[Giant cell tumor--osteoclastoma: part II]

Authors present current views on the comprehensive diagnostics, treatment and prognosis of giant cell tumours. They include an exact algorithm of diagnostics necessary for a timely treatment. They describe an often unexpected behaviour of these tumours which is frequently active and aggressive, to a small extent these tumours show the tendency to become malignant. The treatment prefers curretage, antibiotic irrigation and filling in with bone cement. In case of recurrence and an extensive process, block resection and replacement by an individual implant, in hardly accessible locations (spine, sacrum, pelvis) or radiotherapy is recommended. The authors present in detail results of a 10-year systematic follow-up of 56 patients, of which 61.6% were in active stage, 36.8% in aggressive stage. The most frequently used method (in 73.2%) was curretage, irrigation and filling in with bone grafts, in 12.5% of cases block resection and replacement by bone grafts. Total results after all these types of operations evaluated in the interval of 3 years after the operation were very good, i.e. 85.7% remissions, there were 14.3% of recurrence. Of these setbacks 5.4% were in remission for more than 3 years and thus conduced to the increase of the number of remissions to 94.6% which can be evaluated as an excellent result. Local recurrence occurs in 10-15% with the application and 15-25% without the application of local adjuvant therapy. In the third stage in case of extensive destruction we perform resection en bloc, radiotherapy in hardly accessible locations (spine, sacrum, pelvis). In case of extensive destruction in the region of joints the method of choice is the application of both individual and total replacement.