Giant cell tumour of bone.
| Autor: | Aoude A; Orthopedics Spine and Oncology, Montreal General Hospital, McGill University, Montreal, Canada., Nikomarov D; Musculoskeletal Oncology Surgery, Rambam Health Care Campus, Haifa, Israel., Perera JR; Orthopaedic Oncology, Royal National Orthopaedic Hospital, London, UK., Ibe IK; Department of Orthopaedics and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi, USA., Griffin AM; University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada., Tsoi KM; University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada., Ferguson PC; University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada., Wunder JS; University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada. |
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| Jazyk: | angličtina |
| Zdroj: | The bone & joint journal [Bone Joint J] 2023 May 01; Vol. 105-B (5), pp. 559-567. Date of Electronic Publication: 2023 May 01. |
| DOI: | 10.1302/0301-620X.105B5.BJJ-2022-1231.R1 |
| Abstrakt: | Giant cell tumour of bone (GCTB) is a locally aggressive lesion that is difficult to treat as salvaging the joint can be associated with a high rate of local recurrence (LR). We evaluated the risk factors for tumour relapse after treatment of a GCTB of the limbs. A total of 354 consecutive patients with a GCTB underwent joint salvage by curettage and reconstruction with bone graft and/or cement or en bloc resection. Patient, tumour, and treatment factors were analyzed for their impact on LR. Patients treated with denosumab were excluded. There were 53 LRs (15%) at a mean 30.5 months (5 to 116). LR was higher after curettage (18.4%) than after resection (4.6%; p = 0.008). Neither pathological fracture (p = 0.240), Campanacci grade (p = 0.734), soft-tissue extension (p = 0.297), or tumour size (p = 0.872) affected the risk of recurrence. Joint salvage was possible in 74% of patients overall (262/354), and 98% after curettage alone (262/267). Of 49 patients with LR after curettage, 44 (90%) underwent repeated curettage and joint salvage. For patients treated by curettage, only age less than 30 years (p = 0.042) and location in the distal radius (p = 0.043) predicted higher LR. The rate of LR did not differ whether cement or bone graft was used (p = 0.753), but may have been reduced by the use of hydrogen peroxide (p = 0.069). Complications occurred in 15.3% of cases (54/354) and did not differ by treatment. Most patients with a GCTB can undergo successful joint salvage by aggressive curettage, even in the presence of a soft-tissue mass, pathological fracture, or a large lesion, with an 18.4% risk of local recurrence. However, 90% of local relapses after curettage can be treated by repeat joint salvage. Maximizing joint salvage is important to optimize long-term function since most patients with a GCTB are young adults. Younger patients and those with distal radius tumours treated with joint-sparing procedures have a higher rate of local relapse and may require more aggressive treatment and closer follow-up. Competing Interests: None declared. (© 2023 The British Editorial Society of Bone & Joint Surgery.) |
| Databáze: | MEDLINE |
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