Management Of Giant Cell Tumor Research Articles

Management of Giant Cell Tumor of Distal Radius-Does Curettage Work?

Giant cell tumor affecting distal radius has been considered more aggressive, as compared to its counterparts in other locations. While resection has been advocated as the treatment of choice with lower rates of recurrence, curettage has reportedly led to superior functional outcomes. This retrospective study aimed to evaluate the functional and oncological outcomes of patients managed for GCT distal radius by either extended intralesional curettage (EIC) or resection and arthrodesis with radialisation of ulna (RRU), with respect to rates of local recurrence and function. Twenty-four patients operated for giant cell tumor of distal radius by a single surgeon from 2011 to 2021, were included in the study. The demographic, clinico-radiological, and surgical details were recorded and analyzed, as were the functional and oncological outcomes. At a median (IQR) follow-up of 6.3years (range 2years to 15.9years), the rate of recurrence in curettage was found to be higher than that in resection but was not statistically significant (35.7% vs 20%, p > 0.05). Patients managed elsewhere and then presented to us for recurrence had a higher rate of local recurrence (66.6%, p = 0.01). Average time to recurrence was 14months (range 2-24months). On final follow-up, patients in curettage group had better functional outcomes in terms of grip strength and range of motion. Mean Modified Mayo Wrist score and MSTS score were 78.2 and 25.63, respectively, for EIC group and 69.6 and 25.75, respectively, for RRU group. Extended intralesional curettage resulted in an earlier rehabilitation with a mobile wrist and acceptable disease control when compared with resection and arthrodesis with radialisation of ulna.

Management of giant cell tumor of the distal end radius: extended curettage and adjuvant therapy versus wide resection and reconstruction: a systematic review and meta-analysis

Background Giant cell tumors (GCTs) in the distal end of the radius present unique challenges in balancing oncological clearance with preserving functional capabilities. This study aims to provide a comprehensive comparison between extended curettage with adjuvants and wide resection with reconstruction for GTCs of the distal radius, addressing outcomes such as recurrence rates, functional scores, and complications. Patients and methods A systematic review of the literature was conducted, involving databases such as MEDLINE, Cochrane library, and PubMed. Inclusion criteria comprised comparative cohort studies in English, comparing extended curettage with adjuvants versus wide resection with reconstruction in patients with GCTs of the distal end radius. Outcome measures included functional outcomes (Musculoskeletal Tumor Society, disabilities of the arm, shoulder, and hand), recurrence, metastasis, postoperative complications, and quality of life. Results The literature search identified 17 retrospective comparative cohort studies that met the inclusion criteria. The studies included 527 procedures, with an average participant age of 33.49 years and a mean follow-up of 7.1 years. The pooled estimate showed a significantly lower recurrence rate with wide resection (7.7%) compared with extended curettage with adjuvants (28.4%). Functional outcomes favored extended curettage in terms of visual analog scale pain scale and disabilities of the arm, shoulder, and hand score, with no significant difference in range of motion but higher grip strength in the curettage group. Complication rates were higher with wide resection. Conclusion While extended curettage with adjuvants may pose a higher risk of recurrence, it demonstrates promise for improved functional outcomes. The study suggests that extended curettage leads to reduced pain and disability scores compared with wide resection, with a higher grip strength. The findings contribute to the ongoing discussion on the optimal management of GCTs in the distal radius, highlighting the importance of balancing oncological considerations with functional outcomes. However, study limitations, including retrospective designs and potential selection bias, should be considered in interpreting the results.

Management of Giant Cell Tumor by Curettage and Bone graft in Weight Bearing Bone - A Study Done in CENTRAL MEDICAL COLLEGE.

Background: Giant cell tumor of bone (GCT) has been characterized as benign but often locally aggressive neoplasm that commonly occurs in proximity to weight bearing bone. Management of giant cell tumor of bone by curettage and bone graft in weight bearing bone is an effective method. This prospective experimental study was conducted among the patients with histologically proved giant-cell tumor who were admitted in the Department of orthopedic surgery, Central Medical College Hospital over a period of 18 months from January 2018 to June 2020. A total of 12 consecutive patients with histologically proved giant-cell tumour were included in the study. Majority (55.6%) of patient was in 3rd decade and male female ratio was 1:1.3. More than one fourth (25%) of the patients had GCT in the lower end of right femur, 33.3% in lower end of left femur, 25% in upper end of tibia, 16.7% in lower end of tibia and all patients had painful gait and swelling. According to campanacci grading, Grade-2 was found in all patients, and giant cell tumor was found in all patients, as evaluated by pre-operative biopsy. Cosmetically near normal appearance was found in 88.9% and 88.9% were able to do normal daily work. According to Schatzker and Lamber (1979) criteria excellent outcome was found in 41.7%, good in 50%, fair in 8.3%. Surgery in the form of intralesional curettage and filling the cavity with bone graft resulted in excellent relief of pain, cosmetically near normal appearance and patients were able to do normal daily work.
 Central Medical College Journal Vol 7 No 1 January 2023 Page: 7-12

Denosumab in the complex management of giant cell tumor of the spine

Denosumab in the complex management of giant cell tumor of the spine

Oncology

The August 2023 Oncology Roundup360 looks at: Giant cell tumour of bone with secondary aneurysmal bone cyst does not have a higher risk of local recurrence; Is bone marrow aspiration and biopsy helpful in initial staging of extraskeletal Ewing’s sarcoma?; Treatment outcomes of extraskeletal Ewing’s sarcoma; Pathological complete response and clinical outcomes in patients with localized soft-tissue sarcoma treated with neoadjuvant chemoradiotherapy or radiotherapy; Long-term follow-up of patients with low-grade chondrosarcoma in the appendicular skeleton treated by extended curettage and liquid nitrogen; Cancer-specific survival after limb salvage versus amputation in osteosarcoma; Outcome after surgical treatment of dermatofibrosarcoma protuberans: does it require extensive follow-up, and what is an adequate resection margin?; Management of giant cell tumours of the distal radius: a systematic review and meta-analysis.

Management of Giant Cell Tumor of the Hyoid bone- A rare Clinical Entity with Review of Literature.

Giant cell tumors (GCTs) are typically found in the long bones but can also occur in the head and neck region. GCT of the larynx is a rare entity with only 42 reported cases in the international literature. Furthermore, to the best of our knowledge this is the largest laryngeal GCT reported in the literature to date. GCT of the larynx can present with dysphonia, dyspnea, and/or dysphagia and should be considered in the differential diagnosis of a neck mass. A38-year-old man presented with complaints of mass in the neck with dysphonia and dysphagia. On clinical examination,there was huge spherical swelling extending from submental region till sternal notch with overlying normal skin. Computed tomography (CT) neck revealed a 20 × 15.7cm mass centered on the hyoid bone, which was further diagnosed by histopathology as giant cell tumour on biopsy. The patient was counselled on treatment options and it was decided to proceed with a surgical approach. The patient consented to and successfully underwent en-bloc excision of mass with hyoid bone. Histopathology report revealed GCT of Hyoid bone.Currently the patient has no evidence of disease at 25 months follow-up, has an optimal voice, and is on regular follow -up with us. GCTs of the larynx have a good prognosis and can be treated successfully through complete resection of the tumor, negating the need for adjunctive therapy such as radiation, chemotherapy or denosumab therapy.

Management of giant cell tumors of the distal radius

BackgroundThe distal radius is the most common location for giant cell tumors (GCT) in the upper extremity. Treatment should balance the goals of maximizing function and minimizing recurrence and other complications. Given the complexity in surgical treatment, various techniques have been described without clear standards of treatment. ObjectivesThe purpose of this review is to provide an overview of evaluation of patients presenting with GCT of the distal radius, discuss management, and provide an updated summary on outcomes of treatment options. ConclusionSurgical treatment should consider tumor Grade, involvement of the articular surface, and patient-specific factors. Options include intralesional curettage and en bloc resection with reconstruction. Within reconstruction techniques, radiocarpal joint preserving and sparing procedures can be considered. Campanacci Grade 1 tumors can be successfully treated with joint preserving procedures, whereas for Campanacci Grade 3 tumors consideration should be given to joint resection to prevent recurrence. Treatment of Campanacci Grade 2 tumors is debated in the literature. Intralesional curettage and adjuvants can successfully treat cases where the articular surface can be preserved, while en-bloc resection should be used in cases where the articular surface cannot undergo aggressive curettage. A variety of reconstructive techniques are used for cases needing resection, with no clear gold standard. Joint sparing procedures preserve motion at the wrist joint, whereas joint sacrificing procedures preserve grip strength. Choice of reconstructive procedure should be made based on patient-specific factors, considering relative functional outcomes, complications, and recurrence rates.

Management of giant cell tumor of bone in the era of denosumab: A case series and review of the literature

Giant cell tumor (GCT) of the bone also known as osteoclastoma typically arises from the meta-epiphyseal region of the long bone and comprises 5% of all bone tumors and 20% of benign bone tumors. Understanding pathogenesis is the key to successful systemic therapy with denosumab, a RANK-ligand inhibitor. In this context, we report seven GCT bone-treated denosumab and radiotherapy cases with a diverse clinical presentation from our institute, NRS Medical College, and Hospital Kolkata.

Role of Denosumab in the Management of Giant Cell Tumor, a Cross Sectional Study

ABSTRACT Background: Giant cell tumor (GCT) of bone is a benign lesion which is characterized by presence of multinucleated osteoclasts type giant cells. Nuclear factor kappa B (RANKL) serves as the trigger factor for osteoclasts cells formation. Although surgery is the primary treatment for GCT of bone but recurrence remains the concern. Therefore, the development of denosumab, a monoclonal antibody for treating GCT for both primary and recurrent disease cases. The present study aims to show the role of denosumab along with surgery when given as neo-adjuvant drug to patients of GCT for their treatment. Methodology: A total of 23 patients diagnosed with GCT were included in this study from January 2016–December 2019 and all of these patients had received neo adjuvant denosumab dose of 120 mg SC on day 0, 15, 30 & 45. All patients were treated at the section of Orthopedics, department of surgery, Aga Khan University hospital, Karachi. Other benign lesions were excluded from the study. Results: Out of 23 patients we had 12 (52.2%) males and 11 (47.8%) females. The mean age of our patients was 34±13.8 years and mean follow up duration of all patients was 20.5 ± 10.7 months. There were 15 (65.2%) primary cases of GCT while 8 (34.8%) were recurrent cases. In 8 (34.8%) of the cases primary site of lesion was distal femur followed by 7(30.4%) proximal tibia cases and 3(13%) distal radius cases. In surgical procedure 20 (87%) patients underwent wide margin excision and only 3 (13%) had intralesional curettage. Reconstruction was performed in 21 patients which consist of bone grafting in 9 patients and mega prosthesis insertion in 12 patients. Only two patients had no reconstruction. On final histopathology, there was no residual GCT and we observed no denosumab induced adverse effects. Post-operative complications included wound infection and peri prosthetic infection in 3 patients. On follow-up we had 4(17.4%) cases of recurrence that were offered revision surgery while 19 (82.6%) were disease free. Conclusion: Denosumab has shown successful results in treating patients with GCT along with surgical intervention and it can be a best option for treating recurrent disease as well. Highlights Research registration no: researchregistry4695

Clinico radiological Presentation and Management of Giant Cell Tumour of Calcaneum: A Case Report

Clinico radiological Presentation and Management of Giant Cell Tumour of Calcaneum: A Case Report

A case study of management of giant cell tumour of Proximal Fibula

A case study of management of giant cell tumour of Proximal Fibula

Usage of Denosumab for Giant Cell Rich Tumors: A Case Study and Literature Review

Denosumab is a human monoclonal antibody to receptor activator of NF-κB ligand (RANKL), which has been FDA-approved for the management of giant cell tumor of bone. Here, we present a case of 21-year-old female with solid aneurysmal bone cyst (ABC) treated with denosumab for 6 months to date. The patient experienced positive outcomes as the result of denosumab therapy.

Management of giant cell tumors of the distal radius: a systematic review and meta-analysis.

The treatment of giant cell tumors (GCT) of the distal radius remains challenging, with no consensus on the optimal surgical management. Surgical management remains the mainstay of treatment with options including intralesional curettage and en-bloc resection with reconstruction. The objective of this systematic review and meta-analysis was to evaluate and compare the outcomes of these two procedures. Using OVID-Medline and Embase databases, a systematic literature search was performed. Comparative studies, assessing intralesional curettage and en-bloc resection in patients with GCTs of the distal radius, were included. Data regarding rates of local recurrence, metastasis, overall complications, and functional outcomes, were collected and analyzed. The ROBINS-I tool was utilized for risk of bias appraisal within each study outcome. Thirteen studies (n = 373 patients) reporting on 191 intralesional curettage procedures and 182 en-bloc resections were included in the analysis. The average age of participants was 31.9 (SD ± 2.4) years and average follow-up was 7.1 (SD ± 3.6) years. Patients that underwent intralesional curettage were more likely to develop local recurrence (Risk Ratio (RR) 3.3, 95% CI, [2.1, 5.4], p < 0.00001) when compared to patients that underwent en-bloc resection. In Campanacci grade 3 lesions, the risk for local recurrence was 5.9 (95% CI, [2.2, 16.3], p = 0.0006) times higher in patients that received intralesional curettage. Patients that underwent intralesional curettage showed an 84% reduction in the relative risk of developing overall complications compared to en-bloc resection (95% CI, [0.1, 0.4], p < 0.00001), and a larger decrease in Visual Analog Scale and lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores (p < 0.00001). Risk ratio for developing a local recurrence, with PMMA versus bone graft following an intralesional procedure was not significant (RR 1.2, 95% CI, [0.6, 2.6], p = 0.62). In the surgical management of GCT of the distal radius, intralesional curettage increased local recurrence compared to en-bloc resection with reconstruction, particularly in grade 3 tumors. However, it led to significantly fewer operative complications, lower pain scores, and improved functional outcomes compared to en-bloc resection. Both treatment options remain relevant in the contemporary management of GCTs of the distal radius. Surgical decision making should include both patient and tumor factors when determining the optimal treatment strategy for these patients. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.

Management of Giant Cell Tumor of Talus With Extended Intralesional Curettage and Reconstruction Using Polymethylmethacrylate Cement.

An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results.Level of Evidence: Level V.

Kemiğin Dev Hücreli Tümörünün Tedavisinde Denosumabın Etkililiği ve Güvenliliği: Sistematik Bir Derleme ve Meta-Analiz

The adjuvant treatment of denosumab for the management of giant cell tumor of bone (GCTB) has been widely investigated. However, the inconclusive findings were observed. Therefore, our study aimed to assess the efficacy of denosumab for the adjuvant therapy in the management of GCTB. We conducted a meta-analysis study during the period of FebruaryAugust. Article search was conducted in PubMed, ScienceDirect, and Cochrane library. The predictor was denosumab administration, and the outcomes measures were local recurrence, blood loss, Musculoskeletal Tumor Society (MSTS) score, lung metastase, and malignant transformation. Data were analyzed using Z test to evaluate the association. We included 11 papers, consisting of 253 cases and 1,145 controls. The quality of the included article was evaluated using the Newcastle-Ottawa scale (NOS). Our results identified that denosumab administration was associated with lower blood loss and improved MSTS score compared to those without denosumab administration in patients with GCTB. However, GCTB patients with and without denosumab administration shared similar findings in the context of local recurrence, lung metastase, and malignant transformation. Our study has verified that denosumab administration as an adjuvant treatment for the management of GCTB is associated with lower blood loss during surgical procedure and improved MSTS score.

Surgical management of giant cell tumor in adolescent by excision or curettage followed by fibular strut graft

&lt;p class="abstract"&gt;Giant cell tumour (GCT) in adolescent is a rare tumour. It commonly occurs in skeletally mature patients aged between 20-40 years. In adults it is seen in epiphyseal region. In patients with intact physis, it arises from the metaphysis. Giant cells are more common in females. It is more common in the ends of long bones of distal end of femur, proximal tibia, and distal radius. 14 cases of surgical management of GCT by excision or curettage in adolescent followed by fibular strut graft. 1 year follow up of all cases of GCT in adolescent treated with excision or curettage followed by fibular strut graft was done. Out of 14 patients, 12 patients did not develop any recurrence of GCT. 2 patient developed recurrence after 6 months. All the patients were able to attain good range of movements 2 months after surgery. GCT in adolescent surgically treated with excision or curettage followed by fibular graft had excellent results in terms of recovery of daily activities, wound healing. Chances of recurrence more in patients treated with curettage and bone grafting.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Management of Giant Cell Tumour of Hand and Feet with Special Reference to Reconstruction

Management of Giant Cell Tumour of Hand and Feet with Special Reference to Reconstruction

Giant Cell Tumour Around Knee Managed by Curettage and Zoledronic Acid with Structural Support by Fibula Cortical Struts.

Introduction:Giant cell tumour (GCT) of the bone is a benign tumour with a high tendency to recur after surgery. This study aimed to analyse prospectively the rate of local recurrence following management of giant cell tumours by curettage, using intravenous zoledronic acid as an adjuvant, and fibular struts to support the empty cavity after curettage.Materials and Methods:This study was carried out in ten cases of biopsy-proven GCTs: five males and five females, in the age group between 18 and 39 years. All patients were given three doses of zoledronic acid, one pre-operative and two post-operative. Extended curettage was done three weeks after the pre-operative dose of zoledronate. The cavity was left empty in all the cases. Fibular struts were used to support the cavity from collapse. Patients were followed-up for post-operative local recurrence. The functional status of the patients was assessed during each visit using the Musculoskeletal Tumour Society (MSTS) score.Results:There were no recurrences at a follow-up of two years. All patients had a stable knee and were able to bear weight fully. The average knee flexion was 75º. The average MSTS score of the study was 92%.Conclusion:Extended curettage using hydrogen peroxide, systemic zoledronic acid adjuvant and leaving the cavity empty without using cancellous bone graft did not lead to a recurrence of GCT. Non-vascularised fibular strut provided adequate support while the cavity left empty after curettage did not collapse and there was good knee function.

A Case Report of Giant Cell Tumor of Proximal Fibula in Children

Giant cell tumour (GCT) is histopathologically benign tumor of long bone particularly in distal femur and the proximal tibia. It commonly occurs in adults of age 20-40 years but rare in children. GCT is considered to be locally aggressive tumor and tendency of recurrence is higher even after surgery. The clinical features are nonspecific, the principle symptoms are pain, swelling and limiting adjacent joint movements. Diagnosis is based on the radiographic appearance and histopathological findings .In our case X-ray showed ill defined lytic lesion on proximal fibula with cortical thinning and MRI finding revealed expansile lyticlesion in meta-epiphysis of right fibula 16×16×28mm adjacent to growth plate with fluid level. The sclerotic rim appears hypo intense on T1 &amp; hyper intense on T2. Core needle biopsy showed giant cell tumor on proximal fibula. Considering the risk of recurrence wide local excision was done. Management of GCT of proximal fibula in young patient is critical for preventing recurrence and enhancing functional outcomes by saving adjacent anatomical structure. No evidence of local recurrence and metastasis was found in 24 months of follow up.

Management of Giant Cell Tumors in Hand and Foot.

The aim of this study is to determine the treatment modalities and clinical characteristics of 12 patients diagnosed with giant cell tumor (GCT) of the hand and foot. The clinical findings, treatment modalities, and treatment failures of 12 patients with giant cell tumors of the hand and foot bones between 2007 and 2018years were evaluated retrospectively. The average age at diagnosis was 29.2 ± 14.9 std. (between 16 and 62years old), 8 males (66.6%) and 4 females (33.3%). Tumor was more frequently located in the talus, metacarpal, and metatarsal bones. The mean tumor size was 3.1 ± 1.1cm (between 2.2 and 5.3cm). The mean post-operative follow-up period was 76.3 ± 42.5 (between 12 and 139months). The most of patients' (58.3%) common complaints were pain. The most commonly used surgical method was curettage + autografting (91.7%). Infection was seen in one patient after relapse surgery. Recurrence occurred in 33.3% of the patients in the first year. Only one patient was detected to have knee and lung metastases. Swelling and pain in the hand and foot should be examined for tumor lesions. When a bone lesion is detected, the giant cell tumor of the bone should be included in the differential diagnosis. Patients with giant cell tumors should be followed closely for recurrence and metastasis after treatment.