Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study

Jamshidi, Khodamorad; Zandrahimi, Farshad; Bozorgi, Milad Haji Agha; Arefpour, Amir Mohammad; Bagherifard, Abolfazl; Al-Baseesee, Hamadalla Hadi; Mirzaei, Alireza

doi:10.1007/s00264-020-04836-y

Cited by 15 publications

(39 citation statements)

References 30 publications

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“…In the current study, we found the local recurrence rate was consistent with previous studies (Table 3) after extended curettage combined with adjuvant therapy [13,[25][26][27][28][29]. Although with a lower risk of tumour recurrence, en bloc resection has a greater functional impairment and higher incidence of complications [30].…”

Section: Discussionsupporting

confidence: 90%

Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage

Zhou

Zhu

Lin

et al. 2021

International Orthopaedics (SICOT)

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Background Extended curettage has increasingly become the preferred treatment for giant cell tumour of bone (GCTB), but the high recurrence rate after curettage poses a major challenge for orthopaedic surgeons. Computed tomography (CT) is valuable in the evaluation of GCTB. Our aim was to identify specific features of GCTB around the knee in pre-operative CT images that might have prognostic value for local recurrence. Methods We retrospectively analyzed data from 124 patients with primary GCTB around the knee who underwent extended curettage from 2010 through 2019. We collected demographic, clinical, and therapeutic data along with several CT-derived tumour characteristics. CT-derived tumor characteristics included tumour size, the distance between the tumour edge and articular surface (DTA), and destruction of posterior cortical bone (DPC). Akaike information criterion (AIC) was used to select which variables to enter into multivariate logistic regression models and to determine significant factors affecting recurrence. Results The total recurrence rate was 21.0% (26/124), and the average follow-up time was 69.5 ± 31.2 months (24–127 months). Age, DTA (< 2 mm), and DPC were significantly related to recurrence, as determined by multivariate logistic regression. The C-index of the final model was 0.79 (95% CI: 0.71 to 0.88), representing a good model for predicting recurrence. Conclusion Identifying certain features of GCTB around the knee on CT has prognostic value for patients treated with extended curettage. A three-factor model predicts tumour recurrence well after extended curettage.

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Section: Discussionsupporting

confidence: 90%

Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage

Zhou

Zhu

Lin

et al. 2021

International Orthopaedics (SICOT)

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“…Limb function after en bloc resection of the fibula and distal ulna is usually good; therefore, Campanacci stage 1 or 2 GCTB in the fibula or distal ulna is an indication for en bloc resection [29]. Pathological fractures were found in 9-17% of patients with GCTB [11,19], while the recurrence rate were similar between curettage and en bloc resection (1/13 patients (7%) and 2/33 patients (6%), respectively) [53]; therefore, pathological fracture is not a contraindication for curettage [53][54][55]. For simple fractures, curettage and plate fixation can be performed; cast fixation is indicated to heal the fracture, followed by curettage.…”

Section: Giant Cell Tumor Of the Extremitiesmentioning

confidence: 99%

Current Concepts in the Treatment of Giant Cell Tumors of Bone

Tsukamoto

Mavrogenis

Kido

et al. 2021

Cancers

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The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.

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“…4,5,6 On the opposite end of the spectrum is total en bloc resection which is quite successful at minimizing local recurrence, but is destructive to native anatomy andrequires the implantation of prosthetics. 7 Accordingly, there is a great need for treatment modalities that are effective, reliable, and reduce morbidity.…”

Section: Introductionmentioning

confidence: 99%

Unique Application of K-Y Jelly in Cryotherapy for Giant Cell Tumors of the Distal Femur - A Case Report

2021

AHS

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GCTs are a locally aggressive tumor that can result in significant pain and dysfunction through the disruption of bony and nearby soft tissue architecture. Although generally benign, these tumors have been shown to have 1-9% chance of metastasis and a local recurrence rate of up to 65%. For these reasons, appropriate treatment is essential to remove primary lesions as well as reduce the odds of metastatic disease and lower recurrence rates. Cryosurgery is a welldescribed technique used to achieve local control of primary GCTs. Modern cryoablation utilizes a cryoprobe to freeze surrounding tissues via release of a thermal conducting gas (argonhelium). The optimal technique for eradication of GCT is a widely debated topic rooted in rates of complications and tumor recurrence. Herein, we describe a case report of a 30-year-old female with a large distal femoral GCT that underwent intralesional curettage and adjunctive cryotherapy utilizing K-Y jelly as a semi-solid medium to transmit the freeze zone more evenly within the cavity. Following cryoablation, the cavity was filled with antibiotic loaded polymethyl methacrylate cement. This technique has scarcely been described in the literature and warrants further investigation.

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Extended curettage versus en bloc resection for the treatment of grade 3 giant cell tumour of the knee with pathologic fracture: a retrospective study

Cited by 15 publications

References 30 publications

Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage

Computerised tomography features of giant cell tumour of the knee are associated with local recurrence after extended curettage

Current Concepts in the Treatment of Giant Cell Tumors of Bone

Unique Application of K-Y Jelly in Cryotherapy for Giant Cell Tumors of the Distal Femur - A Case Report

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