Background Giant cell tumor (GCT) of bone is a primary tumor that commonly occurs in the epiphyses of long bones, and most frequently in the distal epyphises of the femur [1-3]. GCT is a benign bone tumor, even though it has local aggressivenes, and it can metastatize to the lungs with nodules having the same histologic features of the primary tumor. Cells in the tumor belong to one of two cell lines: stromal spindle cells, and multinucleated giant cells [5]. The giant cells are a population present in a reactive way to the production of local growth factors, and are responsible for bone resorption and osteolysis of the TCG [2,4]. The histology only serves to make the diagnosis: however the grading cannot predict the behavior of the lesion, and has not prognostic significance. Lesions are classified according to Campanacci et al. Surgery is the gold standard in the treatment of GCT [1,3]: Curettage, with intralesional margins, is carried out in all stage 1 lesions, in most of stage 2 and rarely in lesions with stage 3. After curettage, patients typically have a better functional outcome, but are exposed to an increased rate of local relapse. In the case that curettage is not technically possible for the altered mechanical properties of the bone or because of the soft tissues invasion, segmental resection followed by modular or composite prosthetic implants, (or by grafting and plating in the distal radius) [15]. After curettage of the lesion, the filling of the void can be performed by bone allograf or bone cement, which also has a local adjuvant action. The aim of the current study is to quantify the overall function, and incidence of local recurrence after surgery for TCG depending on the kind of surgery and the material used to fill the local void, by retrospectively analyzing the cohort of patients managed at the Rizzoli Institute of Bologna from 1990- 2013. Materials and Methods The clinical and follow-up data included the charts of 412 patients operated on for GCT of the extremities, followed for at least two year follow-up. 412 patients, of which 216 females and 196 males. The detected average age was 34 years; 101 cases were located upper limb, lower limb 311. Stage 2 and 3 account for the majority of cases, with only 6 cases of stage 1. Curettage was performed with opening of a wide enough window to display the entire tumor cavity, removal of the tumor by means of curettes and use of high-speed milling cutter. Filling the cavity after curettage was performed by bone cement in 108 patients, by cement and subchondral graft in 78, and bone grafts alone in 55; in 4 patients the void was left unfilled. Resection was performed In 159 cases, with wide margins in 140 cases, marginal in 5 and focally intralesional in 14 cases. In these patients, the reconstruction was with osteoarticular graft in 60 cases, modular prosthesis in 58 case, composite implants in 16 cases. It was not carried out no reconstruction in 25 cases localized to the proximal fibula or distal ulna. Functional evaluation was performed by Muscoskeletal Tumor Society Score. Results The overall recurrence rate was 17.5%; in particular, it reached 20.4% after curettage and 13.2% after resection and reconstruction. Local relapse after curettage was observed significanlty less in patients whose void is filled by bone cement. Local relapse after curettage was observed significanlty less in patients whose void is filled by bone cement. Comparing the functional results according to the scale of MSTS Enneking, patients treated with curettage or resection had a mean score of 92.7±13.2 for the former and 85.4±15.6 for the latter. The ANOVA test showed a significant difference between the type of surgery and the remaining functional outcome (Welch test, p = 0.00003) bringing the best values of about 10% in curettage compared to resection.

Trattamento chirurgico del tumore a cellule giganti dell'osso: controllo della recidiva locale e della risposta funzionale / Gianluca Marineo , 2016 Jul 29. 28. ciclo

Trattamento chirurgico del tumore a cellule giganti dell'osso: controllo della recidiva locale e della risposta funzionale

2016-07-29

Abstract

Background Giant cell tumor (GCT) of bone is a primary tumor that commonly occurs in the epiphyses of long bones, and most frequently in the distal epyphises of the femur [1-3]. GCT is a benign bone tumor, even though it has local aggressivenes, and it can metastatize to the lungs with nodules having the same histologic features of the primary tumor. Cells in the tumor belong to one of two cell lines: stromal spindle cells, and multinucleated giant cells [5]. The giant cells are a population present in a reactive way to the production of local growth factors, and are responsible for bone resorption and osteolysis of the TCG [2,4]. The histology only serves to make the diagnosis: however the grading cannot predict the behavior of the lesion, and has not prognostic significance. Lesions are classified according to Campanacci et al. Surgery is the gold standard in the treatment of GCT [1,3]: Curettage, with intralesional margins, is carried out in all stage 1 lesions, in most of stage 2 and rarely in lesions with stage 3. After curettage, patients typically have a better functional outcome, but are exposed to an increased rate of local relapse. In the case that curettage is not technically possible for the altered mechanical properties of the bone or because of the soft tissues invasion, segmental resection followed by modular or composite prosthetic implants, (or by grafting and plating in the distal radius) [15]. After curettage of the lesion, the filling of the void can be performed by bone allograf or bone cement, which also has a local adjuvant action. The aim of the current study is to quantify the overall function, and incidence of local recurrence after surgery for TCG depending on the kind of surgery and the material used to fill the local void, by retrospectively analyzing the cohort of patients managed at the Rizzoli Institute of Bologna from 1990- 2013. Materials and Methods The clinical and follow-up data included the charts of 412 patients operated on for GCT of the extremities, followed for at least two year follow-up. 412 patients, of which 216 females and 196 males. The detected average age was 34 years; 101 cases were located upper limb, lower limb 311. Stage 2 and 3 account for the majority of cases, with only 6 cases of stage 1. Curettage was performed with opening of a wide enough window to display the entire tumor cavity, removal of the tumor by means of curettes and use of high-speed milling cutter. Filling the cavity after curettage was performed by bone cement in 108 patients, by cement and subchondral graft in 78, and bone grafts alone in 55; in 4 patients the void was left unfilled. Resection was performed In 159 cases, with wide margins in 140 cases, marginal in 5 and focally intralesional in 14 cases. In these patients, the reconstruction was with osteoarticular graft in 60 cases, modular prosthesis in 58 case, composite implants in 16 cases. It was not carried out no reconstruction in 25 cases localized to the proximal fibula or distal ulna. Functional evaluation was performed by Muscoskeletal Tumor Society Score. Results The overall recurrence rate was 17.5%; in particular, it reached 20.4% after curettage and 13.2% after resection and reconstruction. Local relapse after curettage was observed significanlty less in patients whose void is filled by bone cement. Local relapse after curettage was observed significanlty less in patients whose void is filled by bone cement. Comparing the functional results according to the scale of MSTS Enneking, patients treated with curettage or resection had a mean score of 92.7±13.2 for the former and 85.4±15.6 for the latter. The ANOVA test showed a significant difference between the type of surgery and the remaining functional outcome (Welch test, p = 0.00003) bringing the best values of about 10% in curettage compared to resection.
29-lug-2016
Tumore a cellule giganti dell'osso
Trattamento chirurgico del tumore a cellule giganti dell'osso: controllo della recidiva locale e della risposta funzionale / Gianluca Marineo , 2016 Jul 29. 28. ciclo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/68785
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