Surgical management for giant cell tumor of bones.

PURPOSE To evaluate the different surgical techniques used in the treatment of giant cell tumor of bone and their effect on the rate of local recurrence. PATIENTS AND METHODS This is a prospective study of fifty-two patients with giant cell tumor (GCT) of the bones treated at the National Cancer Institute, Cairo University between 1998 and 2002. All patients were evaluated by clinical examination, plain X-ray, CT scan and MRI (in some cases). Biopsy was taken in all cases to confirm the diagnosis and to define the grade of the tumor. All patients underwent surgical treatment including curettage, curettage combined with cryosurgery and bone cement or bone graft, bone resection and amputation. Selection of the surgical technique was based on site and size of the lesion, soft tissue involvement (intra- or extra-compartmental), tumor grade and if recurrent or not. Patients were followed up for a minimum of twenty-four months. RESULTS Out of 52 patients 14 patients were males and 38 patients were females, (male to female ratio was (1: 2.7). The age of our patients ranged from 13 to 71 years, with a mean age of 32.9 years. Based on Enneking's staging system, 40 patients (77%) were stage IA, 9 patients (17%) were stage IB & 3 were stage IIB. Histopathological examination of all cases revealed giant cell tumor of borderline malignancy. Curettage alone was done in 4 patients, curettage and bone cement in 7 patients, curettage, cryosurgery and bone graft in 4 patients, curettage, cryosurgery and bone cement in 18 patients, resection in 16 patients and amputation in 3 patients. There were no mortalities among our cases. Local recurrence was highest in cases treated with curettage only (50%), lowest in cases treated with curettage and cryosurgery with bone cement (16.6%). CONCLUSION The main primary treatment of GCT is surgery; the type of which depends on preoperative evaluation, which includes clinical evaluation that involves the site and size of the tumor in relation to surrounding structures, together with plain X-ray, CT scan and/or MRI as indicated, and tissue biopsy to define tumor grade. Curettage alone results in high rate of local recurrence. On the other hand, curettage and adjuvant cryosurgery using bone cement or bone grafts give low rate of local recurrence. Resection is recommended for stages IB and IIB, extremely large lesions, and in cases where resection results in no significant morbidity as proximal fibula and flat bones. Amputation is preserved for massive recurrences and malignant transformation.