title: Giant cell tumours of the small bones of the hands and feet: long-term results of 30 patients and a systematic literature review.
abstract: Giant cell tumours (GCTs) of the small bones of the hands and feet are rare. Small case series have been published but there is no consensus about ideal treatment. We performed a systematic review, initially screening 775 titles, and included 12 papers comprising 91 patients with GCT of the small bones of the hands and feet. The rate of recurrence across these publications was found to be 72% (18 of 25) in those treated with isolated curettage, 13% (2 of 15) in those treated with curettage plus adjuvants, 15% (6 of 41) in those treated by resection and 10% (1 of 10) in those treated by amputation. We then retrospectively analysed 30 patients treated for GCT of the small bones of the hands and feet between 1987 and 2010 in five specialised centres. The primary treatment was curettage in six, curettage with adjuvants (phenol or liquid nitrogen with or without polymethylmethacrylate (PMMA)) in 18 and resection in six. We evaluated the rate of complications and recurrence as well as the factors that influenced their functional outcome. At a mean follow-up of 7.9 years (2 to 26) the rate of recurrence was 50% (n = 3) in those patients treated with isolated curettage, 22% (n = 4) in those treated with curettage plus adjuvants and 17% (n = 1) in those treated with resection (p = 0.404). The only complication was pain in one patient, which resolved after surgical removal of remnants of PMMA. We could not identify any individual factors associated with a higher rate of complications or recurrence. The mean post-operative Musculoskeletal Tumor Society scores were slightly higher after intra-lesional treatment including isolated curettage and curettage plus adjuvants (29 (20 to 30)) compared with resection (25 (15 to 30)) (p = 0.091). Repeated curettage with adjuvants eventually resulted in the cure for all patients and is therefore a reasonable treatment for both primary and recurrent GCT of the small bones of the hands and feet.
authors.affiliation: Centro Hospitalar do Porto - Hospital Santo Antonio, Department of Orthopaedic Surgery, Largo Prof Abel Salazar, 4099-001 Porto, Portugal.
authors.forename: V C
authors.initials: VC
authors.lastname: Oliveira
authors.forename: L
authors.initials: L
authors.lastname: van der Heijden
authors.forename: I C M
authors.initials: IC
authors.lastname: van der Geest
authors.forename: D A
authors.initials: DA
authors.lastname: Campanacci
authors.forename: C L M H
authors.initials: CL
authors.lastname: Gibbons
authors.forename: M A J
authors.initials: MA
authors.lastname: van de Sande
authors.forename: P D S
authors.initials: PD
authors.lastname: Dijkstra
mesh_terms: D001859:Bone Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D005529:Foot Bones; D018212:Giant Cell Tumor of Bone / Q000628:therapy*; D050276:Hand Bones; D006801:Humans; D013997:Time Factors; D016896:Treatment Outcome
keywords: Curettage; Foot; Giant cell tumor; Hand; Resection; Small bones