2002 CTOS Annual Meeting Oral Presentations — Surgery

IS THERE A CASE FOR A RANDOMIZED CLINICAL TRIAL FOR TREATMENT OF GIANT CELL TUMOURS?
[Abstract ID: 77]

Category: Surgery

Presentation: Oral

Authors: Robert Grimer¹

Author Institutions: ¹Royal Orthopaedic Hospital, United Kingdom

Presenter: Robert Grimer
rob.grimer@btopenworld.com

Correspondent: Robert Grimer
rob.grimer@btopenworld.com
Birmingham United Kingdom B31 2AP
Ph: (+44) 121 685 4150
Fax: (+44) 121 685 4146

Objectives: The role of adjuvants in preventing local recurrence following curettage of giant cell tumour of bone (GCT) remains controversial. We have reviewed our experience of curettage alone to fuel the debate.

Methods: All patients treated for primary giant cell tumours of bone over a 27 year period by detailed curettage with a high speed burr were reviewed. Risk factors for local recurrence were identified.

Results: Of 137 with previously untreated GCT of bone, 29 had a pathological fracture. Campanacci grading showed that 14 were grade I, 47 were grade II and 52 were grade III Following curettage, 26 patients (19%) developed local recurrence (LR) at a mean of 22 months. Size, site and fracture were not related to LR. For intraosseous tumours (grades I and II) the LR rate was 7% whilst for extraosseous tumours the LR rate was 29%. Of the 26 LRs, 16 had a further curettage of whom 10 were cured by one curettage and 4 following a third curettage. The success rate of curettage was 81% with one operation, 88% with two and 91% with three curettages. The mean MSTS functional score in these patients was 94%.

Conclusions: The literature suggests an overall LR of 27% for curettage and 19% when an adjuvant is used. With cryotherapy an LR of 4% was achieved. Local control of GCT of bone is not yet resolved. The role of adjuvants has not been proved by the published literature and an international prospective randomized trial is recommended.