Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture

2018 ◽  
Vol 100-B (12) ◽  
pp. 1626-1632 ◽  
Author(s):  
M. R. Medellin ◽  
T. Fujiwara ◽  
R. M. Tillman ◽  
L. M. Jeys ◽  
J. Gregory ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Local Recurrence ◽  
Giant Cell ◽  
Pathological Fracture ◽  
Univariate Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Giant Cell Tumours

Aims The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). Patients and Methods A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. Results The initial surgical treatment was curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. Conclusion In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.

Vascularized Iliac Bone Lining in Downgraded Treatment of Campanacci Grade III Giant Cell Tumor of the Distal Radius

2018 ◽  
Vol 23 (02) ◽  
pp. 255-258
Author(s):  
Kazufumi Sano ◽  
Kazumasa Kimura ◽  
Satoru Ozeki
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Distal Radius ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cell Tumor ◽  
Iliac Bone ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Grade Iii

It is commonly accepted that wide en bloc resection followed by reconstruction is essential in progressive lesions (Campanacci grade III) for local control of possible recurrence. However, specific grade III can be downgraded and treated with intralesional curettage to preserve better wrist function, without increasing the recurrency rates. In this report, Grade III giant cell tumor of the distal radius was successfully treated using vascularized osseous graft from the inner lip of the iliac bone in addition to downgrading strategy.

Recurrent Metacarpal Giant Cell Tumour Treated by En Bloc Resection and Metatarsal Transfer

1998 ◽  
Vol 23 (2) ◽  
pp. 275-278 ◽  
Author(s):  
J. PARDO-MONTANER ◽  
A. PINA-MEDINA ◽  
M. BARCELO-ALCAIÑIZ
Keyword(s):  
Giant Cell ◽  
Giant Cell Tumour ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cell Tumour ◽  
En Bloc ◽  
Giant Cell Tumours ◽  
Risk Of Malignancy

Recurrent giant-cell tumours of bone have a higher risk of malignancy than primary giant-cell tumours of bone, and giant-cell tumours of bone in the hand are more likely to recur than those that arise elsewhere. Therefore, en bloc resection and reconstruction, or amputation, have been the accepted treatments for recurrent giant-cell tumours of bone in the hand. We describe two cases of successful transplantion of a metatarsal to a metacarpal, which was the site of a recurrent giant-cell tumour. The patients had satisfactory results 3 years later without problems in the foot. En bloc resection of the tumour and reconstruction with an autograft should be considered in the treatment of recurrent giant cell tumour of the hand.

Denosumab Does Not Decrease Local Recurrence in Giant Cell Tumor of Bone Treated With En Bloc Resection

Orthopedics ◽  
2021 ◽  
pp. 1-7
Author(s):  
Shinji Tsukamoto ◽  
Andreas F. Mavrogenis ◽  
Yuu Tanaka ◽  
Akira Kido ◽  
Masahiko Kawaguchi ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cell Tumor ◽  
En Bloc

Giant Cell Tumours of the Hand

1996 ◽  
Vol 21 (5) ◽  
pp. 683-687 ◽  
Author(s):  
B. K. S. SANJAY ◽  
G. A. RAJ ◽  
D. A. YOUNGE
Keyword(s):  
Giant Cell ◽  
Giant Cell Tumour ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cell Tumour ◽  
Fibular Graft ◽  
En Bloc ◽  
Giant Cell Tumours ◽  
En Bloc Excision ◽  
Bloc Excision

A study of seven cases of giant cell tumours of the hand is reported. All tumours were treated by an en bloc excision of the tumour or by whole ray resection. En bloc resection of the tumour and reconstruction with a fibular graft where necessary should be considered as the treatment of choice in giant cell tumour of the hand.

scholarly journals Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database

2016 ◽  
Vol 24 (4) ◽  
pp. 644-651 ◽  
Author(s):  
Ziya L. Gokaslan ◽  
Patricia L. Zadnik ◽  
Daniel M. Sciubba ◽  
Niccole Germscheid ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Survival Data ◽  
Large Scale ◽  
Surgical Techniques ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Increased Risk ◽  
Significant Difference ◽  
Mobile Spine

OBJECT A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96–16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

scholarly journals Surgical treatment outcome of giant cell tumor of distal ulna: En bloc resection vs. curettage and bone graft

2018 ◽  
Vol 32 (1) ◽  
pp. 249-253
Author(s):  
Khodamorad Jamshidi ◽  
Mehrdad Bahrabadi ◽  
Abolfazl Bagherifard ◽  
Mehdi Mohamadpour
Keyword(s):  
Treatment Outcome ◽  
Surgical Treatment ◽  
Bone Graft ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cell Tumor ◽  
Distal Ulna ◽  
En Bloc

scholarly journals A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius

2013 ◽  
Vol 7 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Theresa J.C Pazionis ◽  
Hussain Alradwan ◽  
Benjamin M Deheshi ◽  
Robert Turcotte ◽  
Forough Farrokhyar ◽  
...  
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Distal Radius ◽  
Wrist Joint ◽  
Meta Analysis ◽  
En Bloc Resection ◽  
Cell Tumor ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Functional Benefit

Introduction: Surgical management of Giant Cell Tumor of Bone of the distal radius (GCTDR) remains controversial due to risk of local recurrence (LR) offset by functional limitations which result from en-bloc resection. This study aims to determine the oncologic and functional outcomes of wide excision (WE) vs intralesional curettage (IC) of GCTDR. Methods: A complete search of the applicable literature was done. Included studies reported on patients from the same cohort who were surgically treated for GCTDR with WE or IC. Two reviewers independently assessed all papers. The primary outcome measure was LR. Results: One-hundred-forty-one patients from six studies were included: 60 treated with WE, and 81 with IC. Five WE patients (8%) suffered LR whereas 25 IC patients (31%) did. The odds of LR were three times less in the WE group vs the IC group. MSTS1993 scores, where available, were on average 'good' with WE and 'excellent' with IC. Conclusions: Within statistical limitations the data support an attempt, where feasible, at wrist joint preservation and superior function with IC. Intralesional curettage is reasonable when the functional benefit outweighs the risk of recurrence as is the case in many cases of GCT of the distal radius.

scholarly journals Long-Term Outcomes of High-Dose Single-Fraction Radiosurgery for Chordomas of the Spine and Sacrum

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jenny Jin ◽  
John Berry-Candelabra ◽  
Y Josh Yamada ◽  
Daniel Higginson ◽  
Adam Schmitt ◽  
...  
Keyword(s):  
Local Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Dose ◽  
En Bloc ◽  
Intralesional Resection ◽  
Single Fraction ◽  
Mobile Spine ◽  
Symptom Response

Abstract INTRODUCTION To evaluate outcomes of patients with primary chordomas treated with spine stereotactic radiosurgery (SRS) alone or in combination with surgery, drawing from a single-institution database to elucidate treatment options associated with durable radiographic control of these conventionally radioresistant tumors. Chordomas result in significant morbidity, with a high rate of local recurrence and potential for metastases. SRS as a primary treatment could save patients from extensive surgery. Spine SRS outcomes support exploration of its role in the durable control of these conventionally radioresistant tumors. METHODS Clinical records were reviewed for outcomes of patients with primary chordoma of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to extent of surgery. RESULTS In total, 35 patients with de novo chordoma of the mobile spine (49%) and sacrum (51%) received SRS with a median post-SRS follow-up of 38.8 mo (range: 2.0-122.9). The median PTV dose was 24Gy (range: 18–24Gy). Overall, 12 patients (33%) underwent definitive SRS and 23 patients (66%) underwent surgery followed by adjuvant SRS. Surgical strategies included separation surgery prior to SRS, curettage/intralesional resection, and en bloc resection in 7, 6, and 10 patients, respectively. The 3- and 5-yr LRFS rates were 86.2% and 80.5% respectively. Among 32 patients receiving 24 Gy (91%), the 3- and 5-yr LRFS were 96.3% and 89.9%. The 3- and 5-yr OS rates were 90.0% and 84.3%. The symptom response rate to treatment was 88% for pain and radiculopathy. Extent or type of surgery was not associated with LRFS, OS, or symptom response rates (P > .05), but en bloc resection was associated with higher CTCAE v. 5.0 surgical toxicity compared to epidural decompression and curettage/intralesional resection (P = .03). The long-term = grade 2 SRS toxicity rate was 31%, including 17% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, fracture, and secondary malignancy. CONCLUSION High-dose spine SRS offers the chance of durable radiographic control and effective symptom relief with acceptable toxicity for primary chordomas as either definitive or adjuvant therapy.

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