Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones
Background and purpose Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvan...
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| Veröffentlicht in: | Acta orthopaedica 2012-08, Vol.83 (4), p.401-405 |
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| description | Background and purpose Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvants in GCTB.
Methods Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis.
Results The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture.
Interpretation Curettage with adjuvants is a feasible first-choice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not. |
| doi_str_mv | 10.3109/17453674.2012.711193 |
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Methods Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis.
Results The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture.
Interpretation Curettage with adjuvants is a feasible first-choice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not.</description><identifier>ISSN: 1745-3674</identifier><identifier>EISSN: 1745-3682</identifier><identifier>DOI: 10.3109/17453674.2012.711193</identifier><identifier>PMID: 22880716</identifier><language>eng</language><publisher>England: Nordic Orthopaedic Federation</publisher><subject>Adolescent ; Adult ; Aged ; Bone Cements - therapeutic use ; Bone Neoplasms - mortality ; Bone Neoplasms - pathology ; Bone Neoplasms - therapy ; Cohort Studies ; Combined Modality Therapy ; Confidence Intervals ; Curettage - adverse effects ; Curettage - methods ; Disease-Free Survival ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone - mortality ; Giant Cell Tumor of Bone - pathology ; Giant Cell Tumor of Bone - therapy ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Invasiveness - pathology ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Staging ; Phenol - therapeutic use ; Polymethyl Methacrylate - therapeutic use ; Retrospective Studies ; Risk Assessment ; Soft Tissue Injuries - therapy ; Survival Analysis ; Treatment Outcome ; Young Adult</subject><ispartof>Acta orthopaedica, 2012-08, Vol.83 (4), p.401-405</ispartof><rights>Copyright: © Nordic Orthopaedic Federation 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2783-ae0982294e4baedc2aa25f73f4e6f302c4d39e19686547ee85b2de5a064aeba83</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.tandfonline.com/doi/pdf/10.3109/17453674.2012.711193$$EPDF$$P50$$Ginformahealthcare$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.tandfonline.com/doi/full/10.3109/17453674.2012.711193$$EHTML$$P50$$Ginformahealthcare$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,860,27901,27902,61191,61192</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22880716$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Heijden, L</creatorcontrib><creatorcontrib>van de Sande, MA</creatorcontrib><creatorcontrib>Dijkstra, PD</creatorcontrib><title>Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones</title><title>Acta orthopaedica</title><addtitle>Acta Orthop</addtitle><description>Background and purpose Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvants in GCTB.
Methods Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis.
Results The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture.
Interpretation Curettage with adjuvants is a feasible first-choice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Bone Cements - therapeutic use</subject><subject>Bone Neoplasms - mortality</subject><subject>Bone Neoplasms - pathology</subject><subject>Bone Neoplasms - therapy</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Confidence Intervals</subject><subject>Curettage - adverse effects</subject><subject>Curettage - methods</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Giant Cell Tumor of Bone - mortality</subject><subject>Giant Cell Tumor of Bone - pathology</subject><subject>Giant Cell Tumor of Bone - therapy</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Staging</subject><subject>Phenol - therapeutic use</subject><subject>Polymethyl Methacrylate - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Soft Tissue Injuries - therapy</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1745-3674</issn><issn>1745-3682</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9UU1v1TAQtBAVLYV_gJCPXPLwV2LngoSq8iFV4tBytjbO5j0_ErvYDh_X_nIcvZbTzo5Go50dQt5wtpOc9e-5Vq3stNoJxsVOc857-YxcbHQjOyOe_8danZOXOR8Zk0b17AU5F8IYpnl3QR5u41Ro8TmvSPFPwZB9DNQHlxAyZloOSJPPP2ic6BwdzDShW1PC4JDCVDDRumIpsEf625cDhfG4_oJQMp1iontfYeNwnmlZl0pUn81zjmFPhxgwvyJnE8wZXz_OS_L90_Xd1Zfm5tvnr1cfbxontJENIOuNEL1CNQCOTgCIdtJyUthNkgmnRtkj7zvTtUojmnYQI7bAOgU4gJGX5N3J9z7FnyvmYheft8MgYFyz5UyqrtWyV1X69lG6DguO9j75BdJf-_S3KvhwEvhQQy5wQJjLwUFCe4xrCjVH9bNbUfapKLsVZU9FyX8LioZc</recordid><startdate>201208</startdate><enddate>201208</enddate><creator>van der Heijden, L</creator><creator>van de Sande, MA</creator><creator>Dijkstra, PD</creator><general>Nordic Orthopaedic Federation</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201208</creationdate><title>Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones</title><author>van der Heijden, L ; van de Sande, MA ; Dijkstra, PD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2783-ae0982294e4baedc2aa25f73f4e6f302c4d39e19686547ee85b2de5a064aeba83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Bone Cements - therapeutic use</topic><topic>Bone Neoplasms - mortality</topic><topic>Bone Neoplasms - pathology</topic><topic>Bone Neoplasms - therapy</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Confidence Intervals</topic><topic>Curettage - adverse effects</topic><topic>Curettage - methods</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Giant Cell Tumor of Bone - mortality</topic><topic>Giant Cell Tumor of Bone - pathology</topic><topic>Giant Cell Tumor of Bone - therapy</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness - pathology</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Staging</topic><topic>Phenol - therapeutic use</topic><topic>Polymethyl Methacrylate - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Soft Tissue Injuries - therapy</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Heijden, L</creatorcontrib><creatorcontrib>van de Sande, MA</creatorcontrib><creatorcontrib>Dijkstra, PD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Acta orthopaedica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Heijden, L</au><au>van de Sande, MA</au><au>Dijkstra, PD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones</atitle><jtitle>Acta orthopaedica</jtitle><addtitle>Acta Orthop</addtitle><date>2012-08</date><risdate>2012</risdate><volume>83</volume><issue>4</issue><spage>401</spage><epage>405</epage><pages>401-405</pages><issn>1745-3674</issn><eissn>1745-3682</eissn><abstract>Background and purpose Risk factors for local recurrence of giant-cell tumor of bone (GCTB) have mostly been studied in heterogeneous treatment groups, including resection and intralesional treatment. The aim of the study was the identification of individual risk factors after curettage with adjuvants in GCTB.
Methods Of 147 patients treated for primary GCTB between 1981 and 2009, 93 patients were included in this retrospective single-center study. All patients were treated with curettage and polymethylmethacrylate (PMMA) with (n = 75) or without (n = 18) phenol. Mean follow-up was 8 (2-24) years. Recurrence-free survival was assessed for treatment modalities. Age, sex, tumor location, soft tissue extension, and pathological fractures were scored for every patient and included in a Cox regression analysis.
Results The recurrence rate after the first procedure was 25/93. Recurrence-free survival for PMMA and phenol and for PMMA alone was similar. Eventually, local control was achieved using 1 or multiple intralesional procedures in 85 patients. Resection was required in 8 patients. A higher risk of local recurrence was found for soft tissue extension (HR = 5, 95% CI: 2-12), but not for age below 30, sex, location (distal radius vs. other), or pathological fracture.
Interpretation Curettage with adjuvants is a feasible first-choice treatment option for GCTB, with good oncological outcome and joint preservation. Soft tissue extension strongly increased the risk of local recurrence, whereas age, sex, location, and pathological fractures did not.</abstract><cop>England</cop><pub>Nordic Orthopaedic Federation</pub><pmid>22880716</pmid><doi>10.3109/17453674.2012.711193</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | Taylor & Francis Open Access; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Bone Cements - therapeutic use Bone Neoplasms - mortality Bone Neoplasms - pathology Bone Neoplasms - therapy Cohort Studies Combined Modality Therapy Confidence Intervals Curettage - adverse effects Curettage - methods Disease-Free Survival Female Follow-Up Studies Giant Cell Tumor of Bone - mortality Giant Cell Tumor of Bone - pathology Giant Cell Tumor of Bone - therapy Humans Incidence Kaplan-Meier Estimate Male Middle Aged Neoplasm Invasiveness - pathology Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Staging Phenol - therapeutic use Polymethyl Methacrylate - therapeutic use Retrospective Studies Risk Assessment Soft Tissue Injuries - therapy Survival Analysis Treatment Outcome Young Adult |
| title | Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of the long bones |
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