Giant Cell Tumor of Bone: Review of Current Literature, Evaluation, and Treatment Options

Abstract

Giant cell tumor of bone is a benign albeit aggressive tumor commonly affecting the bones of the knee. Patients with these tumors present with pain, swelling, and inability to bear weight on the involved extremity. These destructive tumors typically arise in the metaphyseal region of the long bones in individuals in the second, third, and fourth generations of life. Histologically, the multinucleated giant cells are the hallmark of the lesion, easily recognized on histological review, which recently have become therapeutic targets for medical management of the disease. For decades, surgical management has been the primary treatment for giant cell tumor of the bone. Some tumors can be treated with excision and filling of the osseous void with bone cement or allograft. This is an effective treatment option with a low to moderate risk of local recurrence while preserving limb function. For more destructive tumors, wide excision and reconstruction with prosthetic, structural allograft or combined allograft prosthetic components are utilized. Advances in medical management of the disease have also demonstrated promise as an effective treatment; however, its use has usually been limited to the treatment of metastatic disease, recurrent disease or when advanced local disease would require surgical treatment felt to be overly morbid.

Joint salvage and biological repair of massive-cavity bone defects after extensive curettage of giant cell tumor around the knee with vascularized fibular autograft and cancellous allograft

“…The principal of GCTs treatment should be based on completely removing the tumor, reducing recurrence, and preserving or recovering limb function [3,4,18]. In this study, clinical examination revealed no cases of lung metastasis or local GCT recurrence at the last follow-up.…”

“…Vascularized bula can repair massive-cavity bone defects and save knee joint Many reconstruction procedures, including sandwich technique, arthroplasty, osteoarticular allograft, allograft arthrodesis, and vascularized or non-vascularized bular autograft with or without arthrodesis have been proposed after wide resection of GCT around the knee [3,4,[25][26][27].…”

“…Currently, there are several methods that are used for the treatment of GCT around the knee, such as curettage or en-bloc resection with some reconstructive surgeries, arthrodesis by using a structural bone graft, a sandwich technique based on bone graft and polymethylmethacrylate (PMMA), and knee arthroplasty with structural bone allograft or knee prosthesis [3,4]. However, each of these methods has its advantages and disadvantages, respectively.…”

“…Intralesional curettage with PMMA or bone-graft llings, which can preserve the knee joint function, is an effective primary treatment for GCT around the knee [5]. Yet, GCT has a relatively high recurrent rate after intralesional curettage [3,4,6]. Furthermore, GCT is usually associated with cortical invasion, extracompartmental extension, and pathologic fracture in the metaphyseoepiphyseal region of the knee.…”

Adjuvant Therapy by High-Speed Burr May Cause Intraoperative Bone Tumor Seeding: an animal study

“…Several types of adjuvant therapies, including phenol/alcohol, and cryotherapy, have been performed to maximize tumor kill. Meanwhile, the mechanical adjunct of a high-speed burr is performed to extend the margins of the tumor resection [4].…”