title: The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton.
abstract: BACKGROUND
  The treatment for recurrent giant cell tumor (GCT) remains controversial. In this study, we evaluated the outcome of surgical intervention for recurrent GCT.
  
  
  METHODS
  Twenty-seven patients (14 males and 13 females) with recurrent GCT were recruited. Their primary GCTs were all treated with intralesional surgery. Among these recurrent GCTs, 9 grade III and 1 grade II tumors were treated with en bloc resection and endoprosthetic replacement, whereas 16 grade II and 1 grade III tumors were treated with intralesional curettage and PMMA bone cement filling.
  
  
  RESULTS
  The mean interval between initial surgery and first recurrence was 28.8 months (range 7-97 months). About 70 % of first recurrences affected bones around the knee, 44 % in the proximal tibia and 26 % in the distal femur. Of 27 patients, 3 women treated with intralesional procedures suffered second recurrences in the proximal tibia. No second recurrence was found in patients with en bloc resection. Two grade III re-recurrence GCTs were treated with en bloc resection, and 1 grade II was treated with an intralesional procedure. One patient with en bloc resection developed tumor metastasis in both lungs. Compared to patients with intralesional treatment, the functional score was significantly decreased in patients with en bloc resection (p < 0.01).
  
  
  CONCLUSIONS
  The re-recurrence risk of grade III GCTs can be significantly decreased by wide en bloc resection and endoprosthetic replacement. However, intralesional treatment is a good option for less aggressive (<grade II) recurrent GCTs because it can preserve ideal limb function and reduce surgical complications.
authors.affiliation: Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Rong
authors.initials: R
authors.lastname: Wan
authors.forename: Weibin
authors.initials: W
authors.lastname: Zhang
authors.forename: Jianqiang
authors.initials: J
authors.lastname: Xu
authors.forename: Ping
authors.initials: P
authors.lastname: Hao
authors.forename: Yaoqi
authors.initials: Y
authors.lastname: Yang
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Shen
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Ding
authors.forename: Shijing
authors.initials: S
authors.lastname: Qiu
mesh_terms: D000328:Adult; D001843:Bone Cements; D003475:Curettage; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007867:Leg Bones / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate