Treatment of benign giant cell tumours of bone in Singapore

Abstract

Introduction: Giant cell tumour (GCT) is a distinct neoplasm of undifferentiated cells. The exact cell of origin is unknown. The multinucleated giant cells present are formed from the fusion of mononuclear cells. Giant cell tumour is more common in Southeast Asia than in the West. The incidence is about 20% compared to 4% to 5% in the West. Materials and Methods: Sixteen patients with giant cell tumour were treated in the Singapore General Hospital from 1993 to 2001. The average follow-up period was 64.4 months, with a range of 30 to 132 months. The average age of the patients was 33 years. The tumours were divided into 3 groups. The first group had meticulous curettage and high-speed burring followed by methylmethacrylate cementation. The second group had treatment similar to the first but in addition had an adjuvant treatment with liquid nitrogen, hydrogen peroxide or phenol before cementation of the cavity. The third group had wide resection done. There were 9 in the first group, 5 in the second group and 2 in the third group. The tumours were graded radiologically after the method of Campanacci et al. All patients were followed up clinically and radiologically. Of the 5 in the second treatment group, 1 had phenol irrigation, 2 had cryotherapy and 2 had hydrogen peroxide irrigation intraoperatively. Results: There was a total of 5 recurrences (31%). The 2-year recurrence-free survivorship was 75%. The mean recurrence period was 21 months. There were no complications like fracture, infection or thermal injury to the skin. There was no pulmonary metastasis or mortality. The first group, who had curettage, high-speed burr and cementation, had 44% (4 out of 9) recurrence; the second group, who had treatment like the first with additional adjuvant therapy, had no recurrence; and the third, who had wide resection, had 50% (1 out of 2) recurrence. All the recurrences had a Campanacci grade II or III tumour. There were no recurrences in the group that was treated with curettage, high-speed burr, adjuvant treatment and cementation. Conclusion: Currettage, high-speed burring with added phenol/liquid nitrogen treatment and cementation is a useful and safe method in the treatment of giant cell tumours. The advantages include a low recurrence rate, as well as immediate stabilisation allowing early mobilisation. Patients who have Campanacci grade I tumours have the highest chance of being disease-free after the first operation.