High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis

H Algawahmed,F Farrokhyar,M Ghert,Robert Turcotte

doi:10.1155/2010/586090

Abstract

Local control rates for Giant Cell Tumor of Bone (GCT) have been reported in a large number of retrospective series. However, there remains a lack of consensus with respect to the need for a surgical adjuvant when intralesional curettage is performed. We have systematically reviewed the literature and identified six studies in which two groups from the same patient cohort were treated with intralesional curettage and high-speed burring with or without a chemical or thermal adjuvant. Studies were evaluated for quality and pooled data was analyzed using the fixed effects model. Data from 387 patients did not indicate improved local control with the use of surgical adjuvants. Given the available data, we conclude that surgical adjuvants are not required when meticulous tumor removal is performed.

Highlights

Giant Cell Tumor of Bone (GCT) is a primary bone tumor of mesenchymal origin presenting as a localized osteolytic lesion
Despite an abundance of published series on the surgical management and outcomes of GCT of bone, there remains a lack of consensus with respect to the need for a surgical adjuvant when intralesional curettage is performed
We have systematically reviewed the literature and identified six studies in which two groups from the same patient cohort were treated with intralesional curettage and high-speed burring with or without a chemical or thermal adjuvant such as phenol, liquid nitrogen, and PMMA

Summary

Introduction

Giant Cell Tumor of Bone (GCT) is a primary bone tumor of mesenchymal origin presenting as a localized osteolytic lesion. Intralesional curettage has been widely accepted as the standard of care for GCT of bone. This method of treatment carries a significantly higher recurrence rate with various recurrence rates ranging from approximately 13% to 49% [2, 5, 7,8,9]. In an attempt to reduce these high local recurrence rates, several toxic or thermal adjuvants have been advocated to provide local control. These include phenol, polymethylmethacrylate (PMMA), argon beam coagulation, anhydrous alcohol, and liquid nitrogen [10,11,12,13,14,15]. PMMA can be used as structural filler, it is believed to cause thermal injury to local cells and acts as a surgical adjuvant [16]

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