title: Long-term outcome of the treatment of high-risk tenosynovial giant cell tumor/pigmented villonodular synovitis with radiotherapy and surgery.
abstract: BACKGROUND
  The treatment of diffuse tenosynovial giant cell tumor (TGCT) requires extensive surgical resection of the hypertrophic synovium and multiple soft tissue masses yet still may result in high rates of local failure. The authors of this report examined their experience in treating patients with advanced/multiply recurrent TGCT with a combination of surgery and external-beam radiotherapy.
  
  
  METHODS
  Fifty patients who were treated for TGCT with radiotherapy and surgery from 1972 to 2006 were identified. Patient demographics, radiotherapy treatment parameters, surgical treatment, and oncologic and functional outcomes were evaluated. All patients had pathologic review at presentation and required at least 1 year follow-up.
  
  
  RESULTS
  Forty-nine patients had diffuse TGCT with both intra-articular and extra-articular disease (1 had malignant TGCT). Twenty-eight patients (56%) were referred after at least 1 local recurrence. Thirty patients (60%) underwent at least 2 operations before radiotherapy. The mean dose of radiation delivered was 39.8 gray. At a mean follow-up of 94 months (range, 19-330 months), 47 patients (94%) had not developed a recurrence or had stable disease/signal characteristics on serial cross-sectional imaging (for those patients who had gross residual disease at the time of radiotherapy). Two patients required subsequent total hip arthroplasty because of progressive osteoarthritis, and there were 4 cases of avascular necrosis (only 1 post-treatment). Forty-one patients had good/excellent function.
  
  
  CONCLUSIONS
  For patients with extensive or multiple local relapses or when surgery alone would result in a large burden of residual disease or major functional loss, the addition of moderate-dose adjuvant radiotherapy provided excellent local control while maintaining good function with low treatment-related morbidity.
authors.affiliation: Department of Orthopedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Griffin
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Chung
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: White
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bell
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005870:Giant Cell Tumors / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D018365:Neoplasm, Residual / Q000628:therapy; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013586:Synovitis, Pigmented Villonodular / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome