title: Contemporary adjuvant polymethyl methacrylate cementation optimally limits recurrence in primary giant cell tumor of bone patients compared to bone grafting: a systematic review and meta-analysis.
abstract: BACKGROUND
  Reports of recurrence following restructuring of primary giant cell tumor (GCT) defects using polymethyl methacrylate (PMMA) bone cementation or allogeneic bone graft with and without adjuvants for intralesional curettage vary widely. Systematic review and meta-analysis were conducted to investigate efficacy of PMMA bone cementation and allogeneic bone grafting following intralesional curettage for GCT.
  
  
  METHODS
  Medline, EMBASE, Google Scholar, and Cochrane databases were searched for studies reporting GCT of bone treatment with PMMA cementation and/or bone grafting with or without adjuvant therapy following intralesional curettage of primary GCTs. Pooled risk ratios and 95% confidence intervals (CIs) for local recurrence risks were calculated by fixed-effects methods.
  
  
  RESULTS
  Of 1,690 relevant titles, 6 eligible studies (1,293 patients) spanning March 2008 to December 2011 were identified in published data. Treatment outcomes of PMMA-only (n = 374), bone graft-only (n = 436), PMMA with or without adjuvant (PMMA + adjuvant; n = 594), and bone graft filling with or without adjuvant (bone graft + adjuvant; n = 699) were compared. Bone graft-only patients exhibited higher recurrence rates than PMMA-treated patients (RR 2.09, 95% CI (1.64, 2.66), Overall effect: Z = 6.00; P <0.001), and bone graft + adjuvant patients exhibited higher recurrence rates than PMMA + adjuvant patients (RR 1.66, 95% CI (1.21, 2.28), Overall effect: Z = 3.15, P = 0.002).
  
  
  CONCLUSIONS
  Local recurrence was minimal in PMMA cementation patients, suggesting that PMMA is preferable for routine clinical restructuring in eligible GCT patients. Relationships between tumor characteristics, other modern adjuvants, and recurrence require further exploration.
authors.affiliation: Department of Musculoskeletal Oncology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Dongqing
authors.initials: D
authors.lastname: Zuo
authors.forename: Longpo
authors.initials: L
authors.lastname: Zheng
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.forename: Dong
authors.initials: D
authors.lastname: Fu
authors.forename: Yingqi
authors.initials: Y
authors.lastname: Hua
authors.forename: Zhengdong
authors.initials: Z
authors.lastname: Cai
mesh_terms: D006801:Humans; D001843:Bone Cements; D001859:Bone Neoplasms / Q000517:prevention & control; D016025:Bone Transplantation; D002484:Cementation; D017024:Chemotherapy, Adjuvant; D018212:Giant Cell Tumor of Bone / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011379:Prognosis
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate