Giant cell tumor of bone: risk factors for recurrence.
BACKGROUND
Many surgeons treat giant cell tumor of bone (GCT) with intralesional curettage. Wide resection is reserved for extensive bone destruction where joint preservation is impossible or when expendable sites (eg, fibular head) are affected. Adjuvants such as polymethylmethacrylate and phenol have been recommended to reduce the risk of local recurrence after intralesional surgery. However, the best treatment of these tumors and risk factors for recurrence remain controversial.


OBJECTIVE
We evaluated the recurrence-free survival after surgical treatment of GCT to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence.


METHODS
We retrospectively reviewed 118 patients treated for benign GCT of bone between 1985 and 2005. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum followup was 36 months (mean, 108.4 ± 43.7; range, 36-233 months).


RESULTS
Wide resection had a lower recurrence rate than intralesional surgery (5% versus 25%). Application of polymethylmethacrylate decreased the risk of local recurrence after intralesional surgery compared with bone grafting; phenol application alone had no effect on the risk of recurrence. Pulmonary metastases occurred in 4%; multidisciplinary treatment including wedge resection, chemotherapy, and radiotherapy achieved disease-free survival or stable disease in all of these patients.


CONCLUSIONS
We recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. Because pulmonary metastases are rare and aggressive treatment of pulmonary metastases is usually successful, we believe the potential for metastases should not by itself create an indication for wide resection of primary tumors.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Klenke
Frank M
FM
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Wenger
Doris E
DE
Inwards
Carrie Y
CY
Rose
Peter S
PS
Sim
Franklin H
FH
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D000970:Antineoplastic Agents; D001843:Bone Cements; D019904:Polymethyl Methacrylate