Benign giant-cell tumor of bone: radiation dosage for each type.

Abstract

THE PURPOSE of this paper is to bring some order out of the chaotic mass of published data and opinions concerning the role of irradiation in the treatment of benign giant-cell tumor (GCT) of bone. Material and Methods The study is based upon 57 cases of genuine benign giant-cell tumors: 11 treated by us and 46 from the literature.2 We eliminated from our own material 4 successfully irradiated probable giant-cell tumors because of lack of histologic corroboration and 9 successfully treated cases with long-term follow-up because of insufficient radiation dosage data. The latter lesions were irradiated in the 1930's with radium packs and intermediate voltage radiation. Treatment was often in multiple courses and dosage was uncertain. Many published cases were eliminated from this study for the following reasons: histologic confirmation was lacking; the histologic description was not consistent with genuine giant-cell tumor; irradiation dose data were either absent, inadequate, or presented in archaic terms preventing a reasonable estimation of tumor dose; irradiation and surgery were carried out simultaneously so that the effect of irradiation alone could not be evaluated. Although a follow-up period of five years is desirable for accurate evaluation, almost one third of the reported cases would have been rejected if this criterion had been applied. Therefore, we accepted cases with shorter follow-up periods because they provided data useful to this study. Classification There is insufficient data available for the ultimate classification of benign giant-cell tumor. It is practical and convenient to group these tumors according to combined clinical and radiotherapeutic considerations (Table I). The major parameters are: age (children up to fifteen years of age, young adults up to twenty-five years of age, and adults); anatomy (membranous bones, long bones, and spine); and miscellaneous types of GCT. Special consideration is given to tumors of the jaw. Central Giant-Cell Tumor of the Jaw in Children and Young Adults Central giant-cell tumor of the jaw is an innocent tumor with specific characteristics. It occurs chiefly in children and young adults. It is radiosensitive and is radiocurable with tumor doses considerably smaller than those required for typical GCT. These lesions are equally curable with surgery, but that is a more formidable procedure and sacrifices teeth (6). Figures 1 and 2 illustrate central giant-cell tumors of the upper and lower jaw in two females aged ten and twenty-two years. Tumor doses of 1,850 rads3 in twenty-two days and 3,000 rads in sixty days arrested the lesions and restored the involved teeth to normal function and position for four teen and thirteen years respectively. Our other two patients are listed in Table II. Figure 3 and Table II depict the doses given to 13 central giant-cell tumors of the jaw.