Giant cell tumor of bone: treatment and outcome of 214 cases.
BACKGROUND
Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study.


METHODS
The mean age was 33.3 years with a female-to-male ratio of 1.2 : 1. The mean follow up was 59.8 months. The recurrence rate of patients who received first treatment at our institution was 16.6%. The most common primary treatment was curettage (188 patients) usually followed by adjuvant local therapy. The effects of bone cement (PMMA), burring and hydrogen peroxide (H(2)O(2)) were statistically analyzed and the influence of a subchondral bone graft on the recurrence rate was evaluated.


RESULTS
PMMA alone (n = 52) reduces the likelihood of recurrence by the factor 8.2, additional high-speed burring (n = 39) by the factor 3.9 (compared to PMMA only). H(2)O(2) (n = 42) seems to have an additional effect comparable to that of phenol although it did not reach statistical significance.


CONCLUSIONS
The combination of all adjuncts (PMMA, burring, H(2)O(2) - n = 42) reduces the likelihood of recurrence by the factor 28.2 compared to curettage only and therefore should be recommended as a standard treatment. If the tumor reaches close to the articulating surface a subchondral bone graft (n = 42) can be performed without risking a higher recurrence rate. We add seven cases of pulmonary metastases and two cases of multicentricity to the literature. Bisphosphonates and interferon alpha may have a beneficial effect.
Balke
Maurice
M
Department of Orthopedic Surgery, University of Muenster, Muenster, Germany. maurice.balke@ukmuenster.de
Schremper
Laura
L
Gebert
Carsten
C
Ahrens
Helmut
H
Streitbuerger
Arne
A
Koehler
Gabriele
G
Hardes
Jendrik
J
Gosheger
Georg
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003475:Curettage; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000628:therapy*; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D019904:Polymethyl Methacrylate; D012189:Retrospective Studies; D016896:Treatment Outcome
D019904:Polymethyl Methacrylate; D006861:Hydrogen Peroxide