title: Which treatment is the best for giant cell tumors of the distal radius? A meta-analysis.
abstract: BACKGROUND
  Intralesional excision and en bloc resection are used to treat giant cell tumors (GCTs) of the distal radius. However, it is unclear whether one provides lower rates of recurrences and fewer complications, and whether the use of polymethylmethacrylate (PMMA) after curettage reduces the risk of recurrence.
  
  
  OBJECTIVE
  We examined whether curettage was associated with lower rates of recurrence and fewer major complications compared with en bloc excision, and whether PMMA resulted in lower rates of recurrence compared with a bone graft.
  
  
  METHODS
  We systematically searched the literature using the criteria, "giant cell tumor" AND "curettage" OR "intralesional excision" OR "resection". Six relevant articles were identified that reported data for 80 curettage cases (PMMA, n = 49; bone graft, n = 26; no PMMA or bone grafts, n = 5) and 59 involving en bloc excision. A meta-analysis was performed using these data.
  
  
  RESULTS
  Overall, patients in the intralesional excision group had a higher recurrence rate (relative risk [RR], 2.80; 95% CI, 1.17-6.71), especially for Campanacci grade 3 GCTs (RR, 4.90; 95% CI, 1.36-17.66), yet fewer major complications (RR, 0.21; 95% CI, 0.09-0.54) than the en bloc resection group. The use of PMMA versus bone graft did not affect the recurrence rate (RR, 0.98; 95% CI, 0.44-2.17).
  
  
  CONCLUSIONS
  Based on data obtained from the limited number of studies available, intralesional excision appears to be more appropriate for the treatment of local lesions (e.g., grades 1 and 2) than grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant.
  
  
  METHODS
  Level III, therapeutic study (systematic review). See Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China.
authors: Yu-Peng
authors: YP
authors: Liu
authors: Kang-Hua
authors: KH
authors: Li
authors: Bu-Hua
authors: BH
authors: Sun
mesh_terms: D001859:Bone Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003475:Curettage; D018212:Giant Cell Tumor of Bone / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011884:Radius