title: Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone?
abstract: Adjuvant treatment or filling agents have been recommended for reducing recurrence rates of giant-cell tumors of bone. However, reports of low recurrence rates without either caused us to question this concept. We retrospectively reviewed 193 patients treated during a 27-year period, comparing our results with historic controls. One hundred thirty-seven patients had curettage as a primary treatment, and of these, 26 (19%) had local recurrences. The local recurrence rate of giant-cell tumors confined to bone (Campanacci Grades I and II) was only 7% compared with 29% in tumors with extraosseous extension (Campanacci Grade III). Six patients (4%) had a fracture after curettage. Twenty-nine patients who were referred to us with local recurrences after treatment elsewhere had curettage, and 10 (34%) of these patients had local recurrences develop. Twenty-seven patients had excision as their primary treatment, and two (7%) of these patients had local recurrence develop. We recommend primary curettage for intraosseous giant-cell tumors without adjuvant treatment or filling agents, but tumors with soft tissue extension or with local recurrence require more aggressive treatment.
  
  
  METHODS
  Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham B31 2AP, England.
authors.forename: G H
authors.initials: GH
authors.lastname: Prosser
authors.forename: K G
authors.initials: KG
authors.lastname: Baloch
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
authors.forename: S R
authors.initials: SR
authors.lastname: Carter
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D016009:Chi-Square Distribution; D003475:Curettage; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology; D018212:Giant Cell Tumor of Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome