44例原发性骨巨细胞瘤初次手术治疗临床研究

[目的]探讨原发性骨巨细胞瘤初次手术方式与复发的关系。[方法] 2014年1月～2018年4月44例原发性骨巨细胞瘤初次手术治疗,包括囊内病灶刮除植骨或骨水泥填充术,边缘切除术、广泛切除术。[结果] 44例患者获得12~56个月随访,5例复发,1例出现肺转移,总复发率为11.36%,肺转移率2.27%。行囊内病灶刮除植骨术18例,2例复发,复发率11.11%。行囊内病灶刮除骨水泥填充术22例,3例复发,复发率13.63%。植骨组与骨水泥组复发率差异无统计学意义(P>0.05)。2例行边缘切除术、2例行广泛切除术病例均无复发。本组中8例合并病理骨折的病例中1例复发,复发率12.50%。无病理骨折组复发率11.11%,两组复发率差异无统计学意义(P>0.05)。[结论]骨巨细胞瘤CampanacciⅠ、Ⅱ级及大部分III级病例,都可以行囊内切除,主要是扩大刮除加辅助处理瘤床,得到良好的局部控制。     

四肢骨巨细胞瘤的外科治疗

目的回顾性分析四肢骨巨细胞瘤不同手术方法的疗效。方法自1997年7月至2005年7月收治四肢骨巨细胞瘤128例，男65例，女63例；年龄17-64岁，平均32岁。股骨远端49例，股骨近端8例，胫骨近端37例，肱骨近端14例，桡骨11例，腓骨4例，跟骨2例，胫骨远端1例，尺骨1例，指骨1例。Campanacci分级Ⅰ级29例、Ⅱ级67例、Ⅲ级32例。根据肿瘤的不同部位、放射线分级及患者年龄，采取不同的手术方法。其中刮除后植骨或骨水泥填充37例，刮除后植骨内固定42例，腓骨代桡骨11例，瘤段切除人工关节置换33例，单纯切除不重建5例。结果随访期间未见严重并发症，3例出现切口渗液，3例出现假体迟发性感染。局部复发：刮除后植骨或骨水泥填充组5例（13．5％），刮除后植骨内固定组5例（11．9％），人工关节置换组2例（6．1％）。肺转移2例，均为肱骨近端骨巨细胞瘤，良、恶性各l例。1例股骨远端骨巨细胞瘤患者刮除术后10个月复发。结论对骨巨细胞瘤的治疗应根据肿瘤的部位、放射线分级及患者年龄采取不同的手术方法。囊内切除适合于CampanacciⅠ、Ⅱ级骨巨细胞瘤，符合肿瘤治疗原则，具有较好的术后功能、较低的局部复发率及术后并发症发生率。瘤段切除适合于Campanacci Ⅲ级骨巨细胞瘤，与囊内切除相比局部复发率低，但术后并发症发生率高，可用于切除后无须重建的肿瘤、大的侵袭性病变或复发的骨巨细胞瘤。     

联合石炭酸烧灼治疗骨巨细胞瘤的比较研究——5个相关研究的Meta分析

[目的]用Meta分析的方法研究病灶内刮除+单纯骨水泥填充术与骨水泥填充联合石炭酸烧灼术治疗骨巨细胞瘤,并对术后复发率和并发症发生率进行综合分析。从而为骨巨细胞瘤外科治疗方法的选择提供合理的选择依据。[方法]收集已经公开发表的有关病灶内刮除+单纯骨水泥填充术与骨水泥填充联合石炭酸烧灼术治疗骨巨细胞瘤所有随访严密的随机对照研究(RCT)或设计良好的非随机对照研究,按照Meta分析的要求对检索到的原始文献进行质评。使用专用统计软件RevMan 5.1版对符合条件的所有研究结果进行Meta分析,分别计算病灶内刮除+单纯骨水泥填充术相对于骨水泥填充联合石炭酸烧灼术的复发情况及并发症发生危险的优势比(OR),评价两种术式术后对骨巨细胞瘤患者的复发率和并发症发生的影响。[结果]符合纳入标准的文献5篇,总样本量512例,其中病灶内刮除+单纯骨水泥填充术组310例,复发118例,出现并发症13例;骨水泥填充联合石炭酸烧灼术组202例,复发49例,出现并发症7例;合并OR复发=1.29,95%置信区间0.71².13,合并OR复发病理性骨折=1.39,95%置信区间0.432.13,合并OR复发病理性骨折=1.39,95%置信区间0.43⁴.53,合并OR复发软组织侵袭=2.43,95%置信区间0.644.53,合并OR复发软组织侵袭=2.43,95%置信区间0.64⁹.29。[结论]两种手术治疗方式对术后并发症发生的影响有统计学意义,病灶内刮除术+单纯骨水泥填充术组的并发症发生风险比骨水泥填充联合石炭酸烧灼术组高1.23倍。     

四肢骨巨细胞瘤的手术治疗

目的比较不同手术方法治疗四肢骨巨细胞瘤的疗效。方法自1998年5月至2006年5月收治骨巨细胞瘤48例,男28例,女20例;年龄16～59岁,平均31岁。股骨远端19例,胫骨近端18例,股骨近端5例,肱骨近端5例,肱骨远端1例。按Campanacci分级,Ⅰ级7例,Ⅱ级30例,Ⅲ级11例。根据肿瘤部位、Campanacci分级及患者年龄,采取不同的手术治疗方法,其中单纯刮除植骨或骨水泥填充17例,刮除植骨内固定19例,瘤段切除＋人工关节置换12例。结果随访时间3～11年,平均6.8年,刮除植骨组有4例复发,复发率为11.1%,瘤段切除＋关节置换组有1例复发,复发率为8.3%,术后患者Enneking功能评定优25例,良12例,可6例,差5例,总体满意率为89.6%。结论病灶刮除植骨是骨巨细胞瘤基本的外科治疗方法,局部辅助处理措施如高速磨钻磨削、蒸馏水浸泡可达到安全的外科治疗边界,从而大大降低病灶刮除术后的复发率,且术后肢体具有良好的功能;瘤段切除适用于CampanacciⅢ级骨巨细胞瘤,虽复发率较低,但重建后的并发症相对较多。     

桡骨远端骨巨细胞瘤切除后三种重建方法的比较

[目的]探讨桡骨远端骨巨细胞瘤切除术后三种重建方法的临床效果。[方法]选取2000年10月~2013年12月间15例桡骨远端骨巨细胞进行瘤段切除,之后根据患者病情分别采取自体腓骨移植重建、同种异体骨移植、人工腕关节置换术三种重建方式,其中接受自体腓骨移植重建术5例,接受同种异体骨移植术6例,接受人工腕关节置换术4例,之后对三组患者进行为期5年的跟踪随访,比较三组患者腕部功能恢复情况,并统计不良症状发生的比例。[结果]MSTS保肢评分系统显示,接受自体腓骨移植重建术患者有4例优、1例良,明显优于接受同种异体骨移植术患者与人工腕关节置换术患者;在腕部功能方面,自体腓骨移植重建术患者腕关节屈伸功能分别为(51.32±9.31)°、(38.13±7.80)°,旋前、旋后功能平均为(71.32±5.63)°、(70.31±4.52)°,明显高于人工腕关节置换术患者、同种异体骨移植术患者(P<0.05);而在术后并发症方面,接受自体腓骨移植重建术患者较少。[结论]对于患有桡骨远端骨巨细胞瘤患者,自体腓骨移植重建,同种异体骨移植术,人工腕关节置换术三种重建方式均可以改善患者的病情,安全性较好,无明显不良并发症发生,自体腓骨移植重建术效果更优,可适当临床推广。     

复发性肢体骨巨细胞瘤的临床诊治策略

[目的]探讨复发性肢体骨巨细胞瘤的临床、影像学特点以及不同治疗方法及临床疗效.[方法]自1995年1月～2009年1月治疗29例复发性骨巨细胞瘤,男15例,女14例;复发时平均年龄32.4岁(13～56)岁;股骨远端和胫骨近端各12例,肱骨近端2例,股骨近端、尺骨远端、腓骨近端各1例.首次手术方式与例数:肿瘤刮除植骨26例,瘤段切除骨缺损修复术2例,单纯腓骨近端切除术1例.复发平均时间26.6个月(1～168)个月.再次手术方式与例数:瘤段切除骨缺损修复重建术17例(假体置换14例,自体骨移植2例,灭活再植1例);肿瘤扩大刮除瘤腔灭活骨修复术7例(植骨4例,骨水泥填充内固定3例),肿瘤扩大切除术3例;截肢术2例.[结果]随访时间24～180个月,平均70个月.2例再次复发;总再复发率为6.9％,肿瘤切除骨缺损修复组无复发,病灶内手术组中1例复发(1/7,14.29％),局部扩大切除术组1例复发(1/3,33.33％).随访期内2例死亡(1例死于非肿瘤原因).病灶内手术组肢体功能优良率为100％,瘤段切除骨缺损修复组为73.33％.综合临床疗效评价病灶内手术优良率为85.71％.肿瘤切除骨缺损修复组为66.67％.[结论]骨巨细胞瘤术后定期随访对于早期诊断肿瘤复发至关重要;一旦复发诊断明确,尽管存在再次复发的风险,应首选瘤灶内手术;对放射学Companacci Ⅲ级的复发性骨巨细胞瘤可选择瘤段切除骨缺损重建手术治疗,但存在一定的远期并发症.     

膝关节融合治疗股骨远端侵袭性骨巨细胞瘤

目的：探讨应用自体腓骨移植联合膝关节融合治疗股骨远端侵袭性骨巨细胞瘤的应用及临床效果。方法：自2007-2009年对5例股骨远端侵袭性骨巨细胞瘤（Campanacci Ⅲ级）行整块切除术后骨缺损,采用游离腓骨移植联合钢板内固定行膝关节融合术重建下肢功能。结果：所有患者随访20～80个月,疼痛症状消失,MSTS评分21～27分,骨愈合时间6—18个月,无移植骨吸收和骨折,恢复正常工作劳动。所有患者均未出现病变复发及肺转移。结论：肿瘤整块切除联合腓骨移植膝关节融合术是治疗股骨远端侵袭性骨巨细胞瘤的一种良好选择。     

膝关节融合治疗股骨远端侵袭性骨巨细胞瘤

目的 探讨应用自体腓骨移植联合膝关节融合治疗股骨远端侵袭性骨巨细胞瘤(GCT)的应用及临床效果.方法 对5例股骨远端侵袭性骨巨细胞瘤行整块切除术后骨缺损,采用游离腓骨移植联合钢板内固定行膝关节融合术重建下肢功能.结果 随访20～40个月,MSTS评分21～27分,骨折愈合时间6～18个月,无移植骨吸收和骨折,无病灶复发,恢复正常工作劳动.结论 肿瘤整块切除联合腓骨移植膝关节融合术是治疗股骨远端侵袭性骨巨细胞瘤的一种良好选择.     

骨巨细胞瘤腔内切除与广泛切除术后复发因素分析（英文）

[目的]分析骨巨细胞瘤术后的复发情况,明确手术方式、辅助治疗对肿瘤复发率的影响。[方法]回顾性分析1985²005年本院治疗的骨巨细胞瘤117例,术后随访时间至少362005年本院治疗的骨巨细胞瘤117例,术后随访时间至少36²33个月,平均(108.4+43.7)个月,比较腔内切除术和广泛切除术两种术式的肿瘤复发率,分析影响复发率的因素。[结果]骨巨细胞瘤广泛切除术的复发率(5%)低于腔内切除术(25%)。对于腔内切除术,术中聚甲基甲丙烯酸盐重建的复发率低于单纯植骨重建(P<0.05),石炭酸的应用对骨巨细胞瘤术后复发无显著干预作用(P>0.05)。[结论]骨巨细胞瘤的首次治疗采用腔内切除结合聚甲基甲丙烯酸盐重建术可获得较低的复发率和满意的关节功能,潜在的肺转移可能性不能成为首次治疗采用广泛切除的适应证。     

瘤体刮除术和瘤大块切除术用于膝关节周围骨巨细胞瘤的疗效观察

[目的]比较观察瘤体刮除术和瘤大块切除术两种肿瘤切除方式用于膝关节周围骨巨细胞瘤的疗效,探讨膝关节周围骨巨细胞瘤的临床特点和肿瘤切除方式对预后的影响.[方法]根据肿瘤部位和破坏大小分别选择瘤体刮除术和瘤大块切除术两种手术方法治疗43例膝关节周围骨巨细胞瘤,35例采用瘤体刮除植骨术,8例采用瘤大块切除重建术(人工关节置换、大块异体骨移植).随访比较观察两组患者的术后并发症、肿瘤复发、肢体功能等疗效情况.[结果]两组术后并发症发生率,差异有显著统计学意义,P＜0.01;两组Enneking骨骼肌肉肿瘤术后功能评分结果比较,差异有显著统计学意义,P＜0.01;两组间术后局部肿瘤复发率,差异无统计学意义,P＞0.05;肿瘤复发与Jaffe组织病理学分级和X线Campanacci分期呈正相关系,P＜0.05.[结论]对膝关节周围骨巨细胞瘤应根据肿瘤部位及其破坏的程度,分别选择瘤体刮除术或瘤大块切除术,而瘤体刮除术如能有效切除肿瘤又不影响骨支撑作用应作为膝关节周围骨巨细胞瘤外科治疗的首选手术方式.     

The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton

BackgroundThe treatment for recurrent giant cell tumor (GCT) remains controversial. In this study, we evaluated the outcome of surgical intervention for recurrent GCT.MethodTwenty-seven patients (14 males and 13 females) with recurrent GCT were recruited. Their primary GCTs were all treated with intralesional surgery. Among these recurrent GCTs, 9 grade III and 1 grade II tumors were treated with en bloc resection and endoprosthetic replacement, whereas 16 grade II and 1 grade III tumors were treated with intralesional curettage and PMMA bone cement filling.ResultsThe mean interval between initial surgery and first recurrence was 28.8 months (range 7–97 months). About 70 % of first recurrences affected bones around the knee, 44 % in the proximal tibia and 26 % in the distal femur. Of 27 patients, 3 women treated with intralesional procedures suffered second recurrences in the proximal tibia. No second recurrence was found in patients with en bloc resection. Two grade III re-recurrence GCTs were treated with en bloc resection, and 1 grade II was treated with an intralesional procedure. One patient with en bloc resection developed tumor metastasis in both lungs. Compared to patients with intralesional treatment, the functional score was significantly decreased in patients with en bloc resection (p < 0.01).ConclusionThe re-recurrence risk of grade III GCTs can be significantly decreased by wide en bloc resection and endoprosthetic replacement. However, intralesional treatment is a good option for less aggressive (相似文献   

Recurrent Giant Cell Tumor of Long Bones: Analysis of Surgical Management

Background  

Treatment of giant cell tumor of bone (GCT) often is complicated by local recurrence. Intralesional curettage is the standard of care for primary GCTs. However, there is controversy whether intralesional curettage should be preferred over wide resection in recurrent GCTs.     

Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Background

A giant cell tumor is a benign locally aggressive tumor commonly seen in the distal radius with reported recurrence rates higher than tumors at other sites. The dilemma for the treating surgeon is deciding whether intralesional treatment is adequate compared with resection of the primary tumor for oncologic and functional outcomes. More information would be helpful to guide shared decision-making.

Questions/purposes

We asked: (1) How will validated functional scores, ROM, and strength differ between resection versus intralesional excision for a giant cell tumor of the distal radius? (2) How will recurrence rate and reoperation differ between these types of treatments? (3) What are the complications resulting in reoperation after intralesional excision and resection procedures? (4) Is there a difference in functional outcome in treating a primary versus recurrent giant cell tumor with a resection arthrodesis?

Methods

Between 1985 and 2008, 39 patients (39 wrists) were treated for primary giant cell tumor of the distal radius at two academic centers. Twenty patients underwent primary intralesional excision, typically in cases where bony architecture and cortical thickness were preserved, 15 underwent resection with radiocarpal arthrodesis, and four had resection with osteoarticular allograft. Resection regardless of reconstruction type was favored in cases with marked cortical expansion. A specific evaluation for purposes of the study with radiographs, ROM, grip strength, and pain and functional scores was performed at a minimum of 1 year for 21 patients (54%) and an additional 11 patients (28%) were available only by phone. We also assessed reoperations for recurrence and other complications via chart review.

Results

With the numbers available, there were no differences in pain or functional scores or grip strength between groups; however, there was greater supination in the intralesional excision group (p = 0.037). Tumors recurred in six of 17 wrists after intralesional excision and none of the 15 after en bloc resection (p = 0.030). There was no relationship between tumor grade and recurrence. There were 12 reoperations in eight of 17 patients in the intralesional excision group but only one of 11 patients (p = 0.049) who underwent resection arthrodesis with distal radius allograft had a reoperation. There were no differences in functional scores whether resection arthrodesis was performed as the primary procedure or to treat recurrence after intralesional excision.

Conclusions

Resection for giant cell tumor of the distal radius with distal radius allograft arthrodesis showed a lower recurrence rate, lower reoperation rate, and no apparent differences in functional outcome compared with joint salvage with intralesional excision. Because an arthrodesis for recurrence after intralesional procedures seems to function well, we believe that intralesional excision is reasonable to consider for initial treatment, but the patient should be informed about the relative benefits and risks of both options during the shared decision-making process. Because arthrodesis after recurrence functions similar to the initial resection and arthrodesis, an initial treatment with curettage remains a viable, and likely the standard, mode of treatment for most giant cell tumors of the distal radius unless there is extensive bone loss.

Level of Evidence

Level III, therapeutic study.     

Giant cell tumor - distal end radius: Do we know the answer?

Background:

The distal end of the radius is one of the common sites of involvement in giant cell tumors (GCTs) with reportedly increased propensity of recurrence. The objective of the present analysis was to study the modalities of management of the different types of distal end radius GCTs so as to minimize the recurrence rates and retain adequate function.

Materials and methods:

Twenty-four patients of distal end radius GCTs treated between January 2000 and December 2004 were retrospectively reviewed. Nineteen cases were available for follow-up with an average follow-up of 37.5 months. There was one Campanacci Grade 1 lesion, nine Grade 2 and 14 Grade 3 lesions. Thirteen (54%) of these patients were treated elsewhere earlier and presented with recurrence. The operative procedures that were performed were: curettage and cementing (five), curettage and bone grafting (seven), excision and proximal fibular arthroplasty (two), excision and wrist arthrodesis (nine) and excision of soft tissue recurrence (one).

Results:

Functional status was evaluated using Musculo Skeletal Tumor Society scoring system which averaged 78%. The recurrence rate was 32%. Complications included local recurrence (six), nonunion at the graft bone junction (one), infection (one), deformity (two), stiffness (two), subluxation (two) and bony metastasis (one).

Conclusions:

The majority of patients undergoing curettage were either Campanacci Grade 1 or 2. Patients undergoing curettage and reconstruction had a better functional result (82%) as compared to arthrodesis or fibular arthroplasty (69%). Previous intervention did not appear to increase the recurrence rates. Even though complications occur, judicious decision-making and an appropriate treatment plan can ensure a satisfactory outcome in the majority of cases.     

Extended intralesional curettage preferred over resection–arthrodesis for giant cell tumour of the distal radius

Background

Distal radius giant cell tumour (GCT) is known to be associated with distinct management difficulties, including high rates of local recurrence and lung metastases compared to other anatomic locations. Multiple treatment options exist, each with different outcomes and complications.

Questions/purposes

To compare oncological and functional outcomes and complications following treatment of patients with distal radius GCT by extended intralesional curettage (EIC) or resection–arthrodesis.

Methods

Patients operated on for distal radius GCT were identified from prospectively collected databases at four Canadian musculoskeletal oncology specialty centres. There were 57 patients with a mean age of 35.4 years (range 17–57). Thirteen tumours were Campanacci grade 2, and 40 were Grade 3 (4 unknown). Twenty patients presented with an associated pathologic fracture. There were 34 patients treated by EIC and 23 by en bloc resection and wrist arthrodesis. All resections were performed for grade 3 tumours. The mean follow-up was 86 months (range 1–280).

Results

There were a total of 11 (19%) local recurrences: 10 of 34 (29%) in the EIC group compared to only 1 of 23 (4%) in the resection–arthrodesis group (p = 0.028). For the 10 patients with local recurrence following initial treatment by EIC, 7 underwent repeat EIC, while 3 required resection–arthrodesis. The one local recurrence following initial resection was managed with repeat resection–arthrodesis. Six of the 11 local recurrences followed treatment of Campanacci grade 3 tumours, while 4 were in grade 2 lesions and in one case of recurrence the grade was unknown. There were no post-operative complications after EIC, whereas 7 patients (30%) had post-operative complications following resection–arthrodesis including 4 infections, one malunion, one non-union and one fracture (p = 0.001). The mean post-operative Musculoskeletal Tumor Society score was 33.5 in the curettage group compared to 27 in the resection group (p = 0.001). The mean Toronto Extremity Salvage Score was 98.3% following curettage compared to 91.5% after resection (p = 0.006). No patients experienced lung metastasis or death.

Conclusions

EIC is an effective alternative to wide resection–arthrodesis following treatment of distal radius GCT, with the advantage of preserving the distal radius and wrist joint function, but with a higher risk of local recurrence. Most local recurrences following initial treatment by EIC could be managed with iterative curettage and joint preservation. Wide excision and arthrodesis were associated with a significantly lower risk of tumour recurrence but was technically challenging and associated with more frequent post-operative complications. EIC was associated with better functional scores. Resection should be reserved for the most severe grade 3 tumours and recurrent and complex cases not amenable to treatment with EIC and joint salvage.

Level of evidence

III, retrospective comparative trial.

     

Giant cell tumor of the femoral head and neck: result of intralesional curettage

Background  

There have been not much reports on the result of intralesional excision for giant cell tumors (GCTs) of the femoral head and neck because of its rarity. The purpose of this study is to review the results of patients managed with intralesional curettage for GCT of the femoral head and neck.     

Surgical strategy for the management of sacral giant cell tumors: a 32-case series

Background contextSurgical treatment of sacral giant cell tumors (GCTs) is associated with a high rate of complications, and there is controversy over which type of surgical treatment is optimal.PurposeTo develop an optimal treatment strategy for sacral GCTs.Study design/settingRetrospective/academic medical center.Patient sampleA total of 32 patients (18 women and 14 men) with sacral GCT who underwent surgery between August 1996 and August 2008.Outcome measuresLocal recurrence rate, surgical margins, blood loss, sacral nerve root preservation, and complications.MethodsThe medical charts of 32 patients were reviewed.ResultsPatients underwent either wide resection (n=2), marginal resection (n=11), marginal resection plus curettage (n=12), or curettage alone (n=7). The curettage group and the wide resection group had the highest and lowest amounts of blood loss (4,500 vs. 1,300 mL, respectively). During follow-up (median, 42 months), 12 patients (37.5%) had local recurrence, including five of seven in the curettage group. The recurrence rate was significantly lower in the marginal excision group compared with that in the curettage group (18.2% vs. 71.4%, respectively; p=.049). Five patients had bladder dysfunction, and two patients had bowel dysfunction. Four patients who underwent marginal resection had lower limb dysfunction. Overall survival was 93.6%, and 2-year recurrence-free survival was 84.4%.ConclusionsChoosing an optimal surgical margin in the treatment of sacral GCTs is of great importance for local recurrence control and sacral nerve root preservation. Curettage alone should not be used to treat sacral GCT.     

Treatment and outcome of giant cell tumors of the pelvis

Background and purpose Giant cell tumors (GCTs) of bone rarely affect the pelvis. We report on 20 cases that have been treated at our institution during the last 20 years.

Methods 20 patients with histologically benign GCT of the pelvis were included in this study. 9 tumors were primarily located in the iliosacral area, 6 in the acetabular area, and 5 in the ischiopubic area. 8 patients were treated by intralesional curettage and 6 by intralesional resection with additional curettage of the margins. 3 patients with iliacal tumors were treated by wide resection. 2 patients were treated by a combination of external beam irradiation and surgery, and 1 patient solely by irradiation. In addition, 9 patients received selective arterial embolization one day before surgery. Of the 6 patients with acetabular tumors, 1 secondarily received an endoprosthesis and 1 was primarily treated by hip transposition. The patients were followed for a median time of 3 (1–11) years.

Results 1 patient with a pubic tumor developed a local recurrence 1 year after intralesional resection and additional curettage of the margins. The recurrence presented as a small soft tissue mass within the scar tissue of the gluteal muscles and was treated by resection. No secondary sarcoma was detected and none of the patients developed pulmonary metastases or multicentricity. No major complication occurred during surgery.

Interpretation We conclude that most GCTs of the pelvis can be treated by intralesional procedures. For tumors of the iliac wing, wide resection can be an alternative. Surgical treatment of tumors affecting the acetabular region often results in functional impairment. Pre-surgical selective arterial embolization appears to be a safe procedure that may reduce the risk of local recurrence.     

Present day controversies and consensus in curettage for giant cell tumor of bone

BackgroundThe ideal treatment for giant cell tumor of bone (GCTB) is still controversial. The purpose of this study was to evaluate whether curettage was successful in the treatment of GCTB. Intralesional curettage with adjuvant therapies, such as high-speed burring, polymethylmethacrylate, phenol, ethanol, and liquid nitrogen, may be used to reduce the local recurrence rate. However, there is no consensus on the optimal use of curettage, along with fillers and adjuvants, to limit the recurrence rate.MethodsWe performed a systematic review of articles using the terms long bones, GCTB, and treatment. Case reports, reviews, opinion articles, or technique notes were excluded based on the abstract. Twenty-six articles included in this review were then studied to establish the index in suggesting the surgical treatment of GCTB.ResultsThe patient’s gender, their age, the Campanacci grade of their tumor, and the type of surgery they had were not significantly associated with the local recurrence rate. Local recurrences seemed to be associated with the site of the tumor, occurring more frequently in the proximal femur or distal radius. A pathological fracture was not a contraindication for intralesional curettage. Treatment with denosumab did not decrease the local recurrence rate in patients who had been treated with curettage.ConclusionThe current literature seems to suggest that the ideal treatment for GCTB is to remove the tumor while preserving as much of the joint as possible. Local recurrent tumors can be treated with curettage to keep the re-recurrence rate within an acceptable limit. The choice for how to treat GCTB in the proximal femur or distal radius requires special attention.