title: Giant cell tumour of bone in the appendicular skeleton: an analysis of 276 cases.
abstract: This retrospective study analyzed 276 cases of giant cell tumour of bone in the appendicular skeleton of patients first diagnosed and treated at the Orthopaedic Department of the West China Hospital in Sichuan University between 1988 and 2007. Fifty-eight percent of the tumours involved the knee region. The most common primary treatment was curettage (162 patients) combined with adjuvant local therapy. The effects of bone cement (PMMA), high-speed burring, electro- cauterization, liquid nitrogen, and phenol on the recurrence rate were also analyzed. The differences in local recurrence rates were analyzed between giant-cell tumours confined to bone (Campanacci grades I and II) and giant-cell tumours with extraosseous extension (Campanacci grade III) treated with intralesional curettage. The recurrence rate of patients who received the first treatment at our institution was 11.2%. Recurrence was observed in 31 cases and multiple recurrences were observed in 5 cases. Treatment included intralesional curettage (173%), marginal excision (143%), wide excision (1.9%), or radical resection (0%). Metastases, which mainly involved the lung, occurred in 6 cases (2.2%). There was a significantly lower recurrence rate (p = 0.004) following intralesional curettage combined with high-speed burring (n = 102) as compared with intralesional curettage without high-speed burring (n = 60). Although the efficacy of liquid nitrogen and electrocauterization did not reach significance, they seem to have a similar effect to high-speed burring. Therefore, we recommend high-speed burring as a necessary adjuvant therapy. The combination of all adjuvants (burring, liquid nitrogen, and electro-cauterization) is recommended as a standard treatment. Cement filling of the cavity after curettage was not widely used in this series, but its merits have been reported in several studies; we therefore recommend that cement filling should be added to the adjuvants to be used after burring, liquid nitrogen and/or electrocauterization.
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Guoxue Road 37, Wuhou District, Chengdu 610041, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Xing
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Guoxue Road 37, Wuhou District, Chengdu 610041, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Guoxue Road 37, Wuhou District, Chengdu 610041, China.
authors.forename: Qingquan
authors.initials: Q
authors.lastname: Kong
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Guoxue Road 37, Wuhou District, Chengdu 610041, China.
authors.forename: Chongqi
authors.initials: C
authors.lastname: Tu
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Guoxue Road 37, Wuhou District, Chengdu 610041, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Guoxue Road 37, Wuhou District, Chengdu 610041, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Duan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D003475:Curettage; D005260:Female; D005598:Fractures, Spontaneous / Q000601:surgery; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001843:Bone Cements