Customized treatment algorithm for giant cell tumor of bone: report of a series

Between 1991 and 2000, 30 patients with 31 resections of giant cell tumors of bone were treated (average followup, 4.9 years; range, 1-9.6 years). Intralesional resection with curettes and a high-speed burr and reconstruction with polymethylmethacrylate cementation or bone grafting was used for salvageable, nonexpendable bones. Wide resection and allograft reconstruction was done in nonexpendable bones that were too destroyed for salvage. Adjuvant treatments were used for all intralesional procedures and when wide resection with a close margin was obtained. Adjuvant treatments included hydrogen peroxide instillation in 30 patients, electrocautery in 27 patients, phenol irrigation in 26 patients, sterile water irrigation in 15 patients, and polymethylmethacrylate cementation in 15 patients. There have been only two (6.4%) local recurrences, one in bone and one in soft tissue. Both patients had intralesional resections initially and both had salvage procedures with wide resections of the recurrent tumors. The 5-year recurrence-free survivorship was 93%. A delayed ray amputation for failed bone graft of the little finger was the only amputation. In all other patients, a functional limb was preserved. Wide resection only is required when bone salvageability is impractical. Intralesional curettage and high-speed burr resection, when supplemented with the adjuvant therapies as described, is adequate for the majority of patients with giant cell tumor of bone. A proposed treatment algorithm is presented.