Giant Cell Tumors of the Upper Extremity: A 40-year Experience
Jonathan Lans, MD1; Kamilcan Oflazoglu, MD1; Rene M Castelein, MD PhD2; Hang Lee, PhD3; Santiago Lozano-Calderon, MD PhD4; Neal C Chen, MD5
1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands, 3MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, 4Department of Orthopaedic Oncology, Massachusetts General Hospital, Boston, MA, 5Massachusetts General Hospital, Boston, MA
Background: Giant cell tumors (GCT) are rare tumors affecting the upper extremity in roughly 20% of the cases. Campanacci grade and tumor location have shown to be associated with recurrence, however reports are inconsistent. Distal radius tumors are thought to be more aggressive in nature compared to other locations. The aim of this study was to investigate the factors associated with recurrence of GCT's in the upper extremity. Additionally, we evaluated treatment preferences over a 40-year period.
Methods: In this retrospective chart review, 73 patients that underwent primary treatment for a GCT at our institution were identified. Patients had a median age of 32 (IQR: 24-41) years and a median follow up of 6.5 years (IQR:2.9-10.7). Tumors were located in the radius (n=42), humerus (n=17), ulna (n=7) and hand (n=7) and included Campanacci grade 2 and grade 3 tumors. Treatment consisted of either wide resection or intralesional resection with or without adjuvant.
Results: The recurrence rate after intralesional resection was 49% and after wide resection the recurrence rate was 13%. After correcting for tumor grade and location, the type of surgery was the only factor independently associated with recurrence, hazards ratio= 8.8 (SE:7.0). Patients treated after 1985 were treated with intralesional curettage 6.9-8.0 times more often and patients treated for recurrence were twice as likely to undergo negative margin resection compared to the treatment of primary lesions.
Conclusion: Contrary to previous reports, location in the distal radius did not play a role as a predictor of recurrence in giant cell tumor of bone. Treatment of giant cell tumor of bone with intralesional resection is reasonable for less aggressive disease to preserve function; however, the recurrence rate is substantially lower with wide resection and may be preferable in more aggressive disease.
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