title: Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones.
abstract: OBJECTIVE
  Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvants in GCTB.
  
  
  METHODS
  Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis.
  
  
  RESULTS
  The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture.
  
  
  CONCLUSIONS
  Curettage with adjuvants is a feasible first-choice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not.
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, the Netherlands. L.van_der_Heijden@lumc.nl
authors.forename: L
authors.initials: L
authors.lastname: van der Heijden
authors.forename: M A
authors.initials: MA
authors.lastname: van de Sande
authors.forename: P D
authors.initials: PD
authors.lastname: Dijkstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003475:Curettage / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D019800:Phenol / Q000627:therapeutic use; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019800:Phenol; D019904:Polymethyl Methacrylate