DOI: https://doi.org/10.15674/0030-59872020372-79

The results of surgical treatment of giant cell tumor of long bones

Anatolii Diedkov, Bogdan Maksymenko, Sergii Boychuk Boychuk, Viktor Kostiuk, Maria Kukuskina

Abstract


The standard treatment option for Giant cell tumor (GCT) is surgery. The radical resection followed by reconstruction is associated with definite clinical problem: high rate of complications, reducing of limb function. Tumor excohleation allows to preserve the joint, but has a high rate of local recurrence. Objective: in retrospective study to analyze the advantages and disadvantages of intralesions and wide radical resection based on results of treatment in patients with Giant cell tumor. Methods: we performed a retrospective analysis of treatment results of 142 patients with long bones Giant cell tumor in the period from 1977 to 2012 years. Tumor excohleation (intralesional resection, IR) with grafting the defect with bone or biodegradable materials was performed in 70 cases, wide resections (WR) with defect reconstructions — in 72 patients. Results: in the group of patients who underwent IR the local relapses were revealed in 35.7 % of cases, which is seven times higher than in WR group. Functional result according to MSTS scale in patients after IR was 92.5 %, after WR — 78.8 % (p = 0.02). Such clinical factors as IR, localization of tumor in the distal radius, age under 25 years is strongly associated with appearence of local recurrence. For patients after IR PFS was 71.0 %, after WR — 95.8 % (p = 0.001). Conclusions: the optimal surgical method in patients with Giant cell tumor of long bones is IR due to good functional results. However, local relapse rate in this group remains high — 35.7 % versus 4.5 % in group after WR (p < 0.05). One of the way of its reducing is application of new therapeutic agents e. g. denosumab, the effectiveness of which can be assessed in prospective trials.

Keywords


giant cell tumor, surgical treatment; relapses; complications; prognostic factors

References


Eckardt, J. J., & GrogaN, T. J. (1986). Giant cell tumor of bone. Clinical Orthopaedics and Related Research, (204), 45-58. doi:10.1097/00003086-198603000-00006

Grote, H. J., Braun, M., Kalinski, T., Pomjanski, N., Back, W., Bleyl, U., … & Roessner, A. (2004). Spontaneous malignant transformation of conventional giant cell tumor. Skeletal Radiology, 33(3), 169-175. doi:10.1007/s00256-003-0682-5

Gitelis, S., Mallin, B. A., Piasecki, P., & Turner, F. (1993). Intralesional excision compared with en Bloc resection for giant-cell tumors of bone. The Journal of Bone & Joint Surgery, 75(11), 1648-1655. doi:10.2106/00004623-199311000-00009

Gortzak, Y., Kandel, R., Deheshi, B., Werier, J., Turcotte, R. E., Ferguson, P. C., & Wunder, J. S. (2010). The efficacy of chemical adjuvants on giant-cell tumour of bone. The Journal of Bone and Joint Surgery. British volume, 92-B(10), 1475-1479. doi:10.1302/0301-620x.92b10.23495

Haque, A. U., & Moatasim, A. (2008). Giant cell tumor of bone: a neoplasm or a reactive condition? International Journal of Clinical and Experimental Pathology, 1(6), 489–501

Wu, P., Tang, J., & Li, K. (2015). RANK pathway in giant cell tumor of bone: Pathogenesis and therapeutic aspects. Tumor Biology, 36(2), 495-501. doi:10.1007/s13277-015-3094-y

Jaffe, H. L. (1958). Tumours and Tumourous Conditions of the Bones and Joints. Philadelphia : Lea and Febiger

Enneking, W. F. (1983). Staging of muskuloskeletal tumors. Musculoskeletal Tumor Surgery. New York: Churchill Livingstone, 1, 87–88

Rock, M. (1990). Curettage of giant cell tumor of bone. Factors influencing local recurrences and metastasis. Chirurgia Degli Organi di Movimento, 75(1 Suppl), 204–205

Present, D., Bertoni, F., Enneking, W. F., & Hudson, T. (1986). The correlation between the radiologic staging studies and histopathologic findings in aggressive stage 3 giant cell tumor of bone. Cancer, 57(2), 237-244. doi:10.1002/1097-0142(19860115)57:2<237::aid-cncr2820570209>3.0.co;2-8

Campanacci, M., Baldini, N., Boriani, S., & Sudanese, A. (1987). Giant-cell tumor of bone. The Journal of Bone & Joint Surgery, 69(1), 106-114. doi:10.2106/00004623-198769010-00018

Grigorovsky, V. V. (2012). Giant cell bone tumor: morphogenesis, clinical morphological features, differential diagnosis, approaches to treatment. Oncology, 14(1), 64–76. [in Russian]

Campanacci, M., Capanna, R., Fabbri, N., & Bettelli, G. (1990). Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chirurgia Degli Organi di Movimento, 75(1 Suppl), 212–213

Oda, Y., Miura, H., Tsuneyoshi, M., & Iwamoto, Y. (1998). Giant cell tumor of bone: Oncological and functional results of long-term follow-up. Japanese Journal of Clinical Oncology, 28(5), 323-328. doi:10.1093/jjco/28.5.323

Khan, M., Gray, J., Carter, S., Grimer, R., & Tillman, R. (2004). Management of the giant-cell tumours of the distal radius. Annals of The Royal College of Surgeons of England, 86(1), 18-21. doi:10.1308/003588404772614632

Von Steyern, F. V., Kristiansson, I., Jonsson, K., Mannfolk, P., Heineg̊rd, D., & Rydholm, A. (2007). Giant-cell tumour of the knee. The Journal of Bone and Joint Surgery. British volume, 89-B(3), 361-365. doi:10.1302/0301-620x.89b3.18604

Vyrva, O. E., Golovina, I. V., Shevchenko, I. V., & Malyk, R. V. (2011). Modular arthroplasty for tumor lesions of the bones of the lower limb. Orthopedics, Traumatology and Prosthetics, 1, 25–29. doi: 10.15674/0030-59872011125-29. [in Russian]

Dedkov, A. G. (2010). Distraction method of replacing bone defects in the treatment of bone tumors of the lower extremities. Orthopedics, Traumatology and Prosthetics, 1, 33–36. doi: 10.15674/0030- 59872010133-36. [in Russian]

Protsenko, V. V. (2006). Treatment methods for lesions of the pelvic girdle bones by a giant cell tumor. Oncology, 8(4), 342–344. [in Russian]

Ruka, W., Rutkowski, P., Morysiński, T., Nowecki, Z., Zdzienicki, M., Makula, D., … & Grzesiakowska, U. (2010). The Megavoltage radiation therapy in treatment of patients with advanced or difficult giant cell tumors of bone. International Journal of Radiation Oncology, Biology, Physics, 78(2), 494-498. doi:10.1016/j.ijrobp.2009.07.1704

Girolami, I., Mancini, I., Simoni, A., Baldi, G. G., Simi, L., Campanacci, D., … & Franchi, A. (2015). Denosumab treated giant cell tumour of bone: A morphological, immunohistochemical and molecular analysis of a series. Journal of Clinical Pathology, 69(3), 240-247. doi:10.1136/jclinpath-2015-203248

Saiz, P., Virkus, W., Piasecki, P., Templeton, A., Shott, S., & Gitelis, S. (2004). Results of giant cell tumor of bone treated with Intralesional excision. Clinical Orthopaedics and Related Research, 424, 221-226. doi:10.1097/01.blo.0000128280.59965.e3

Prosser, G. H., Baloch, K. G., Tillman, R. M., Carter, S. R., & Grimer, R. J. (2005). Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clinical Orthopaedics and Related Research, (435), 211-218. doi:10.1097/01.blo.0000160024.06739.ff

Klenke, F. M., Wenger, D. E., Inwards, C. Y., Rose, P. S., & Sim, F. H. (2010). Recurrent giant cell tumor of long bones: Analysis of surgical management. Clinical Orthopaedics and Related Research, 469(4), 1181-1187. doi:10.1007/s11999-010-1560-9




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