Treatment of a Large Bone Defect of the Distal Part of the Radius After Intralesional Excision of Stage-III Recurrent Giant Cell Tumor by Bone Regeneration.

Abstract

Giant cell tumor of bone is a benign but often locally aggressive primary bone neoplasm, with a peak incidence in adults twenty to forty years of age1,2. The tumor often recurs, and it metastasizes to the lungs in approximately 3% of cases. Giant cell tumor of bone predominantly affects the ends of long bones, where it causes expansile lytic destruction of the metaphyseal-epiphyseal region as it enlarges. The distal part of the radius is commonly mentioned as the third most common site—after the distal part of the femur and the proximal part of the tibia—and accounts for approximately 10% of all cases3-8. Distal radial giant cell tumors enlarge rapidly and recur more often than tumors at other sites2,4,9-11. The description of the large tumors (i.e., Campanacci stage-III lesions12) was predominant in many reports on these tumors13-15, suggesting that distal radial cases often present late. Large giant cell tumors generally manifest higher rates of recurrence or metastasis16. Influenced by these aggressive features, many surgeons have recommended wide tumor resection and reconstruction of the bone defect for treating distal radial lesions13-15,17,18, but the functional results have generally been unsatisfactory. From a recent meta-analysis by Liu et al.19, there emerged a consensus that stage-I and II lesions can be treated successfully with intralesional excision. Curettage of such intraosseous tumors creates cavitary bone defects with cortical continuity with the distal part of the radius. Although these defects are traditionally treated with void-filling with bone graft or cement, Prosser et al.16 recently observed spontaneous bone regeneration in such small defects. Surgeons are divided with respect to the optimal surgical treatment of …