Giant cell tumor of bone: A single center study of 115 cases

Abstract

Background: Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor that represents about 4-5% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and may include intralesional curettage with adjuvants or, in rare cases, wide resection. In recent years the monoclonal antibody denosumab has been introduced as a potential (neo-)adjuvant systemic treatment option for patients with borderline resectable or unresectable lesions. Currently several studies reported that the use of denosumab prior to curettage possibly increase the risk of local recurrence.

Methods: In this retrospective study we reviewed 115 cases of GCT with a mean follow-up of 65.6 (24-404) months who underwent a surgical treatment with or without preoperative denosumab therapy in our institution. Potential risk factors for LR and complications were analyzed.

Results: The study includes 47 male (40.9%) and 68 female (59.1%) patients with a mean age of 33.9 (10-77) years and a mean follow-up of 65.6 (24-404) months. Denosumab was used in 33 (28.7%) cases, in 14 cases (12.2%) in a neoadjuvant setting and in 17 cases preoperatively before re-curettage (14.8%) after LR. In 105 cases (91.3%) an intralesional curettage was performed. The overall LR rate was 47.8% (55 cases). Patients who underwent intralesional curettage and bone cement augmentation without neoadjuvant denosumab treatment had LR in 42.2% (38/90) of the cases. Patients who underwent neoadjuvant denosumab treatment prior to curettage had LR in 28.6% (4/14). Re-recurrence was frequent in patients with neoadjuvant denosumab treatment who had LR after initial curettage (50%, 8/16). After wide resection and endoprosthetic replacement one case (20%) of local recurrence was detectable (1/5 cases).

Conclusions: GCTB recurs frequently after intralesional curettage and cement augmentation. While denosumab is a potential (neo-)adjuvant treatment option that might be used for lesions that are difficult to resect, surgeons should be aware that LR is still frequent.

Keywords: Denosumab; GCTB, Giant cell tumor of bone; Giant cell tumor; Giant cell tumor of bone; Intralesional curettage.

Fig. 1

Microscopic image of a giant cell tumor of bone, H&E stain. (mononuclear) cells.

Fig. 2

a-e: case of a 36-year-old male patient with GCTB of the distal femur with pathological fracture: 2a: radiographs of the distal femur showing an osteolysis with pathological fracture of the lateral condyle; 2b: CT- (left) and MRI-scan (right) of the distal femur with pathological fracture due to a GCTB; 2c: radiographs 3 months after systemic denosumab treatment showing partial sclerosis of the lesion and consolidation of the fracture, 2d: intraoperative radiograph after intralesional curettage and defect reconstruction with bone cement; 2e: radiographs 36 months after surgery without local recurrence.

Fig. 2

a-e: case of a 36-year-old male patient with GCTB of the distal femur with pathological fracture: 2a: radiographs of the distal femur showing an osteolysis with pathological fracture of the lateral condyle; 2b: CT- (left) and MRI-scan (right) of the distal femur with pathological fracture due to a GCTB; 2c: radiographs 3 months after systemic denosumab treatment showing partial sclerosis of the lesion and consolidation of the fracture, 2d: intraoperative radiograph after intralesional curettage and defect reconstruction with bone cement; 2e: radiographs 36 months after surgery without local recurrence.

Fig. 2

a-e: case of a 36-year-old male patient with GCTB of the distal femur with pathological fracture: 2a: radiographs of the distal femur showing an osteolysis with pathological fracture of the lateral condyle; 2b: CT- (left) and MRI-scan (right) of the distal femur with pathological fracture due to a GCTB; 2c: radiographs 3 months after systemic denosumab treatment showing partial sclerosis of the lesion and consolidation of the fracture, 2d: intraoperative radiograph after intralesional curettage and defect reconstruction with bone cement; 2e: radiographs 36 months after surgery without local recurrence.

Fig. 3

a-e: case of a 39-year-old female patient with GCTB of the proximal tibia: 3a: radiographs (left and middle) and MRI-scan (middle and right) of the proximal tibia showing an osteolysis; 3b: postoperative radiograph after intralesional curettage and defect reconstruction with bone cement; 3c radiographs of first local recurrence 18 months after surgery; 3d: radiographs (left and middle) and MRI-scan (middle and right) of second local recurrence 9 months after second curettage; 3e: radiographs of a modular tumor endoprosthesis which had to be implanted due to massive bone defect.

Fig. 3

a-e: case of a 39-year-old female patient with GCTB of the proximal tibia: 3a: radiographs (left and middle) and MRI-scan (middle and right) of the proximal tibia showing an osteolysis; 3b: postoperative radiograph after intralesional curettage and defect reconstruction with bone cement; 3c radiographs of first local recurrence 18 months after surgery; 3d: radiographs (left and middle) and MRI-scan (middle and right) of second local recurrence 9 months after second curettage; 3e: radiographs of a modular tumor endoprosthesis which had to be implanted due to massive bone defect.