local curettage and wide resection.
Changgeng Yi Xue Za Zhi. 1998; 21(1):37-43.
29. Puri A, Agarwal M. Treatment of giant cell tumor
of bone: current concepts. Indian J Orthop. 2007;
41(2):101-8.