Personalized treatment options and clinical results of giant cell tumor of the long bone --A retrospective analysis of 281 patients from one institution

Abstract

Objective To explore the personalized treatment options and clinical results obtained by our hospital for different parts of bone destruction of different degrees of bone giant cell tumor. Methods Retrospective analysis from January 2005 to December 2014, according to the giant bone cell tumor diagnosis and treatment procedures used in thehospital to take wide resection or intralesional curettage and adjuvant therapy for the treatment of primary limb long bone giant cell tumor 281 cases. There were 150 males and 131 females, with overall age from 14 to 71 years and an average of 35.10 yearsold. The distal ulna was 9 cases.The distal radiuswas 26 cases. The proximal humerus was 19 cases. The distal humerus was 2 cases. The proximal femur was 38 cases.The distal femur was 95 cases. The proximal tibiawas 59 cases. The distal tibiawas 10 cases. There were 19 proximal fibula cases, 3 distal fibula cases and 1 case of multiple giant cell tumor of bone. We chose curettage and/or adjuvant therapy or wide resection, then with bone cement, allograft or autograft, prostheses to reconstructionaccording to tumor site, the degree of destruction, pathological fractures. The χ2 test and Cox regression analysis were used to detect the statistic differences. The Kaplan-Meier survival analysis was used to count the disease-free survival. The relationship between tumor location, destruction degree, Campanacci grading, pathological fractures, treatment methods at different stages and recurrence were analyzed. Results A total of 281 patients with long bone giant cell tumor were included in the follow-up study, including 37 pathological fracture and 244 non-fracture. According to the author's giant cell tumor diagnosis and treatment process, 122 patients received a wide resection, 159 cases were treated with curettage ± adjuvant therapy. 23 patients had postoperative recurrence, the recurrence rate was 8.19%. The recurrence time after operation ranged from 9 to 75 months (average 30.95 months). There was no significant difference between the recurrence rate of lesions around the knee and other parts (χ2=0.370, P=0.240). In the non-pathologic fracture group, the recurrence rate was significantly lower in the large section compared with curettage surgery (χ2=9.393, P=0.002). Of the patients with intralesional surgery, 126 patients reconstructed with cement and 28 patients reconstructed with autograft/allograft bone to rebuild mechanical stability. There were 14 recurrence cases (14/126, 11.11%) in the bone cement group and 8 recurrence cases (8/28, 28.57%) in the bone graft group. The recurrence rate in the bone cement group was significantly lower than that in the simple bone graft group (χ2=5.846, P=0.017). The patients with lesion less than 50%, 4 had recurrences (4/55, 7.27%), 12 recurrences occurred (12/76, 15.79%) in more than 50% and less than 75% of the cross-sections, and if the lesion was more than 75% cross-sectional area, 4 cases of recurrence (4/113, 3.54%). There was no significant difference in the proportion of bone destruction between different cross-sections in affecting tumor recurrence. The recurrence rate of Campanacci Grade III patients was significantly higher than that of Campanacci Grade II patients with curettage surgery (χ2=9.909, P=0.002). Only 1 of the patients with pathological fracture had recurrence (1/37, 2.70%), the recurrence rate was significantly lower than that the curettage group (χ2=11.972, P=0.001). Among the early patients, 79 cases (63.71%) were cured by surgery and 17 cases were relapsed, while in the last 5 years 80 cases (50.96%) were cured by surgery and 6 cases were relapsed, In two different periods, the curettage recurrence rate was significantly decreased (χ2=9.246, P=0.003). Conclusion By selecting personalized treatment options for different patients, it is possible to increase the proportion of patients who maintain their knee joints while reducing the local recurrence rate, providing doctors and patients with a choice of treatment options. Key words: Giant cell tumor of bone; Recurrence; Antineoplastic protocols