Management of grade III giant cell tumors of bones

Authors

  • Hsien-Chung Wang MD,

    1. Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    Current affiliation:
    1. Department of Orthopedic Surgery, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung City, Taiwan.
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  • Song-Hsiung Chien MD,

    Corresponding author
    1. Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung City 807, Taiwan. Fax: +886-7-3119544.
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  • Gau-Tyan Lin MD

    1. Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract

Background and Objectives

Surgical treatment of high-grade giant cell tumors (GCT) of bones with an intralesional excision or a wide excision still poses a dilemma between eradicating the tumor and saving the extremity's function. Our study evaluates the possibility of managing high grade GCT with an intralesional curettage combined with adjuvant therapies, instead of a wide excision, to better avoid limb salvage procedures with endoprostheses.

Methods

According to the grading system of Campanacci et al., twenty-four patients with grade III giant cell bone tumors were treated between May 1983 and Aug 2001 period. We analyzed the differences in local recurrence rates, functional results, and complications between wide excision and curettage with adjuvant therapy in management of the patients diagnosed with primary lesions after a mean follow-up period of 7.5 years (range: 2.1–20.3 years).

Results

Fourteen patients underwent the curettage procedure with adjuvant therapy and reconstruction with bone grafts. In the curettage group, two patients had local recurrences and three patients had fracture complications. None of the nine patients receiving wide excisions had experienced local recurrence at the time of their most recent follow-up examination. Using the Musculoskeletal Tumor Society system to evaluate average function, the results were 25.56 points for the wide excision group and 25.64 points for the curettage group, respectively.

Conclusions

Our results suggest that surgical curettage with various adjuvant modalities might be considered as the first choice for treatment of high-grade GCTs in weight-bearing areas, especially in young patients, to avoid unnecessary endoprosthesis. J. Surg. Oncol. 2005;92:46–51. © 2005 Wiley-Liss, Inc.

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