Abstract
BackgroundReports of recurrence following restructuring of primary giant cell tumor (GCT) defects using polymethyl methacrylate (PMMA) bone cementation or allogeneic bone graft with and without adjuvants for intralesional curettage vary widely. Systematic review and meta-analysis were conducted to investigate efficacy of PMMA bone cementation and allogeneic bone grafting following intralesional curettage for GCT.MethodsMedline, EMBASE, Google Scholar, and Cochrane databases were searched for studies reporting GCT of bone treatment with PMMA cementation and/or bone grafting with or without adjuvant therapy following intralesional curettage of primary GCTs. Pooled risk ratios and 95% confidence intervals (CIs) for local recurrence risks were calculated by fixed-effects methods.ResultsOf 1,690 relevant titles, 6 eligible studies (1,293 patients) spanning March 2008 to December 2011 were identified in published data. Treatment outcomes of PMMA-only (n = 374), bone graft-only (n = 436), PMMA with or without adjuvant (PMMA + adjuvant; n = 594), and bone graft filling with or without adjuvant (bone graft + adjuvant; n = 699) were compared. Bone graft-only patients exhibited higher recurrence rates than PMMA-treated patients (RR 2.09, 95% CI (1.64, 2.66), Overall effect: Z = 6.00; P <0.001), and bone graft + adjuvant patients exhibited higher recurrence rates than PMMA + adjuvant patients (RR 1.66, 95% CI (1.21, 2.28), Overall effect: Z = 3.15, P = 0.002).ConclusionsLocal recurrence was minimal in PMMA cementation patients, suggesting that PMMA is preferable for routine clinical restructuring in eligible GCT patients. Relationships between tumor characteristics, other modern adjuvants, and recurrence require further exploration.
Highlights
Reports of recurrence following restructuring of primary giant cell tumor (GCT) defects using polymethyl methacrylate (PMMA) bone cementation or allogeneic bone graft with and without adjuvants for intralesional curettage vary widely
For benign to locally aggressive GCT tumors, recurrence is most common in local tissues due to narrow surgical margins [3]; 3.5% of GCT patients develop remote benign or metastatic lesions [4,5,6], with malignancy variably reported in ≤30% of cases [7]
Though modern curettage with local adjuvant or en bloc excision with prosthetic reconstruction are widely accepted treatment strategies for GCT of bone, consistently reported to reduce recurrence compared to wide excision [10,11,12,13,14,15,16,17], there is no consensus for optimal surgical curettage methodology, including fillers and adjuvants, to limit recurrence
Summary
Reports of recurrence following restructuring of primary giant cell tumor (GCT) defects using polymethyl methacrylate (PMMA) bone cementation or allogeneic bone graft with and without adjuvants for intralesional curettage vary widely. PMMA cementation treatment after curettage immediately stabilizes the affected limb and releases heat during polymerization that may kill remaining tumor cells [18,19], achieving recurrence rates ranging from 12 to 65.2% in various reports [13,20]. For lesions near the articulating surface, subchondral allogeneic bone grafting is a widely accepted alternative for filling voids during intralesional curettage either with or without additional adjuvants, with recurrence rates comparable to PMMA treatment [2]
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