Clinical Outcomes of Grade 3 Giant Cell Tumor of Bone After Extended Intralesional Curettage

Introduction: The recommended treatment of grade 3 giant cell tumor of bone (grade 3 GCTB) aims to eliminate tumor and conserve limb with extended intralesional curettage. This treatment makes patients better function of bone and joint as usual. Even it can reduce postoperative complications and replace endoprosthesis. Still, there is limited information about the outcomes of surgical treatment and recurrence of the disease. This study aimed to evaluate the clinical outcomes and recurrence of grade 3 GCTB with extended intralesional curettage. Case Description: This study performed a retrospective review of 26 consecutive patients with grade 3 GCTB treated by extended intralesional curettage at Khon Kaen hospital from June 2012 to May 2017. Clinical outcomes including, functional analysis according to Musculoskeletal Tumor Society functional classification (MSTS score), pain score, postoperative complication and recurrence rate were evaluated. Twenty out of twenty-six patients were motion as usual within 6 months after surgery while recurrence of the disease is shown only one case. However, postoperative complications have not yet been reported. Conclusion: The extended intralesional curettage of grade 3 GCTB grade is an effective treatment. Nevertheless, it have to keep recall the patient for detection of disease recurrence. Introduction The giant cell tumor of bone (GCTB) was described by Cooper and Travers in 1818 [1]. It is considered a locally aggressive benign bone tumor with tendency for high recurrence. GCTB represents approximately 5-10% of all primary bone tumors [2-4]. It typically occurs in 30-40 years of age and is slightly more common in female [4], also is higher incidence rate in Southeast Asia than Western [4,5]. The most common GCTB is involved in the epiphyseal regions of long bones, particularly the distal femur and the proximal tibia [6,7]. Primary malignant turn and distant lung metastasis are about 1% and 3% in GCTB patients, respectively [8]. The principal symptoms are pain and swelling which are caused by cortical bone destruction and tumor expansion. Addition, joint effusion and limited range of motion are also possible. Pathological fracture shows aggressive progression of disease. The definitive diagnosis is confirmed by histological method. This benign tumor has characteristic multinucleated osteoclast-type giant cells [9]. There is still not a consensus in surgical treatment of grade 3 GCTB between a wide excision and an extended intralesional excision which it is all about balance between eliminating the tumor and preserving the extremity’s function [10-12]. This study assesses the functional and oncological outcomes grade 3 GCTB with an extended intralesional curettage combined with adjuvant therapies comprising high-speed burring and bone cementation, instead of a wide excision, to better avoid limb salvage surgery with endoprosthetic reconstruction. Methods The study is a retrospective descriptive study of the clinical outcomes in grade 3 GCTB treated by extended intralesional curettage at Khon Kaen hospital, Thailand from June 2012 to May 2017. All patients with histologically and staging verified grade 3 GCTB underwent extended intralesional curettage followed by high-speed burring in some cases used of phenol. The resultant intraosseous defects were reconstructed with polymethylmethacrylate bone cement because not only provides immediate stability but also help detect local recurrence from postoperative radiograph (Figure 1). Addition, some patients with impending or actual pathological fractures managed with plate fixation (Figure 2). Patients were admitted for 5 to 10 days deciding by size and site of GCTB. The patients with the upper extremity were managed with a sling for 2 to 4 weeks postoperatively, while the lower extremities, patients were either non-weight-bearing or partial weight-bearing for 4 to 6 weeks and used crutches when they walked. Patients were followed by means of physical examination, radiographs of the extremity (to rule out local recurrence) and on the chest (to rule out lung metastasis) every 6 months from 1 to 2 years, and annually after that [8]. The clinical outcome assessment was performed using the Musculoskeletal Tumor Society (MSTS) scoring system for the upper and lower limbs. The radiographic evidence of endosteal scalloping or cortical erosion, tumor size, tumor location and soft tissue extension on MRI and patient age affect successfully treatment. The outcomes included the MSTS score, pain score, local recurrence and tumor metastasis. Results Oncological outcomes The average age of patients was 35 (range; 14 to 67) years. There were 14 male and 12 female patients. All of them do not have the family health history of cancer. The treated lesions were located in the distal femur (n=9), proximal tibia (n=6), proximal femur (n=2), distal ulnar Citation: Sukpanichyingyong S, Sangkomkamhang T (2017) Clinical Outcomes of Grade 3 Giant Cell Tumor of Bone After Extended Intralesional Curettage. J Orthop Oncol 3: 118. doi: 10.4172/2472-016X.1000118