Khalil El Sayed Ashraf, Younis Alaa, Aziz Sherif A, El Shahawy Magdy
The Department of Surgical Oncology, National Cancer Institute, Cairo University.
J Egypt Natl Canc Inst. 2004 Sep;16(3):145-52.
To evaluate the different surgical techniques used in the treatment of giant cell tumor of bone and their effect on the rate of local recurrence.
This is a prospective study of fifty-two patients with giant cell tumor (GCT) of the bones treated at the National Cancer Institute, Cairo University between 1998 and 2002. All patients were evaluated by clinical examination, plain X-ray, CT scan and MRI (in some cases). Biopsy was taken in all cases to confirm the diagnosis and to define the grade of the tumor. All patients underwent surgical treatment including curettage, curettage combined with cryosurgery and bone cement or bone graft, bone resection and amputation. Selection of the surgical technique was based on site and size of the lesion, soft tissue involvement (intra- or extra-compartmental), tumor grade and if recurrent or not. Patients were followed up for a minimum of twenty-four months.
Out of 52 patients 14 patients were males and 38 patients were females, (male to female ratio was (1: 2.7). The age of our patients ranged from 13 to 71 years, with a mean age of 32.9 years. Based on Enneking's staging system, 40 patients (77%) were stage IA, 9 patients (17%) were stage IB & 3 were stage IIB. Histopathological examination of all cases revealed giant cell tumor of borderline malignancy. Curettage alone was done in 4 patients, curettage and bone cement in 7 patients, curettage, cryosurgery and bone graft in 4 patients, curettage, cryosurgery and bone cement in 18 patients, resection in 16 patients and amputation in 3 patients. There were no mortalities among our cases. Local recurrence was highest in cases treated with curettage only (50%), lowest in cases treated with curettage and cryosurgery with bone cement (16.6%).
The main primary treatment of GCT is surgery; the type of which depends on preoperative evaluation, which includes clinical evaluation that involves the site and size of the tumor in relation to surrounding structures, together with plain X-ray, CT scan and/or MRI as indicated, and tissue biopsy to define tumor grade. Curettage alone results in high rate of local recurrence. On the other hand, curettage and adjuvant cryosurgery using bone cement or bone grafts give low rate of local recurrence. Resection is recommended for stages IB and IIB, extremely large lesions, and in cases where resection results in no significant morbidity as proximal fibula and flat bones. Amputation is preserved for massive recurrences and malignant transformation.
评估治疗骨巨细胞瘤所采用的不同手术技术及其对局部复发率的影响。
这是一项对1998年至2002年间在开罗大学国家癌症研究所接受治疗的52例骨巨细胞瘤（GCT）患者的前瞻性研究。所有患者均通过临床检查、X线平片、CT扫描以及（部分病例）MRI进行评估。所有病例均进行活检以确诊并确定肿瘤分级。所有患者均接受了手术治疗，包括刮除术、刮除术联合冷冻手术及骨水泥或骨移植、骨切除术和截肢术。手术技术的选择基于病变的部位和大小、软组织受累情况（骨内或骨外）、肿瘤分级以及是否复发。对患者进行了至少24个月的随访。
52例患者中，男性14例，女性38例，男女比例为1:2.7。患者年龄在13至71岁之间，平均年龄为32.9岁。根据Enneking分期系统，40例患者（77%）为IA期，9例患者（17%）为IB期，3例患者为IIB期。所有病例的组织病理学检查均显示为交界性恶性骨巨细胞瘤。仅行刮除术的患者有4例，刮除术加骨水泥的患者有7例，刮除术、冷冻手术加骨移植的患者有4例，刮除术、冷冻手术加骨水泥的患者有18例，切除术的患者有16例，截肢术的患者有3例。我们的病例中无死亡病例。仅行刮除术治疗的病例局部复发率最高（50%），刮除术联合冷冻手术加骨水泥治疗的病例局部复发率最低（16.6%）。
骨巨细胞瘤的主要初始治疗方法是手术；手术类型取决于术前评估，术前评估包括临床评估，涉及肿瘤相对于周围结构的部位和大小，以及根据需要进行的X线平片、CT扫描和/或MRI检查，还有用于确定肿瘤分级的组织活检。单纯刮除术导致局部复发率较高。另一方面，刮除术联合使用骨水泥或骨移植的辅助冷冻手术可使局部复发率较低。对于IB期和IIB期、极大的病变以及如近端腓骨和平骨等切除后不会导致明显功能障碍的病例，建议进行切除术。截肢术适用于大量复发和恶性转化的情况。
