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

• Published in: Journal of cancer research and clinical oncology 2008-09, Vol.134 (9), p.969-978
• Main Authors: Balke, Maurice, Schremper, Laura, Gebert, Carsten, Ahrens, Helmut, Streitbuerger, Arne, Koehler, Gabriele, Hardes, Jendrik, Gosheger, Georg
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic agents; Biological and medical sciences; Bone diseases; Bone Neoplasms - pathology; Bone Neoplasms - therapy; Bone surgery; Cancer Research; Chemotherapy, Adjuvant; Clinical outcomes; Curettage; Diseases of the osteoarticular system; Female; Giant Cell Tumor of Bone - pathology; Giant Cell Tumor of Bone - therapy; Hematology; Humans; Hydrogen Peroxide - pharmacology; Internal Medicine; Male; Medical sciences; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Oncology; Original Paper; Pharmacology. Drug treatments; Polymethyl Methacrylate; Retrospective Studies; Treatment Outcome; Tumors; Tumors of striated muscle and skeleton
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-008-0370-x

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 (H 2 O 2 ) 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). H 2 O 2 ( 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, H 2 O 2  −  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.