Giant cell tumour of bone: its aggressiveness and potential for malignant change

Thirty cases of giant cell tumour of bone are reviewed. The average follow-up for 22 cases was 7.5 years. The recurrence rate in 19 appendicular tumours treated by curettage, with or without bone grafting, was 52%. Treatment of recurrences, however, resulted in cure of an additional 10 tumours, for an overall success rate of primary and secondary treatment of 89%. Pulmonary metastases occurred in two patients (6.7%) and there was one death attributable to the tumour (3.3%). The authors conclude that the conservative primary treatment is justified even with a 52% recurrence rate, since normal function and appearance are preserved and, further, more aggressive treatment of the recurrent tumour can be performed. They prefer limb-saving resection and occasionally amputation for this more aggressive secondary treatment rather than cryosurgery with its complications, allograft replacement with its uncertainties or supervoltage radiation with its risk of later development of malignant tumours.