title: Management of grade III giant cell tumors of bones.
abstract: OBJECTIVE
  Surgical treatment of high-grade giant cell tumors (GCT) of bones with an intralesional excision or a wide excision still poses a dilemma between eradicating the tumor and saving the extremity's function. Our study evaluates the possibility of managing high grade GCT with an intralesional curettage combined with adjuvant therapies, instead of a wide excision, to better avoid limb salvage procedures with endoprostheses.
  
  
  METHODS
  According to the grading system of Campanacci et al., twenty-four patients with grade III giant cell bone tumors were treated between May 1983 and Aug 2001 period. We analyzed the differences in local recurrence rates, functional results, and complications between wide excision and curettage with adjuvant therapy in management of the patients diagnosed with primary lesions after a mean follow-up period of 7.5 years (range: 2.1-20.3 years).
  
  
  RESULTS
  Fourteen patients underwent the curettage procedure with adjuvant therapy and reconstruction with bone grafts. In the curettage group, two patients had local recurrences and three patients had fracture complications. None of the nine patients receiving wide excisions had experienced local recurrence at the time of their most recent follow-up examination. Using the Musculoskeletal Tumor Society system to evaluate average function, the results were 25.56 points for the wide excision group and 25.64 points for the curettage group, respectively.
  
  
  CONCLUSIONS
  Our results suggest that surgical curettage with various adjuvant modalities might be considered as the first choice for treatment of high-grade GCTs in weight-bearing areas, especially in young patients, to avoid unnecessary endoprosthesis.
authors.affiliation: Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Wang
authors.forename: Song-Hsiung
authors.initials: SH
authors.lastname: Chien
authors.forename: Gau-Tyan
authors.initials: GT
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation; D003475:Curettage; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies
chemical_list: D001843:Bone Cements