Local recurrence after curettage treatment of giant cell tumors in peripheral bones: Retrospective study by the GSF-GETO (French Sarcoma and Bone Tumor Study Groups) - 24/08/13

Doi : 10.1016/j.otsr.2013.07.006

F. Gouin ^a,^⁎,^b , V. Dumaine ^c
the French Sarcoma and Bone Tumor Study Groups (GSF-GETO)^¹
Centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
^a Clinique chirurgicale orthopédique et traumatologique, CHU Hôtel-Dieu, Nantes, France
^b Inserm UI 957, laboratoire de la résorption osseuse et des tumeurs osseuses primitives (LROP), faculté de médecine de Nantes, Nantes, France
^c Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France

^⁎Corresponding author.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 24 August 2013
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Summary

Background

Curettage is a well-established treatment modality for giant cell tumors of bone. The purpose of this retrospective study by the French Sarcoma and Bone Tumor Study Groups (GSF-GETO) was to analyze various tumor-specific and surgery-specific factors that could influence the rate of local recurrence.

Patients and method

Data was collected from patients with giant cells tumors of the appendicular skeletal who were treated by intralesional curettage. The hazard ratio for tumor recurrence was calculated for the different variables collected and a multifactorial analysis carried out.

Results

One hundred and ninety-three surgical procedures were included from nine centers. One hundred and seventy-one (89%) were primary tumors and 22 had been referred after one or more recurrences. The mean follow-up was 6years and 11months. The distal femur and proximal tibia were the most common locations: 42.5 and 34.2% of cases, respectively. The bone defect after curettage was filled in 176 cases (91.2%) and left empty in 16 cases. Local adjuvant treatment (phenol, alcohol, cryotherapy or combination treatment) was used in 39 cases (20.2%) and systemic adjuvant treatment used in 24 cases (calcitonin 11 and zoledronic acid 13). Local recurrence occurred in 71 cases (36.8%). Risk factors for local recurrence were an empty defect, a defect filled with autograft, and patients treated before 2005. Multivariate analysis showed that the only risk factors for local recurrence were a surgical procedure before 2005 (odds ratio 3.6 (95% CI: 1.2, 7.9) P=0.017) and a bone defect filled with autograft (odds ratio 3.9 [95% CI: 1.3, 11.6] P=0.013)

Conclusion

Neither tumor-specific nor surgery-specific factors such as adjuvant treatment were found to be as risk factors for local recurrence after curettage of giant cell tumors in the appendicular skeleton. As recently reported, high-quality local curettage is probably the most effective technique to prevent local recurrence. The current study suggests that two factors associated with more recent management of these tumors in France, high-speed burring and centralization to skilled surgical teams, can improve the quality of curettage.