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Comparative Study
. 2008 Sep;134(9):969-78.
doi: 10.1007/s00432-008-0370-x. Epub 2008 Mar 6.

Giant cell tumor of bone: treatment and outcome of 214 cases

Maurice Balke  1 , Laura Schremper, Carsten Gebert, Helmut Ahrens, Arne Streitbuerger, Gabriele Koehler, Jendrik Hardes, Georg Gosheger
Affiliations
Comparative Study

Giant cell tumor of bone: treatment and outcome of 214 cases

Maurice Balke et al. J Cancer Res Clin Oncol. 2008 Sep.

Abstract

Background: Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study.

Patients and methods: The mean age was 33.3 years with a female-to-male ratio of 1.2 : 1. The mean follow up was 59.8 months. The recurrence rate of patients who received first treatment at our institution was 16.6%. The most common primary treatment was curettage (188 patients) usually followed by adjuvant local therapy. The effects of bone cement (PMMA), burring and hydrogen peroxide (H(2)O(2)) were statistically analyzed and the influence of a subchondral bone graft on the recurrence rate was evaluated.

Results: PMMA alone (n = 52) reduces the likelihood of recurrence by the factor 8.2, additional high-speed burring (n = 39) by the factor 3.9 (compared to PMMA only). H(2)O(2) (n = 42) seems to have an additional effect comparable to that of phenol although it did not reach statistical significance.

Conclusion: The combination of all adjuncts (PMMA, burring, H(2)O(2) - n = 42) reduces the likelihood of recurrence by the factor 28.2 compared to curettage only and therefore should be recommended as a standard treatment. If the tumor reaches close to the articulating surface a subchondral bone graft (n = 42) can be performed without risking a higher recurrence rate. We add seven cases of pulmonary metastases and two cases of multicentricity to the literature. Bisphosphonates and interferon alpha may have a beneficial effect.

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Figures

Fig. 1
Fig. 1
Typical radiograph of GCTB of the distal femur Anteroposterior radiograph of an expansive stage II GCTB in typical meta-diaphyseal localization in the distal femur pre-operatively (a) and after curettage and bone cement packing (b)
Fig. 2
Fig. 2
Age and gender distribution of GCTB Typical age and gender distribution of GCTB. The mean age at first diagnosis of the female patients was 33.0, of the male patients 33.6 years. The youngest patient was 14.5 years and the oldest 73.9 years. The female-to-male ratio was 1.2:1
Fig. 3
Fig. 3
Anatomical localizations of giant cell tumors of bone Anatomical distribution of giant cell tumors of bone. The percentage is indicated in parentheses with a total of 214 patients. The vast majority of tumors affected the meta-epiphyseal region of the long bones especially around the knee joint
See this image and copyright information in PMC

References

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