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. 2022 Jul;3(7):515-528.
doi: 10.1302/2633-1462.37.BJO-2022-0064.R1.

Surgical challenges, novel techniques, and systemic treatment of giant cell tumour of bone of the distal radius : clinical outcomes and systematic review of the literature

Lizz van der Heijden  1 , Sjaan Bindt  1 , Maurizio Scorianz  2 , Colin Ng  3 , Max C L H Gibbons  3 , Michiel A J van de Sande  1 , Domenico A Campanacci  2
Affiliations

Surgical challenges, novel techniques, and systemic treatment of giant cell tumour of bone of the distal radius : clinical outcomes and systematic review of the literature

Lizz van der Heijden et al. Bone Jt Open. 2022 Jul.

Abstract

Aims: Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review.

Methods: We included 76 patients with distal radius GCTB in three sarcoma centres (1990 to 2019). Median follow-up was 8.8 years (2 to 23). Seven patients underwent curettage, 38 curettage with adjuvants, and 31 resection; 20 had denosumab.

Results: Recurrence rate was 71% (5/7) after curettage, 32% (12/38) after curettage with adjuvants, and 6% (2/31) after resection. Median time to recurrence was 17 months (4 to 77). Recurrences were treated with curettage with adjuvants (11), resection (six), or curettage (two). Overall, 84% (38/45) was cured after one to thee intralesional procedures. Seven patients had 12 months neoadjuvant denosumab (5 to 15) and sixmonths adjuvant denosumab; two recurred (29%). Twelve patients had six months neoadjuvant denosumab (4 to 10); five recurred (42%). Two had pulmonary metastases (2.6%), both stable after denosumab. Complication rate was 18% (14/76, with 11 requiring surgery). At follow-up, median MusculoSkeletal Tumour Society score was 28 (18 to 30), median Short Form-36 Health Survey was 86 (41 to 95), and median Disability of Arm, Shoulder, and Hand was 7.8 (0 to 58).

Conclusion: Distal radius GCTB treatment might deviate from general GCTB treatment because of complexity of wrist anatomy and function. Novel insights on surgical treatment are presented in this multicentre study and systematic review. Intralesional surgery resulted in high recurrence-rate for distal radius GCTB, also with additional denosumab. The large majority of patients however, were cured after repeated curettage. Cite this article: Bone Jt Open 2022;3(7):515-528.

Keywords: Denosumab; MusculoSkeletal Tumour Society score; Short Form 36; curettage; denosumab; distal radius; functional outcomes; giant cell tumor of bone; giant cell tumour of bone; neoadjuvant denosumab; resection; surgical approaches; wrist.

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Conflict of interest statement

ICMJE COI statement: All authors declare that they have no conflicts of interest related to this work.

Figures

Fig. 1
Fig. 1
35-year-old patient with conventional giant cell tumour of the distal radius, without cortical breakthrough nor soft-tissue extension. Treatment consisted of extended curettage with high-speed burring, phenol and filling of the remaining cavity with bone cement. There were no recurrences nor complications during follow-up.
Fig. 2
Fig. 2
a) 32-year-old patient with high-risk giant cell tumour of of the distal radius with cortical thinning, soft-tissue extension, and disturbed radiocarpal alignment. b) En bloc resection was performed with arthrodesis with a tibia strut autograft and screw fixation. c) Radiographs at five-year follow-up show complete fusion of both radiocarpal arthrodesis and proximal bone junction, with remodelling of the graft.
Fig. 3
Fig. 3
a) 36-year-old patient with high-risk giant cell tumour of of the distal radius with cortical thinning and soft-tissue extension. b) En bloc resection was performed with wrist arthrodesis with osteoarticular allograft and plate fixation. There were no recurrences nor complications during 15-year follow-up.
Fig. 4
Fig. 4
a) 36-year-old patient with high-risk giant cell tumour of the distal radius with cortical thinning and very large soft-tissue component. b) En bloc resection was performed with wrist arthrodesis with a free vascularized fibula autograft and plate fixation. This patient developed pulmonary metastases, treated with continuous denosumab. Otherwise, there were no recurrences nor complications during ten-year follow-up.
Fig. 5
Fig. 5
Flowchart of systematic literature review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
Fig. 6
Fig. 6
Flowchart of treatment for primary distal radius giant cell tumour of bone and their recurrences.
See this image and copyright information in PMC

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