Recurrence Rate of Giant Cell Tumor With the Treatment of Scooping Curettage, Burr Down Technique, Phenolization, and Bone Cement

Gillani, Syed Faraz Ul Hassan Shah; Iqbal, Yasir; Taqi, Muhammad; Blouch, Tauseef Ahmad; Iqbal, Muhammad; Abubakar, Siddiq

doi:10.7759/cureus.11953

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…The ability of this technique to detect clinically occult tumour residuals in piecemeal resection is meaningful in aggressive benign tumours, such as GCTs, where the recurrence is about 20% even after curettage with high-speed burrs and inactivation therapy. 18 The accuracy of ICG imaging predicting tumour residuals has been reported to be 80% to 100% in patients with lung and liver cancer, 10,11,16 which is a little higher than the 71% of accuracy in piecemeal resection we report. It is clear therefore that in order to make decisions surgeons will still need to combine fluorescent with conventional visual and tactile information, in patients with bone and soft-tissue tumours.…”

Section: Discussionmentioning

confidence: 52%

Indocyanine green fluorescence imaging may detect tumour residuals during surgery for bone and soft-tissue tumours

Wang

et al. 2023

Bone Joint J

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AimsThe aim of this study was to determine the rate of indocyanine green (ICG) staining of bone and soft-tissue tumours, as well as the stability and accuracy of ICG fluorescence imaging in detecting tumour residuals during surgery for bone and soft-tissue tumours.MethodsICG fluorescence imaging was performed during surgery in 34 patients with bone and soft-tissue tumours. ICG was administered intravenously at a dose of 2 mg/kg over a period of 60 minutes on the day prior to surgery. The tumour stain rate and signal-to-background ratio of each tumour were post hoc analyzed. After tumour resection, the tumour bed was scanned to locate sites with fluorescence residuals, which were subsequently inspected and biopsied.ResultsThe overall tumour stain rate was 88% (30/34 patients), and specific stain rates included 90% for osteosarcomas and 92% for giant cell tumours. For malignant tumours, the overall stain rate was 94%, while it was 82% for benign tumours. The ICG tumour stain was not influenced by different pathologies, such as malignant versus benign pathology, the reception (or lack thereof) of neoadjuvant chemotherapies, the length of time between drug administration and surgery, the number of doses of denosumab for patients with giant cell tumours, or the tumour response to neoadjuvant chemotherapy. The overall accuracy rate of successfully predicting tumour residuals using fluorescence was 49% (23/47 pieces of tissue). The accuracy rate after en bloc resection was significantly lower than that after piecemeal resection (16% vs 71%; p < 0.001).ConclusionA high percentage of bone and soft-tissue tumours can be stained by ICG and the tumour staining with ICG was stable. This approach can be used in both benign and malignant tumours, regardless of whether neoadjuvant chemotherapy is adopted. The technique is also useful to detect tumour residuals in the wound, especially in patients undergoing piecemeal resection.Cite this article: Bone Joint J 2023;105-B(5):551–558.

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Section: Discussionmentioning

confidence: 52%

Indocyanine green fluorescence imaging may detect tumour residuals during surgery for bone and soft-tissue tumours

Wang

et al. 2023

Bone Joint J

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“…A higher rate of recurrence has been seen after curettage-only surgeries; hence, isolated curettage is not performed and is rather extended with the use of adjuvant therapy that can target residual tumor cells. These include the use of a high-speed burr for its mechanical action of removing the residual cells; polymethyl methacrylate cement or cryotherapy with liquid nitrogen, which is thermal cauterization; and chemical cauterization using phenol or alcohol, with or without the use of a bone graft [ 8 ]. This line of treatment is possible when the tumor is localized with a relatively good cortical rim and >5 mm of subchondral bone.…”

Section: Discussionmentioning

confidence: 99%

En Bloc Resection With Reconstruction Using a Customized Megaprosthesis in a Case of Proximal Humerus Giant Cell Tumor: A Case Report

Maniar¹,

Mankar²,

Sakhre³

2023

Cureus

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A giant cell tumor is a common, benign but locally aggressive bone tumor faced by orthopedic surgeons. The proximal humerus is a rare site of occurrence for this tumor, and the challenges posed while approaching such a case are discussed in this report of a 29-year-old male who presented with pain, swelling, and restricted motion at the left shoulder. Plain radiographs and MRI were suggestive of an aggressive giant cell tumor of the proximal humerus, which was confirmed on histopathological examination. Due to the lesion's extensive soft-tissue involvement, en-bloc resection with reconstruction was planned, but due to the COVID-19 pandemic, surgery was delayed. During the same period, the patient had trivial trauma to the same shoulder, following which the size of the lesion began increasing. The patient was operated on with en-bloc resection and reconstruction with a custom megaprosthesis; following the surgery, there was a complete resolution of pain and improvement in the range of motion. En bloc resection and replacement with a customized megaprosthesis, though technically demanding, offer a safe and cost-effective modality for limb salvage surgery for large giant cell tumors, with good functional outcomes and decreased chances of recurrence.

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“…12 However, PMMA might on the other hand induce thermal damage to surrounding tissue, increase the risk of infection and promote degenerative conditions in the surrounding bone due to stress shielding. 5,7,11,17 Various combinations of medical and surgical techniques have been suggested to reduce the recurrence rates such as high-speed burring, hydrogen peroxide, phenol, and liquid nitrogen among others. However, none of them has been reported systematically as independent significant predictors for decreased LRRs.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…4,5 With the use of more extended curettage with high speed burring and employment of local adjuvants such as bone cement, liquid nitrogen, hydrogen peroxide, zinc chloride, phenol and cauterization with argon beam, recurrence rates between 10 and 20% has been reported. 6,7 Today, wide bone resection is usually only considered when the joint is deemed unsalvageable although other variables such as tumor characteristics, the patients' overall health status and surgeons' preference might also affect the choice of the surgical treatment strategy. 5,8 After intralesional curettage, the optimal technique for reconstruction of the residual bone defect is a matter of ongoing debate.…”

Section: Introductionmentioning

confidence: 99%

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Does the use of polymethyl-methacrylate cement after intralesional curettage of giant cell tumors of appendicular bone guarantee reduced local recurrence rates? A retrospective analysis

Colding-Rasmussen,

Horstmann,

Jørgensen

et al. 2023

J Orthop Surg (Hong Kong)

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Purpose Polymethyl-methacrylate cement (PMMA) is often used as bone defect reconstruction material after surgical removal of giant cell tumors. The purpose of this study was to investigate if the application of PMMA improves the local recurrence rates for giant cell tumors (GCT) of appendicular bone treated with intralesional curettage. Methods A retrospective analysis of all appendicular GTCs treated at two major Danish sarcoma centres between the 1st of January 1998 and December 31st 2013; minimum follow-up of 3.0 years (median: 8.9; 1.3–18.7 years). Kaplan-Meier survival model, log-rank and multivariate Cox regression were used to calculate and compare local recurrence rates. p-values <0.05 were considered statistically significant. Results 102 patients (M59/F43), median age 31Y (11–84) were included in this study. The overall 3-years local recurrence-rate was 19.9% (95%CI: 11.9–27.9%); 91% had occurred within 3 years. In patients treated with intralesional curettage ( n = 64), the 3-years recurrence-rate was 30.6% (95%CI: 18.8–42.4%), compared to 2.6% (95%CI: 0.0–7.8%) in patients treated with wide resection or amputation ( n = 38), p < .001. The 3-years recurrence-rate for patients treated with intralesional curettage and reconstruction using PMMA was 29.0% (95%CI: 12.6–45.4%) and without PMMA: 31.8% (95%CI: 15.2–48.4%), p = .83. Conclusion We found that the use of PMMA for bone defect reconstruction after intralesional curettage of GTCs in the appendicular skeleton did not ensure a reduced risk of local recurrence.

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Recurrence Rate of Giant Cell Tumor With the Treatment of Scooping Curettage, Burr Down Technique, Phenolization, and Bone Cement

Cited by 4 publications

References 20 publications

Indocyanine green fluorescence imaging may detect tumour residuals during surgery for bone and soft-tissue tumours

Indocyanine green fluorescence imaging may detect tumour residuals during surgery for bone and soft-tissue tumours

En Bloc Resection With Reconstruction Using a Customized Megaprosthesis in a Case of Proximal Humerus Giant Cell Tumor: A Case Report

Does the use of polymethyl-methacrylate cement after intralesional curettage of giant cell tumors of appendicular bone guarantee reduced local recurrence rates? A retrospective analysis

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