In-depth analysis of local recurrence of giant cell tumour of bone with soft tissue extension after intralesional curettage

Aims Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up. Methods Patients with GCTB of the limb considered high-risk for unsuccessful joint salvage, due to minimal periarticular and subchondral bone, large soft tissue mass, or pathological fracture, were treated with Denosumab followed by extended intralesional curettage with the goal of preserving the joint surface. Patients were followed for local recurrence, metastasis, and secondary sarcoma. Results A total of 25 patients with a mean age of 33.8 years (18 to 67) with high-risk GCTB received median six cycles of Denosumab before surgery. Tumours occurred most commonly around the knee (17/25, 68%). The median follow-up was 57 months (interquartile range (IQR) 13 to 88). The joint was salvaged in 23 patients (92%). Two required knee arthroplasty due to intra-articular fracture and arthritis. Local recurrence developed in 11 patients (44%) at a mean of 32.5 months (3 to 75) following surgery, of whom four underwent repeat curettage and joint salvage. One patient developed secondary osteosarcoma and another benign GCT lung metastases. Conclusion The use of Denosumab for joint salvage was associated with a higher than expected rate of local recurrence at 44%. Neoadjuvant Denosumab for joint-sparing procedures should be considered with caution in light of these results. Cite this article: Bone Joint J 2021;103-B(1):184–191.

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Giant cell tumour of soft tissue causing oncogenic osteomalacia: report demonstrating the use of octreotide scintigraphy in tumour localization

Clinical Radiology ◽

10.1016/j.crad.2007.05.017 ◽

2008 ◽

Vol 63 (1) ◽

pp. 101-107 ◽

Cited By ~ 8

Author(s):

S. Harish ◽

E. Jurriaans ◽

E. Jan ◽

M. Sur ◽

N. Colterjohn

Keyword(s):

Soft Tissue ◽

Giant Cell ◽

Giant Cell Tumour ◽

Cell Tumour ◽

Oncogenic Osteomalacia ◽

Tumour Localization ◽

Octreotide Scintigraphy

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Radiological Assessment of Giant Cell Tumour of Bone in the Sacrum: From Diagnosis to Treatment Response Evaluation

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210406121006 ◽

2021 ◽

Vol 17 ◽

Author(s):

Kirsten Van Langevelde ◽

Niels Van Vucht ◽

Shinji Tsukamoto ◽

Andreas F. Mavrogenis ◽

Costantino Errani

Keyword(s):

Soft Tissue ◽

Giant Cell ◽

Giant Cell Tumour ◽

Imaging Modality ◽

Treatment Options ◽

World Health Organisation ◽

Axial Skeleton ◽

Cell Tumour ◽

World Health ◽

Response Evaluation

: Giant cell tumour of bone (GCTB) typically occurs in young adults from 20-40 years old. Although the majority of lesions are located in the epi-metaphyses of the long bones, approximately one third of tumours is located in the axial skeleton, of which only 4% in the sacrum. Sacral tumours tend to be large at the time of presentation, and they present with aggressive features such as marked cortical destruction and an associated soft tissue component. The 2020 World Health Organisation classification of Soft Tissue and Bone Tumours describes GCTB as neoplasm which is locally aggressive and rarely metastasizing. The tumour contains three different cell types: neoplastic mononuclear stromal cells, macrophages and osteoclast-like giant cells. Two tumour subtypes were defined: conventional GCTB and malignant GCTB. Only 1-4% of GCTB is malignant. In this review article, we will discuss imaging findings at the time of diagnosis to guide the musculoskeletal radiologist in reporting these tumours. In addition, imaging for response evaluation after various treatment options will be addressed, such as surgery, radiotherapy, embolization and denosumab. Specific findings will be presented per imaging modality and illustrated by cases from our tertiary sarcoma referral center. Common postoperative and post radiotherapy findings in GCTB of the sacrum on MRI will be discussed.

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Extended intralesional curettage preferred over resection–arthrodesis for giant cell tumour of the distal radius

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02496-2 ◽

2019 ◽

Vol 30 (1) ◽

pp. 11-17 ◽

Cited By ~ 3

Author(s):

Hasan Abuhejleh ◽

Jay S. Wunder ◽

Peter C. Ferguson ◽

Marc H. Isler ◽

Sophie Mottard ◽

...

Keyword(s):

Giant Cell ◽

Distal Radius ◽

Giant Cell Tumour ◽

Cell Tumour ◽

Intralesional Curettage

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Phenotypic and molecular differences between giant-cell tumour of soft tissue and its bone counterpart

Histopathology ◽

10.1111/his.13249 ◽

2017 ◽

Vol 71 (3) ◽

pp. 453-460 ◽

Cited By ~ 10

Author(s):

Irene Mancini ◽

Alberto Righi ◽

Marco Gambarotti ◽

Piero Picci ◽

Angelo P Dei Tos ◽

...

Keyword(s):

Soft Tissue ◽

Giant Cell ◽

Giant Cell Tumour ◽

Cell Tumour

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ANALYSIS OF GIANT CELL TUMOUR OF BONES: ITS PATTERN, VARIOUS TREATMENT MODALITIES AND THEIR RESULTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v2i5.35 ◽

2018 ◽

Author(s):

Anil Pandey ◽

Pratyush Goyal ◽

Deepak S , Maravi ◽

S Uikey

Keyword(s):

Knee Joint ◽

Giant Cell ◽

Giant Cell Tumour ◽

Lung Metastases ◽

Histopathological Examination ◽

Cell Tumour ◽

Treatment Modalities ◽

Tumour Mass ◽

Intralesional Curettage ◽

Extended Curettage

Background: Giant cell tumour is a benign aggressive tumour of bone accounting for 5% of all primary bone tumours with feature of local recurrence, potential for metastasis and malignant transformation and usually seen at the end of long bones after skeletal maturity. The incidence of lung metastases from a histologically-proven GCT ranges from 1% to 9%. The recurrence rate after intralesional curettage without adjuvant therapy is reported to be up to 50%. Extended curettage with use of adjuvents is the treatment of choice for treating the most GCT of bones. Material and method: 25 patients presented with GCTBs included.In all patients standard plain anteroposterior and lateral radiographs of the involved extremity were done.MRI of involved extremity was done in 19 cases. Diagnosis confirmed by biopsy and histopathological examination. The treatment of GCT is directed towards local control without scarifying joint function. This has been traditionally achieved by intralesional curettage with autograft reconstruction by packing the cavity of excised tumour with iliac cortico-cancellous bone. Results: We have treated 25 patients of GCTBs. Females (15) were more commonly affected than male (10). Most common site for GCT was around the knee joint mostly in proximal tibia (6 out of 25). Average range of motion of knee joint was 60 to 112 degree and in wrist joint it was 0 to 45 degree of palmar flexion and 0 to 30 degree of dorsi flexion. Conclusion: We believe that removal of most of tumour mass by extended curettage is very essential step in preventing recurrence and achieving good functional outcome in future. Key words: giant cell tumour of bones, autograft, extended curettage

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

International Orthopaedics ◽

10.1007/s00264-021-05260-6 ◽

2021 ◽

Author(s):

Lenian Zhou ◽

Hongyi Zhu ◽

Shanyi Lin ◽

Hanqiang Jin ◽

Zhaoyuan Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Local Recurrence ◽

Giant Cell ◽

Recurrence Rate ◽

Prognostic Value ◽

Giant Cell Tumour ◽

Cell Tumour ◽

High Recurrence Rate ◽

Multivariate Logistic Regression ◽

Extended Curettage

Abstract 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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