title: 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.
abstract: BACKGROUND
  Giant cell tumors of bone rarely metastasize but often recur locally after surgery. There is limited knowledge about the risk of recurrence related to different types of treatment.
  
  
  METHODS
  We analyzed factors affecting the local recurrence rate in 294 patients with giant cell tumors of the extremities using prospectively collected material from 13 centers. The median follow-up time was 5 (0.2-18) years.
  
  
  RESULTS
  A local recurrence was diagnosed in 57 of 294 patients (19%). The overall 5-year local recurrence rate was 0.22. Univariate analysis identified young age and intralesional surgery to be associated with a higher risk of recurrence. Based on multivariate analysis, the relative risk was 2.4-fold for intralesional surgery compared to more extensive operative methods. There was no correlation between tumor size, tumor extension, sex of the patient, tumor location, or fracture at diagnosis and outcome. In the subgroup of 200 patients treated with intralesional surgery, the method of filling (cement or bone) was known for 194 patients and was statistically highly significant in favor of the use of cement.
  
  
  CONCLUSIONS
  Intralesional surgery should be the first choice in most giant cell tumors, even in the presence of a pathological fracture. After thorough evacuation, the cavity should be filled with cement.
authors.affiliation: Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland. aarne.kivioja@hus.fi
authors.forename: Aarne H
authors.initials: AH
authors.lastname: Kivioja
authors.forename: Carl
authors.initials: C
authors.lastname: Blomqvist
authors.forename: Kalevi
authors.initials: K
authors.lastname: Hietaniemi
authors.forename: Clement
authors.initials: C
authors.lastname: Trovik
authors.forename: Anders
authors.initials: A
authors.lastname: Walloe
authors.forename: Henrik C F
authors.initials: HC
authors.lastname: Bauer
authors.forename: Peter H
authors.initials: PH
authors.lastname: Jorgensen
authors.forename: Peter
authors.initials: P
authors.lastname: Bergh
authors.forename: Gunnar
authors.initials: G
authors.lastname: Follerås
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation; D002484:Cementation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000601:surgery*; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D012516:Osteosarcoma / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements