Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone?

Abstract

We investigated whether the presence of a pathological fracture increased the risk of local recurrence in patients with a giant cell tumour (GCT) of bone. We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients with a GCT with and without a pathological fracture at presentation. We computed the odds ratio (OR) of local recurrence in those with and without a pathological fracture. We selected 19 eligible papers for final analysis. This included 3215 patients, of whom 580 (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients with and without a pathological fracture was 1.05 (95% confidence interval (CI) 0.66 to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75 to 2.01, p = 0.417). A post hoc sample size calculation showed adequate power for both comparisons. There is no difference in local recurrence rates between patients who have a GCT of bone with and without a pathological fracture at the time of presentation. The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture.

Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

“…Other studies did not confirm the previous reports . A recent meta‐analysis concluded that pathological fractures associated with GCTB do not significantly impact local recurrence . According to our literature search, 812 of a total of 4782 patients with GCTB (17.0%) presented with a pathological fracture; the rate of local recurrence for these patients was 22.0% after curettage and 8.8% after resection (Table ).…”

“…6 impact local recurrence. 37 According to our literature search, 812 of a total of 4782 patients with GCTB (17.0%) presented with a pathological fracture; the rate of local recurrence for these patients was 22.0% after curettage and 8.8% after resection ( Table 2). The type of pathological fracture has been reported a conflicting factor for the treatment decision making and possibly the risk for local recurrence.…”

“…In the presence of a pathological fracture, treatment with curettage may be difficult and may lead to a higher local recurrence rate because of tumor contamination of adjacent soft tissues and joint by the hematoma . According to a recent meta‐analysis, however, pathological fractures associated with GCTB do not significantly impact local recurrence . On the other hand, there is only one study comparing local recurrence rates, complications and function after curettage versus resection for patients with GCTB and pathological fracture at presentation .…”

“…11 According to a recent meta-analysis, however, pathological fractures associated with GCTB do not significantly impact local recurrence. 37 On the other hand, there is only one study comparing local recurrence rates, complications and function after curettage versus resection for patients with GCTB and pathological fracture at presentation. 29 This study showed that local recurrence rate was higher, complications rate was lower and function was better after curettage and adjuvants when compared to resection; the authors concluded that curettage and adjuvants is a reasonable option for GCTB with pathological fracture, and resection should be considered for those tumors with soft-tissue extension, fracture through a local recurrence, or when structural integrity cannot be regained after reconstruction.…”

Outcome of Treatment of Giant-Cell Tumor of Bone: a Single-Institutional Retrospective Study

“…Only 2 (4.8%) patients in the current study had pathological fracture at initial presentation. This is much lower than that described in most of the published data showing that approximately 10 to 35% of patients present with pathologic fracture because of thinning of the bone cortex especially in weight-bearing areas [31][32][33][34] .…”