[Case analysis on treatment and recurrence of giant cell tumor of bone].
OBJECTIVE
To analyze the clinical features, treatment methods, and recurrence factors of giant cell tumor of the bone and to investigate the surgical therapy choice for the tumor around the knees.


METHODS
Thirty-eight patients (13 males and 25 females; average age 31.1 years, range 14-59 years) with giant cell tumor of the bone were treated and followed up from January 1993 to January 2005. The patients' diagnoses were established by biopsies of the specimens from the preoperative punctures or operations. The clinical features and the radiological and laboratory data from the 38 patients were reviewed. By the Campanacci's radiological grading system, 5 patients were in Grade I, 22 in Grade II, and 11 in Grade III . By the Enneking classification, 9 patients were in Grade I, 21 in Grade II, and 8 in Grade III . By the Jaffe's classification, 7 patients were in Grade I, 24 in Grade II, and 7 in Grade III. The intralesional excision (curettage) with the bone grafting was performed on 4 patients; the curettage with some adjuvant treatments (high-speed burring, phenol, alcohol, cement, hydrogen peroxide, 50% ZnCl2, 3% iodine tincture, or bone cement) was used in 26 patients; and resection of the whole tumor was performed on 8 patients.


RESULTS
The follow-up of the 38 patients for 12-144 months (average, 67 months) revealed that giant cell tumor of the bone was found around the knees in 29 of the 38 patients (13 at the distal femur, 16 at the proximal tibia), at the proximal femur in 2, at the proximal ulna in 2, at the distal radius in 2, at the sacroiliac area in 2, and at lumbar spine in 1. Of the 38 patients, 4 had a recurrence after simple curettage, 8 had no recurrence after resection of the whole tumor, and 8 of the remaining 26 patients had a recurrence after curettage with some adjuvant treatments. Five patients in Grade I (Campanacci's radiological grading) had no recurrence, 6 of the 11 patients in Grade II had a recurrence, and 6 of the 11 patients in Grade III had a recurrence. Two of the 9 patients in Grade I (Enneking grading) had a recurrence, 6 of the 21 patients in Grade II had a recurrence, and 4 of the patients in Grade III had a recurrence; all the recurrent lesions were around the knee, with a duration of the recurrence ranging from 2 months to 36 months (average, 14.3 months). Of the patients with the recurrence, 12 underwent reoperations (8 by the total resection of the recurrent tumor, 4 by the curettage with adjuvant treatments), and there was no recurrence after the reoperation.


CONCLUSIONS
Giant cell tumor of the bone usually recurs around the knee joint, especially at the proximal tibia, usually graded as Grade II or III by the Campanacci's radiological grading system. Simple curettage has a higher recurrence rate; therefore, extensive curettage and resection of the lesions combined with some adjuvant treatments after the correct diagnosis can be used to reduce the high recurrence rate of giant cell tumor of the bone.
Zhang
Zhicheng
Z
Center of Orthopedic Surgery of Chinese People's Liberation Army, Beijing Army General Hospital, Beijing, 100700, PR China. dadouzc@126.com
Zhu
Bing
B
Sun
Tiansheng
T
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013977:Tibia / Q000473:pathology