Late Results in Benign Giant-Cell Tumor of Bone Obtained by Radiation Therapy

Abstract

The principles of therapy of giant-cell tumor of bone have been, from the beginning, subordinated to the variation in pathologic and histogenetic interpretation. In the early days, when the lesion was commonly regarded as belonging to the group of true bone sarcoma, radical surgery canconstituted the mode of attack. In 1920, the Bone Tumor Registry of the American College of Surgeons, recognizing the benign character of most giant-cell-containing new growths of bone, placed them in a separate division under the name of “benign giant-cell tumor.” Since then the trend of therapy has been toward conservatism. Inasmuch as metastases were not to be feared, attention was centered on how to apply the treatment locally in the most advantageous manner. Where formerly amputation or resection was advocated, curettage, swabbing of the bony cavity with escharotics, intracavitary radium, etc., were applied, the aim being to save the limb and if possible to restore its normal function. Later, when it was found that the curetted bony cavity was often slow in filling in and when a certain number of cases recurred or became secondarily infected, irradiation was tried. Thus in its incipience, radiation therapy of giant-cell tumor of bone formed a supplement to surgical intervention, usually under most unfavorable circumstances. If one also considers the peculiar radiation reaction which is observed in this lesion, and which was not altogether understood at that time, there can be no doubt that the method was placed in a position of jeopardy even as to its merit in an auxiliary capacity. All too often the cases treated by such a combination had to be subjected in the end to amputation, a procedure which, in fact, signified complete failure of the local therapeutic effort. Additional study of the radiation behavior of this tumor became necessary when it was unexpectedly noted that some of the patients who, after presumably unsuccessful treatment by curettage and irradiation, refused to submit to more radical surgery turned up later entirely recovered from their former trouble with out further treatment. During the same time new concepts started to make a heavy inroad on the histogenetic interpretation of the lesion. The opinion was heard with increasing frequency that giant-cell tumors are merely the result of a foreign-body response or a repair process of the disturbed osseous structure and, since not all arise under the same circumstances, they may represent parts of a more complex agglomeration of tumors. It thus became apparent that radiation therapy in order to be of value must be carried out with a technic which would take into consideration special requirements. These factors have given impetus to a long series of clinical investigations which now are apparently leading to the establishment of irradiation, in the form of roentgen therapy, as the primary method of treatment in all cases of benign giantcell tumors and allied cystic conditions of bone.