title: Adjuvant treatment with zoledronic acid after extensive curettage for giant cell tumours of bone.
abstract: BACKGROUND
  Giant cell tumours (GCT) of bone are benign neoplasms associated with a high rate of local recurrence after extensive intra-lesional curettage. Recently, understanding of the biological molecular availability of strong anti-osteoclastic drugs has suggested their potential value in reducing local recurrences after curettage. Through a phase II clinical trial, we investigated the effect of a short treatment with zoledronic acid (ZOL) after intra-lesional curettage of GCT, as well as local recurrence and tolerance of the treatment.
  
  
  METHODS
  Twenty-four patients were enrolled in a multicentre, phase 2 study. The patients were treated with extensive intra-lesional curettage followed by five courses of ZOL (4 mg IV every 3 weeks). The clinical and biological tolerance of each patient was assessed. Patients were reviewed clinically and by X-ray every 6 months until the end of the study (36 months).
  
  
  RESULTS
  Eighteen out of 20 patients reported side-effects with ZOL, mainly grade 1 and 2 effects. The local recurrence rate was 15%; three patients had a recurrence, one at 4 months (huge GCT of the sacrum), one at 24 months (patient who discontinued the treatment after the first course of ZOL), and one after the observational period, at 58 months. Finally, local relapse-free survival was 82 ± 9% at 60 months.
  
  
  CONCLUSIONS
  Short adjuvant treatments with ZOL after extensive intra-lesional curettage of GCT were associated with a low rate of recurrence but did not prevent local recurrence in this study. No serious general adverse effects were observed. More studies are needed to evaluate the potential benefit of medical bisphosphonate injections combined with intra-lesional curettage in the treatment of GCTB.
authors.affiliation: Orthopaedics and Traumatology Department, University Hospital of Nantes CHU, Hôtel-Dieu, 44 093 Nantes Cedex, France; LPRO, Inserm U957, UFR Médecine, Université de Nantes, 1 Rue Gaston Veil, 44000 Nantes, France. Electronic address: francois.gouin@chu-nantes.fr.
authors.forename: Francois
authors.initials: F
authors.lastname: Gouin
authors.affiliation: Univeristy Hospital de la Conception, 147 Bd Baille, 13005 Marseille, France. Electronic address: RichardAlexandre.ROCHWERGER@ap-hm.fr.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Rochwerger
authors.affiliation: University Hospital de Hautepierre, Av. Molière, 67 000 Strasbourg, France. Electronic address: antonio.di.marco@chru-strasbourg.fr.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Marco
authors.affiliation: University Hospital Trousseau, Rue des Loches, 37 004 Tours, France. Electronic address: philippe.rosset@orange.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rosset
authors.affiliation: University Hospital of Purpan, Place du Dr. Baylac, 31 059 Toulouse, France. Electronic address: bonnevialle.sec@chu-toulouse.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Bonnevialle
authors.affiliation: University Hospital Dupuytren, Av. Martin Luther King, 87 042 Limoges, France. Electronic address: fabrice.fiorenza@chu-limoges.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Fiorenza
authors.affiliation: University Hospital of Cochin-Port Royal, Av. Du Fb Saint Jacques, 75 014 Paris, France. Electronic address: philippe.anract@cch.aphp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Anract
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D055815:Young Adult; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid
keywords: Bisphosphonate; Bone curettage; Giant cell tumours of bone; Local recurrence