Segmental excision versus intralesional curettage with adjuvant therapy for giant cell tumour of bone

To review the functional outcome and local recurrence rate of 29 patients who underwent segmental excision or intralesional curettage with adjuvant therapy for giant cell tumour (GCT) of bone.

Records of 17 men and 12 women (mean age, 30.17 years) who underwent segmental excision (n=18) or intralesional curettage followed by adjuvant therapy (n=11) for GCT of the femur (n=13), tibia (n=8), radius (n=6), or ulna (n=2) were reviewed. Nine of the patients had recurrent GCT of bone and had undergone segmental excision (n=6) or intralesional curettage (n=3) elsewhere. Functional outcome was evaluated using the Musculoskeletal Tumour Society (MSTS) scoring system.

The mean follow-up period was 6.4 (range, 3-13.5) years. 14 patients were followed up for 3 to 5 years, 12 for 5 to 10 years, and 3 for >10 years. Of 20 patients with primary GCT of bone, 12 underwent segmental excision and had no recurrence, and 8 underwent intralesional curettage, 2 of whom developed local recurrence. Of the remaining 9 patients with recurrent GCT of bone, there was one re-recurrence in each surgical option. Local recurrence was not associated with Campanacci grading or type of surgery. One of 18 patients with segmental excision and 3 of 11 patients with intralesional curettage had local recurrence (5.6% vs. 27.3%, p=0.139). The MSTS score was excellent in 7, good in 6, moderate in 2, fair in 2, and poor in one patient after segmental excision, whereas the score was excellent in 9 and good in 2 patients after intralesional curettage (p=0.206). The proportion of yielding an excellent outcome was higher after intralesional curettage (38.9% vs. 81.8%, p=0.0289). Nonetheless, the mean MSTS score of the 2 groups was comparable (74.17% vs. 86.36%, p=0.054).

Local recurrence of GCT was not associated with the surgical option. Nonetheless, intralesional curettage resulted in better functional outcome.