How do we ensure recurrences do not happen in giant cell tumor (GCT) of bone?
This is a common question that patients with recurrences of giant cell tumor have in their minds. Unfortunately, no one can guarantee a treatment of giant cell tumor where there are absolutely no chances of recurrence. What one can ensure, however, is that the correct principles of treatment are followed that lead to the maximum percentage of patients getting cured of this disease, while maintaining good function of the affected limb.
Giant cell tumor (GCT) is a locally aggressive benign tumor of bone that has a tendency for local recurrence. The treatment of giant cell tumor is mainly surgical. There can be mainly two surgical approaches for giant cell tumor- a wide resection with margins (complete removal of bone) and a curettage (cleaning of tumor tissue while retaining the bony shell). While the risk of recurrence with a resection is lower, it usually necessitates a major reconstruction of the bone defect- one which may involve a more morbid surgery, or a limited durability of the construct, or both. It may also mean a that the functional outcome may not be as good. Resection, therefore, is reserved for cases where curettage is not possible because of advanced disease, or for bones which are not that important for our function.
Hence, wherever feasible, the favoured treatment for GCT is extended curettage, where the surgeon thoroughly cleans all tumor from the cavity, retains the patient’s native bone and joint, and fills it up with either bone graft or cement or both. Though this procedure will see a slightly higher number of recurrences as compared to resection, it will still keep a vast majority (80- 90 percent in most studies) free of disease, with a much better and durable function. To make sure the risk of recurrence is low, surgeons use a high-speed burr and often use some physical, chemical or thermal means after curettage. A close follow up with x rays every three to four months is advised after surgery.