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

Theresa J.C Pazionis,Forough Farrokhyar,Robert Turcotte,Michelle Ghert,Hussain Alradwan,Benjamin M Deheshi

doi:10.2174/1874325001307010103

Abstract

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. 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. 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. 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.

Highlights

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
Giant cell tumor of bone (GCT) is the most common benign aggressive primary bone tumor, accounting for approximately 5% of primary bone tumors in adults from ages 20 to 50 [1], with a slight predominance for females compared to males [1]
The hallmark appearance of GCT is an expansile lesion which is centrally radiolucent with formation of a thin neocortex at the border of the lesion [1]

Summary

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. Giant cell tumor of bone (GCT) is the most common benign aggressive primary bone tumor, accounting for approximately 5% of primary bone tumors in adults from ages 20 to 50 [1], with a slight predominance for females compared to males [1]. GCT may exhibit metastatic disease in less than 5% of cases [2,3,4,5] most often to lung if observed. The typical radiographic appearance of GCT is a lesion which is eccentrically located in the metaphyseal and epiphyseal regions of the long bones [1]. Campanacci grade is the classification system of choice for giant cell tumors. Grade 1 tumors are confined within the cortex, grade 2 expand the cortex, and grade 3 perforate the cortex with resultant soft tissue

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