Factors of local recurrence of giant cell tumor of long bone after treatment: plain radiographs, pathology and surgical procedures

Abstract

Background: To evaluate the relationship between local recurrence of giant cell tumor (GCT) after surgical treatments and plain radiography, pathology grade and surgical procedures.

Material and method: Patients with pathologically proven primary giant cell tumor of long bones, who underwent surgical treatment in Siriraj Hospital between 1995 and 2007, were retrospectively reviewed. Plain radiographic findings were reviewed by an experienced musculoskeletal radiologist without knowledge of the clinical history or pathologic results. Specific attention on plain radiographic evaluations included site of tumor in long bone, total tumor volume, expansion of cortex, breaking of cortex, and presence of pathological fracture. Patients with grade III tumor were excluded due to malignant histology. Patients received treatments with amputation were also excluded due to no possibility of tumor recurrence. Only patients who received surgical treatments with wide excision or curettage with cement were included in the present study. Univariate analysis and Cox proportional hazard ratio was used to evaluate the influence of plain radiographic findings and histology grade on risk of tumor recurrence.

Results: Seventy-four patients participated in this study and included 32 males (43%) and 42 (57%) females with a mean age of 35 years (range 17 to 84). The median follow-up time was 3.2 years. Forty-eight patients (65%) underwent curettage with cement or bone graft and 26 patients (35%) underwent wide excision. Sixty-three patients (85%) did not develop tumor recurrence while 11 patients (15%) developed local recurrent tumor. Those occurred only in patients who underwent curettage with cement or bone graft. None of the patients who underwent wide excision developed local recurrence. Median of time after operation to recurrence was 3.5 years (range, 0.5 to 10.3 years). Local recurrence occurred in the distal femur in five patients (45%), in the proximal tibia in five patients (45%), and in distal radius in one patient (9%). Risk of local recurrence of GCT was not statistically different in patients with any abnormal features of plain radiography as well as histology grade.

Conclusion: No radiographic findings and histological grade of GCT can predict tumor recurrence after curettage procedure. Compared with wide excision, risk of local recurrence in patients that received treatment with curettage was significantly higher. However the choice of treatment should be balanced between preserving maximal joint function and risks of tumor recurrence.