title: Impact severity of local recurrence in giant cell tumor of bone.
abstract: We retrospectively reviewed 183 consecutive patients diagnosed with giant cell tumor at the three most common sites (distal femur, proximal tibia, and distal radius) to determine the pattern of local tumor recurrence and the impact severity of the recurrence on adjacent joint function. The primary tumor was treated in all patients with intralesional excision of tumor by curettage. Forty-five patients developed locally recurrent disease. Twenty-three of the patients had their first surgery at our institution, and 22 had been referred from other institutions after the development of local recurrence. The intrainstitutional recurrences were salvaged by a repeat curettage (n = 12) or en bloc osteoarticular resection (n = 10) for bone recurrences and wide local excision for soft tissue recurrence (n = 1). The prereferral recurrences were salvaged by a repeat curettage (n = 7) and en bloc osteoarticular resection (n = 15) for bone recurrences. Incomplete initial surgery, a delay in diagnosis of the recurrence of greater than 6 months, and subchondral recurrence of tumor were contributing factors in the failure to salvage the joint. Despite its benign histology, giant cell tumor of bone is an aggressive tumor that demands meticulous attention to surgical detail and close postoperative surveillance for successful local tumor control and durable, joint-preserving function.
  
  
  METHODS
  Therapeutic study, Level III-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: From the University of Texas M.D. Anderson Cancer Center, Department of Orthopaedic Oncology, Houston, TX.
authors.forename: Richard L
authors.initials: RL
authors.lastname: McGough
authors.forename: Janie
authors.initials: J
authors.lastname: Rutledge
authors.forename: Valerae O
authors.initials: VO
authors.lastname: Lewis
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Lin
authors.forename: Alan W
authors.initials: AW
authors.lastname: Yasko
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007596:Joints / Q000503:physiopathology / Q000601:surgery; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery