Management of Recurrent Giant Cell Tumors and Aggressive Giant Cell Tumors with Pathological Fracture: A Prospective study.

Manohar, T M (2006) Management of Recurrent Giant Cell Tumors and Aggressive Giant Cell Tumors with Pathological Fracture: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Giant cell tumor is a primary bone tumor. It is benign but locally aggressive neoplasm with a tendency for local recurrence. The incidence of giant cell tumor in the Western World is relatively low, constituting 5 per cent of all skeletal tumors, however, in the Orient it may account for 20 per cent of all primary skeletal neoplasms. It is unknown whether genetic differences exist in different races that may account of the high incidence and different behaviour of this tumor among the South East Asian population. In the pre roentgen era, most of these tumors were treated by radical amputation. With the invention of X-ray less radical surgery was proposed and practiced. The optimum treatment of giant cell tumor of bone is a matter of controversy. With the advent of variety of adjuvant and reconstruction techniques the recurrence rate has decreased remarkably. But there are no absolute clinical, radiological, or histological parameters that accurately predict the tendency of any single lesion to recur or metastasize. Most patients incurring a giant cell tumor of bone are young and active with normal life expectancy. The aim of treatment is to remove the tumor completely and to preserve the joint. These aims have not changed, but the methods of treatment have changed with time. As might be expected, when feasible, curettage with preservation of the joint is to be preferred over an en bloc resection, which is associated with a higher rate of complications and less satisfactory functional results. Local recurrence is a well documented problem. It is more common after simple curettage. 25% of the recurrences were within six months and 97% within two years. AIM OF THE STUDY: This study is aimed at analysing the treatment of the recurrent GCT and aggressive GCT with pathological fracture by adequate curettage, using adjuvants like H2O2, liquidnitrogen, followed by filling the curetted cavity with bone grafts, bone substitutes & bone cement, thereby preventing the recurrence, and to provide structural stability in aggressive GCT with Pathological fracture. MATERIALS AND METHODS: This study was conducted between Aug 2003 to Feb 2006, of which, 10 cases of Aggressive GCT with pathological fracture and 10 cases of recurrent GCT was done. In the cases of Aggressive GCT with Pathological fracture, the bone was structurally unstable and had to be mechanically stabilized. Mere cortical breach does not qualify for this criteria. RESULTS: 10 cases of Recurrent GCT and 10 cases of Aggressive GCT with pathological fracture were studied. Out of 10 recurrent lesions, in three patients proximaltibia, in three patients distal femur, in two patients distal radius, in one patient proximalfibula and in one patient metacarpal bone were affected. Out of 10 Aggressive GCT with pathological fracture in 7 patients distal femur and in three patients proximal tibia were affected. For recurrent GCT, removal of bone cement, extended curettage with adjuvant Hydrogen peroxide and reconstruction with bone cement/ born graft/ amputation were the treatment methods employed. For Aggressive GCT with pathological fracture, extended curettage with adjuvant H2O2/ liquid nitrogen and reconstruction with fibular strut graft cancellous bone graft, bone substitute and bone cement were the treatment methods employed. The results were assessed with the scoring system proposed by Enneking. CONCLUSION: GCTis a locally aggressive benign tumor occurring in young individuals with a normal life expectancy. If inadequately or inappropriately treated it results in considerable morbidity and recurrence. Careful attention to soft tissue protection while using cryosurgery significantly decreased the previously published reports of high rates of infection and wound healing problem. Hydrogen peroxide is an ideal adjuvant, which gives a comparable rate of recurrence and least local or systemic complications. Free fibular strut graft along with PMMA incorporates in the bone early and the joints can be salvaged with useful function. Enbloc resection must also be followed by adjuvant to prevent recurrence due to local tissue contamination.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective study ; Management of Recurrent Giant Cell Tumors ; Aggressive Giant Cell Tumors ; Pathological Fracture.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:26
Last Modified: 17 Sep 2017 13:28

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