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Journal of Cancer Research and Clinical Oncology

Erschienen in:

01.09.2008 | Original Paper

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

verfasst von: Maurice Balke, Laura Schremper, Carsten Gebert, Helmut Ahrens, Arne Streitbuerger, Gabriele Koehler, Jendrik Hardes, Georg Gosheger

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 9/2008

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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 (H₂O₂) 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). H₂O₂ (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, H₂O₂ − 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.

Becker W (1989) [Diagnosis of recurrence and therapy of recurrence with in situ bone cement filling in the treatment of giant cell tumor]. Z Orthop Ihre Grenzgeb 127(4):379–381PubMed

Bertoni F, Present D, Enneking WF (1985) Giant-cell tumor of bone with pulmonary metastases. J Bone Joint Surg Am 67(6):890–900PubMed

Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M (1988) Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin Orthop Relat Res 237:275–285PubMed

Bini SA, Gill K, Johnston JO (1995) Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res 321:245–250PubMed

Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS (1999) Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am 81(6):811–820PubMed

Campanacci M (1990) Bone and soft tissue tumors. Springer, New York, pp 117–151

Campanacci M (1994) Giant-cell tumor and chondrosarcoma: grading, treatment and results. Recent Results Cancer Res 999:257–261

Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69(1):106–114PubMed

Carrasco CH, Murray JA (1989) Giant cell tumors. Orthop Clin North Am 20(3):395–405PubMed

Chang SS, Suratwala SJ, Jung KM, Doppelt JD, Zhang HZ, Blaine TA, Kim TW, Winchester RJ, Lee FY (2004) Bisphosphonates may reduce recurrence in giant cell tumor by inducing apoptosis. Clin Orthop Relat Res 426:103–109PubMedCrossRef

Cheng YY, Huang L, Lee KM, Xu JK, Zheng MH, Kumta SM (2004) Bisphosphonates induce apoptosis of stromal tumor cells in giant cell tumor of bone. Calcif Tissue Int 75(1):71–77PubMedCrossRef

Cheng JC, Johnston JO (1997) Giant cell tumor of bone. Prognosis and treatment of pulmonary metastases. Clin Orthop Relat Res 338:205–214PubMedCrossRef

Demichev NP (1994) [Giant-cell tumors of the bones: experience with resections and adjuvant cryotherapy]. Vestn Khir Im I I Grek 153(7–12):47–51PubMed

Dickerman JD (1999) Interferon and giant cell tumors. Pediatrics 103(6 Pt 1):1282–1283PubMedCrossRef

Dominkus M, Ruggieri P, Bertoni F, Briccoli A, Picci P, Rocca M, Mercuri M (2006) Histologically verified lung metastases in benign giant cell tumours-14 cases from a single institution. Int Orthop 30(6):499–504PubMedCrossRef

Durr HR, Maier M, Jansson V, Baur A, Refior HJ (1999) Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone. Eur J Surg Oncol 25(6):610–618PubMedCrossRef

Enneking WF (1983) Staging of musculoskeletal tumors. In: Enneking WF (ed) Musculoskeletal tumor surgery, vol 1. Churchill Livingstone, New York, pp 87–88

Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24PubMed

Fan Q, Ma B, Guo A, Li Y, Ye J, Zhou Y, Qiu X (1996) Surgical treatment of bone tumors in conjunction with microwave-induced hyperthermia and adjuvant immunotherapy. A preliminary report. Chin Med J (Engl) 109(6):425–431

Frassica FJ, Sim FH, Pritchard DJ, Chao EY (1990) Subchondral replacement: a comparative analysis of reconstruction with methyl methacrylate or autogenous bone graft. Chir Organi Mov 75(1 Suppl):189–190PubMed

Freyschmidt J, Ostertag H, Jundt G (1998) Knochentumoren. 2. Auflage. Springer, Berlin, pp 611–649

Fujimoto N, Nakagawa K, Seichi A, Terahara A, Tago M, Aoki Y, Hosoi Y, Ohtomo K (2001) A new bisphosphonate treatment option for giant cell tumors. Oncol Rep 8(3):643–647PubMed

Goldenberg RR, Campbell CJ, Bonfiglio M (1970) Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am 52(4):619–664PubMed

Harle A, Wuisman P (1989) [Curettage of giant cell tumors with temporary implantation of bone cement]. Z Orthop Ihre Grenzgeb 127(4):382–386PubMedCrossRef

Haskell A, Wodowoz O, Johnston JO (2003) Metachronous multicentric giant cell tumor: a case report and literature review. Clin Orthop Relat Res 412:162–168PubMedCrossRef

Hindman BW, Seeger LL, Stanley P, Forrester DM, Schwinn CP, Tan SZ (1994) Multicentric giant cell tumor: report of five new cases. Skelet Radiol 23(3):187–190CrossRef

Hoch B, Inwards C, Sundaram M, Rosenberg AE (2006) Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am 88(9):1998–2008PubMedCrossRef

Jaffe HL, Lichtenstein L, Portis RB (1940) Giant cell tumor of bone. Its pathologic appearance, grading, supposed variants and treatment. Arch Pathol 30:993–1031

Jones KB, DeYoung BR, Morcuende JA, Buckwalter JA (2006) Ethanol as a local adjuvant for giant cell tumor of bone. Iowa Orthop J 26:69–76PubMedCrossRef

Kaban LB, Mulliken JB, Ezekowitz RA, Ebb D, Smith PS, Folkman J (1999) Antiangiogenic therapy of a recurrent giant cell tumor of the mandible with interferon alfa-2a. Pediatrics 103(6 Pt 1):1145–1149PubMedCrossRef

Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB (2002) Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. J Oral Maxillofac Surg 60(10):1103–1111 (discussion 1111–1113)PubMedCrossRef

Kaiser U, Neumann K, Havemann K (1993) Generalised giant-cell tumour of bone: successful treatment of pulmonary metastases with interferon alpha, a case report. J Cancer Res Clin Oncol 119(5):301–303PubMedCrossRef

Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ (1994) Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res 302:219–230PubMed

Kirchen ME, Menendez LR, Lee JH, Marshall GJ (1996) Methotrexate eluted from bone cement: effect on giant cell tumor of bone in vitro. Clin Orthop Relat Res 328:294–303PubMedCrossRef

Larsson SE, Lorentzon R, Boquist L (1975) Giant-cell tumor of bone. A demographic, clinical, and histopathological study of all cases recorded in the Swedish Cancer Registry for the years 1958 through 1968. J Bone Joint Surg Am 57(2):167–173PubMed

Lausten GS, Jensen PK, Schiodt T, Lund B (1996) Local recurrences in giant cell tumour of bone. Long-term follow up of 31 cases. Int Orthop 20(3):172–176PubMedCrossRef

Leeson MC, Lippitt SB (1993) Thermal aspects of the use of polymethylmethacrylate in large metaphyseal defects in bone. A clinical review and laboratory study. Clin Orthop Relat Res 295:239–245PubMed

Leggon RE, Zlotecki R, Reith J, Scarborough MT (2004) Giant cell tumor of the pelvis and sacrum: 17 cases and analysis of the literature. Clin Orthop Relat Res 423:196–207PubMedCrossRef

Leichtle CI, Leichtle UG, Gartner V, Schimmel H, Hartmann JT, Rudert M (2006) Multiple skeletal metastases from a giant cell tumour of the distal fibula with fatal outcome. J Bone Joint Surg Br 88(3):396–399PubMedCrossRef

Liu HS, Wang JW (1998) Treatment of giant cell tumor of bone: a comparison of local curettage and wide resection. Changgeng Yi Xue Za Zhi 21(1):37–43PubMed

Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y (1999) Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res 359:176–188CrossRef

Malek F, Krueger P, Hatmi ZN, Malayeri AA, Faezipour H, O’Donnell RJ (2006) Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy. Int Orthop 30(6):495–498PubMedCrossRef

Maloney WJ, Vaughan LM, Jones HH, Ross J, Nagel DA (1989) Benign metastasizing giant-cell tumor of bone. Report of three cases and review of the literature. Clin Orthop Relat Res 243:208–215PubMed

Masui F, Ushigome S, Fujii K (1998) Giant cell tumor of bone: a clinicopathologic study of prognostic factors. Pathol Int 48(9):723–729PubMed

McDonald DJ, Sim FH, McLeod RA, Dahlin DC (1986) Giant-cell tumor of bone. J Bone Joint Surg Am 68(2):235–242PubMed

Mjoberg B, Pettersson H, Rosenqvist R, Rydholm A (1984) Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand 55(6):597–600PubMed

Nelson DA, Barker ME, Hamlin BH (1997) Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia 13(3):287–306PubMedCrossRef

Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK (1998) Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res 347:250–260PubMedCrossRef

Oda Y, Miura H, Tsuneyoshi M, Iwamoto Y (1998) Giant cell tumor of bone: oncological and functional results of long-term follow-up. Jpn J Clin Oncol 28(5):323–328PubMedCrossRef

Osaka S, Toriyama M, Taira K, Sano S, Saotome K (1997) Analysis of giant cell tumor of bone with pulmonary metastases. Clin Orthop Relat Res 335:253–261PubMed

Ozalp T, Yercan H, Okcu G, Ozdemir O, Coskunol E (2006) [Giant cell tumor at the wrist: a review of 23 cases]. Acta Orthop Traumatol Turc 40(2):144–150PubMed

Persson BM, Ekelund L, Lovdahl R, Gunterberg B (1984) Favourable results of acrylic cementation for giant cell tumors. Acta Orthop Scand 55(2):209–214PubMed

Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ (2005) Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res 435:211–218PubMedCrossRef

Punyaratabandhu T, Srisawat P, Charoenvareekul S, Songpatanasilp T, Khunkitti N, Pipithkul S (2007) The effect of intravenous bishosphonate on giant cell tumor of bone: Preliminary report. ISOLS P 2.31

Ritschl P, Salzer-Kuntschik M, Giurea A, Fellinger E, Kropej D (1989) [Results following spongiosa transplantation in giant cell tumor of bone]. Z Orthop Ihre Grenzgeb 127(4):387–391PubMed

Rock MG, Pritchard DJ, Unni KK (1984) Metastases from histologically benign giant-cell tumor of bone. J Bone Joint Surg Am 66(2):269–274PubMed

Rooney RJ, Asirvatham R, Lifeso RM, Ali MA, Parikh S (1993) Giant cell tumour of bone. A surgical approach to grade III tumours. Int Orthop 17(2):87–92PubMedCrossRef

Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S (2004) Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res 424:221–226PubMedCrossRef

Salzer-Kuntschik M (1998) [Differential diagnosis of giant cell tumor of bone]. Verh Dtsch Ges Pathol 82:154–159PubMed

Sanjay BK, Frassica FJ, Frassica DA, Unni KK, McLeod RA, Sim FH (1993) Treatment of giant-cell tumor of the pelvis. J Bone Joint Surg Am 75(10):1466–1475PubMed

Sanjay BK, Kadhi SM (1998) Giant cell tumour of bone with pulmonary metastases. A report of three cases. Int Orthop 22(3):200–204PubMedCrossRef

Sanjay BK, Younge DA (1996) Giant cell tumour of metacarpal with pulmonary and skeletal metastases. J Hand Surg [Br] 21(1):126–132

Schiller C, Ritschl P, Windhager R, Kropej D, Kotz R (1989) [The incidence of recurrence in phenol treated and non-phenol treated bone cavities following intralesional resection of non-malignant bone tumors]. Z Orthop Ihre Grenzgeb 127(4):398–401PubMed

Schwartz HS (1998) Update on giant cell tumor of bone. Comp Ther 24(10):488–493

Siebenrock KA, Unni KK, Rock MG (1998) Giant-cell tumour of bone metastasising to the lungs. A long-term follow-up. J Bone Joint Surg Br 80(1):43–47PubMedCrossRef

Stewart DJ, Belanger R, Benjamin RS (1995) Prolonged disease-free survival following surgical debulking and high-dose cisplatin/doxorubicin in a patient with bulky metastases from giant cell tumor of bone refractory to “standard” chemotherapy. Am J Clin Oncol 18(2):144–148PubMedCrossRef

Suzuki Y, Nishida Y, Yamada Y, Tsukushi S, Sugiura H, Nakashima H, Ishiguro N (2007) Re-operation results in osteoarthritic change of knee joints in patients with giant cell tumor of bone. Knee 14(5):369–374PubMedCrossRef

Szalay K, Antal I, Kiss J, Szendroi M (2006) Comparison of the degenerative changes in weight-bearing joints following cementing or grafting techniques in giant cell tumour patients: medium-term results. Int Orthop 30(6):505–509PubMedCrossRef

Szendroi M (1992) [Adjuvant therapy (phenol, bone cement) in giant cell tumors]. Z Orthop Ihre Grenzgeb 130(2):95–98PubMed

Taraporvala JC, Goyal DR, Hire D (1997) Multicentric giant cell tumor of bone–a case report and comprehensive review of literature. Indian J Cancer 34(3):128–135PubMed

Taylor KF, Yingsakmongkol W, Conard KA, Stanton RP (2003) Multicentric giant cell tumor of bone: a case report and review of the literature. Clin Orthop Relat Res 410:267–273PubMedCrossRef

Trieb K, Bitzan P, Lang S, Dominkus M, Kotz R (2001) Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy. Eur J Surg Oncol 27(2):200–202PubMedCrossRef

Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK (1992) Benign giant-cell tumor of bone with pulmonary metastases: clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol 158(2):331–334PubMed

Tunn PU, Schlag PM (2003) [Giant cell tumor of bone. An evaluation of 87 patients]. Z Orthop Ihre Grenzgeb 141(6):690–698PubMedCrossRef

Turcotte RE (2006) Giant cell tumor of bone. Orthop Clin North Am 37(1):35–51PubMedCrossRef

Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM (2002) Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res 397:248–258PubMedCrossRef

Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jorgensen P, Folleras G, Rydholm A (2006) Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. J Bone Joint Surg Br 88(4):531–535CrossRef

Wada T, Kaya M, Nagoya S, Kawaguchi S, Isu K, Yamashita T, Yamawaki S, Ishii S (2002) Complications associated with bone cementing for the treatment of giant cell tumors of bone. J Orthop Sci 7(2):194–198PubMedCrossRef

Ward WG Sr, Li G III (2002) Customized treatment algorithm for giant cell tumor of bone: report of a series. Clin Orthop Relat Res 397:259–270PubMedCrossRef

Werner M (2006) Giant cell tumour of bone: morphological, biological and histogenetical aspects. Int Orthop 30(6):484–489PubMedCrossRef

Wuisman P, Harle A, Nommensen B, Erlemann R, Reiser M, Rossner A (1989) [Giant cell tumor of bone. An analysis of 69 cases]. Z Orthop Ihre Grenzgeb 127(4):392–395PubMed

Titel: Giant cell tumor of bone: treatment and outcome of 214 cases
verfasst von: Maurice Balke
Laura Schremper
Carsten Gebert
Helmut Ahrens
Arne Streitbuerger
Gabriele Koehler
Jendrik Hardes
Georg Gosheger
Publikationsdatum: 01.09.2008
Verlag: Springer-Verlag
Erschienen in: Journal of Cancer Research and Clinical Oncology / Ausgabe 9/2008
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-008-0370-x

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