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Curettage as first surgery for bone giant cell tumor : adequate surgery is more important than oncology training or surgical management by high volume specialized teams

  • Shinji Tsukamoto
  • Andreas F. Mavrogenis
  • Piergiuseppe Tanzi
  • Giulio Leone
  • Manabu Akahane
  • Yasuhito Tanaka
  • Costantino ErraniEmail author
Original Article • TUMORS - CURETTAGE
  • 25 Downloads

Abstract

We reviewed the files of 203 patients with extremities GCTB treated with curettage as first surgery from 1990 to 2013. Median follow-up was 84.2 months. We evaluated whether the years of practice and training in orthopaedic oncology are associated with local recurrences, function and complications after curettage as first surgery for giant cell tumour of bone (GCTB). Local recurrences were not significantly different between orthopaedic oncology trained and non-trained orthopaedic surgeons and between orthopaedic surgeons with < 10 years and ≥ 10 years of practice. Function was not significantly different between orthopaedic oncology trained and non-trained surgeons and between orthopaedic surgeons with < 10 years and ≥ 10 years of practice. The only important univariate and multivariate predictor for local recurrence was PMMA adjuvant. Complications were not significantly different between orthopaedic oncology trained and non-trained orthopaedic surgeons and between orthopaedic surgeons with < 10 years and ≥ 10 years of practice. Curettage may be effectively performed as first surgery for GCTB by early-career (< 10 years of practice) non-trained orthopaedic oncology orthopaedic surgeons. PMMA adjuvant is recommended after appropriate curettage.

Keywords

Giant cell tumour of bone Curettage Local recurrence Orthopaedic oncology Fellowship training 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Fletcher CDM, Bridge JA, Hogendoorn P, Mertens F (2013) WHO classification of tumours of soft tissue and bone. IARC, Lyon, pp 321–324Google Scholar
  2. 2.
    Lackman RD, Crawford EA, King JJ, Ogilvie CM (2013) Conservative treatment of Campanacci grade III proximal humerus giant cell tumors. Clin Orthop Relat Res 467:1355–1359CrossRefGoogle Scholar
  3. 3.
    Lin WH, Lan TY, Chen CY, Wu K, Yang RS (2011) Similar local control between phenol- and ethanol-treated giant cell tumors of bone. Clin Orthop Relat Res 469:3200–3208CrossRefGoogle Scholar
  4. 4.
    Errani C, Tsukamoto S, Leone G et al (2018) Denosumab may increase the risk of local recurrence in patients with giant-cell tumor of bone treated with curettage. J Bone Joint Surg Am 100:496–504CrossRefGoogle Scholar
  5. 5.
    O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ (1994) Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 76:1827–1833CrossRefGoogle Scholar
  6. 6.
    Errani C, Ruggieri P, Asenzio MAN et al (2010) Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 36:1–7CrossRefGoogle Scholar
  7. 7.
    Tsukamoto S, Mavrogenis AF, Leone G et al (2018) Denosumab does not decrease the risk of lung metastases from bone giant cell tumour. Int Orthop 43:483–489CrossRefGoogle Scholar
  8. 8.
    Errani C, Tsukamoto S, Mavrogenis AF (2017) How safe and effective is denosumab for bone giant cell tumour? Int Orthop 41(11):2397–2400CrossRefGoogle Scholar
  9. 9.
    Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69:106–114CrossRefGoogle Scholar
  10. 10.
    van der Heijden L, van der Geest IC, Schreuder HW, van de Sande MA, Dijkstra PD (2014) Liquid nitrogen or phenolization for giant cell tumor of bone? A comparative cohort study of various standard treatments at two tertiary referral centers. J Bone Joint Surg Am 96:e35CrossRefGoogle Scholar
  11. 11.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246Google Scholar
  12. 12.
    Rock M (1990) Adjuvant management of benign tumors; basic concepts of phenol and cement use. Chir Organi Mov 75:195–197Google Scholar
  13. 13.
    Knochentumoren A, Becker WT, Dohle J et al (2008) Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 90:1060–1067CrossRefGoogle Scholar
  14. 14.
    Persson BM, Wouters HW (1976) Curettage and acrylic cementation in surgery of giant cell tumors of bone. Clin Orthop Relat Res 120:125–133Google Scholar
  15. 15.
    Errani C, Tsukamoto S, Leone G, Akahane M, Cevolani L, Tanzi P, Kido A, Honoki K, Tanaka Y, Donati DM (2017) Higher local recurrence rates after intralesional surgery for giant cell tumor of the proximal femur compared to other sites. Eur J Orthop Surg Traumatol 27(6):813–819CrossRefGoogle Scholar
  16. 16.
    Perrin M, Fraisse J, Cuisenier J (1997) Use of cement for treatment of giant-cell tumors. Eur J Orthop Surg Traumatol 7:95CrossRefGoogle Scholar
  17. 17.
    Ashford RU, Soper J, Stalley PD (2010) Beware the “giant cell tumour” of the distal radius. Eur J Orthop Surg Traumatol 20:109CrossRefGoogle Scholar
  18. 18.
    Kundu ZS, Gogna P, Singla R, Sangwan SS, Kamboj P, Goyal S (2015) Joint salvage using sandwich technique for giant cell tumors around knee. J Knee Surg 28(2):157–164CrossRefGoogle Scholar
  19. 19.
    He Y, Zhang J, Ding X (2017) Prognosis of local recurrence in giant cell tumour of bone: what can we do? Radiol Med 122(7):505–519CrossRefGoogle Scholar
  20. 20.
    Sobti A, Agrawal P, Agarwala S, Agarwal M (2016) Giant cell tumor of bone: an overview. Arch Bone Jt Surg 4(1):2–9Google Scholar
  21. 21.
    van der Heijden L, Dijkstra PD, van de Sande MA, Kroep JR, Nout RA, van Rijswijk CS, Bovée JV, Hogendoorn PC, Gelderblom H (2014) The clinical approach toward giant cell tumor of bone. Oncologist 19(5):550–561CrossRefGoogle Scholar
  22. 22.
    Amanatullah DF, Clark TR, Lopez MJ, Borys D, Tamurian RM (2014) Giant cell tumor of bone. Orthopedics 37(2):112–120CrossRefGoogle Scholar
  23. 23.
    Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ (2013) Giant cell tumor of bone. J Am Acad Orthop Surg 21(2):118–126CrossRefGoogle Scholar
  24. 24.
    Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr (2013) Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics 33(1):197–211CrossRefGoogle Scholar
  25. 25.
    Miller BJ, Rajani R, Leddy L et al (2015) How much tumor surgery do early-career orthopedic oncologists perform? Clin Orthop Relat Res 473:695–702CrossRefGoogle Scholar
  26. 26.
    Halm EA, Lee C, Chassin MR (2002) Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 137:511–520CrossRefGoogle Scholar
  27. 27.
    Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369CrossRefGoogle Scholar
  28. 28.
    Hillner BE, Smith TJ, Desch CE (2000) Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 18:2327–2340CrossRefGoogle Scholar
  29. 29.
    Gruen RL, Pitt V, Green S, Parkhill A, Campbell D, Jolley D (2009) The effect of provider case volume on cancer mortality: systematic review and meta-analysis. CA Cancer J Clin 59:192–211CrossRefGoogle Scholar
  30. 30.
    Post PN, Kuijpers M, Ebels T, Zijlstra F (2010) The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis. Eur Heart J 31:1985–1992CrossRefGoogle Scholar
  31. 31.
    Karanicolas PJ, Dubois L, Colquhoun PH, Swallow CJ, Walter SD, Guyatt GH (2009) The more the better? The impact of surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg 249:954–959CrossRefGoogle Scholar
  32. 32.
    Gutierrez JC, Perez EA, Moffat FL, Livingstone AS, Franceschi D, Koniaris LG (2007) Should soft tissue sarcomas be treated at high-volume centers? An analysis of 4205 patients. Ann Surg 245:952–958CrossRefGoogle Scholar
  33. 33.
    Venigalla S, Nead KT, Sebro R et al (2018) Association between treatment at high-volume facilities and improved overall survival in soft tissue sarcomas. Int J Radiat Oncol Biol Phys 100:1004–1015CrossRefGoogle Scholar
  34. 34.
    Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN (2018) Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 33:3329–3342CrossRefGoogle Scholar
  35. 35.
    Mavčič B, Saraph V, Gilg MM, Bergovec M, Brecelj J, Leithner A (2019) Comparison of three surgical treatment options for unicameral bone cysts in humerus. J Pediatr Orthop B 28(1):51–56CrossRefGoogle Scholar
  36. 36.
    Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, Federman N, Bernthal NM (2016) Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med 9(4):435–444CrossRefGoogle Scholar
  37. 37.
    Harving S, Søballe K, Bünger C (1991) A method for bone-cement interface thermometry: an in vitro comparison between low temperature curing cement Palavit, and Surgical Simplex P. Acta Orthop Scand 62:546–548CrossRefGoogle Scholar
  38. 38.
    Remedios D, Saifuddin A, Pringle J (1997) Radiological and clinical recurrence of giant-cell tumour of bone after the use of cement. J Bone Joint Surg Br 79:26–30CrossRefGoogle Scholar
  39. 39.
    Gulia A, Puri A, Salunke A, Desai S, Jambhekar NA (2013) Iatrogenic implantation of giant cell tumor at bone graft donor site and clinical recommendations to prevent “a rare avoidable complication”. Eur J Orthop Surg Traumatol 23(6):715–718CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNara Medical UniversityNaraJapan
  2. 2.First Department of Orthopaedics, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  3. 3.Department of Orthopaedic OncologyIRCCS Istituto Ortopedico RizzoliBolognaItaly
  4. 4.Department of Orthopaedic SurgerySan Gerardo HospitalMonzaItaly
  5. 5.Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan

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