title: Recurrent giant cell tumor of long bones: analysis of surgical management.
abstract: BACKGROUND
  Treatment of giant cell tumor of bone (GCT) often is complicated by local recurrence. Intralesional curettage is the standard of care for primary GCTs. However, there is controversy whether intralesional curettage should be preferred over wide resection in recurrent GCTs.
  
  
  OBJECTIVE
  We investigated the rerecurrence-free survival after surgical treatment of recurrent GCTs to determine the influence of the surgical approach, adjuvant treatment, local tumor presentation, and demographic factors on the risk of further recurrence.
  
  
  METHODS
  We retrospectively reviewed the medical records of 46 patients with recurrent GCTs of long bones treated with wide resection or intralesional curettage and compared these cohorts. Recurrence rates, risk factors for recurrence, and the development of pulmonary metastases were determined. The minimum followup was 37 months (mean, 134 months; range, 37-337 months).
  
  
  RESULTS
  The rate of rerecurrence after wide resection was 6%. Intralesional curettage showed an overall rerecurrence rate of 32%. Implantation of polymethylmethacrylate (PMMA) instead of bone grafting was associated with a lower risk of subsequent recurrence in intralesional procedures (14% versus 50%). Extracompartmental disease did not increase the risk of rerecurrence. Pulmonary metastases occurred in seven patients and appeared independent of the surgical treatment modality chosen.
  
  
  CONCLUSIONS
  Intralesional curettage with methylmethacrylate for recurrent GCT provided equivalent tumor control compared with resection in this retrospective study. If joint salvage is possible, we advocate this treatment over resection in recurrent GCTs to preserve the native joint articulation.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Klenke
authors.forename: Doris E
authors.initials: DE
authors.lastname: Wenger
authors.forename: Carrie Y
authors.initials: CY
authors.lastname: Inwards
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rose
authors.forename: Franklin H
authors.initials: FH
authors.lastname: Sim
mesh_terms: D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation; D003475:Curettage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000556:secondary; D008910:Minnesota; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate