Faisham W I, Zulmi W, Halim A S, Biswal B M, Mutum S S, Ezane A M
Department of Orthopaedics, Musculoskeletal Oncology Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Singapore Med J. 2006 Aug;47(8):679-83.
The surgical treatment of Stage III or aggressive giant cell tumour of the bone, whether to perform intralesional or en-bloc resection, remains controversial. The aim of this study is to identify the effectiveness of en-bloc resection for local control and final oncological outcome of the disease.
The data of 20 consecutive patients with Stage III giant cell tumour were retrospectively reviewed to determine the local control and oncological outcome after treatment with wide resection.
The majority of the patients presented late with mean duration of symptoms of 24 months, and four patients presented with recurrences. All patients were treated with wide resection except for two patients who underwent ablative surgery due to major neurovascular involvement. Ten patients required free vascularised tissue transfer to cover massive soft tissue defect. Local recurrence occurred in one patient who was again treated with wide resection and vascularised flap. Six patients had pulmonary metastases. Two patients with resectable disease were treated with thoracoscopic surgery and they remained disease-free 36 months after surgery. Two patients with multiple lung metastases were treated with chemotherapy and the disease remained non-progressive. The remaining two patients who refused chemotherapy showed radiological progression, and one succumbed to the disease with massive haemoptysis.
Aggressive giant cell tumour of bone should be treated with wide resection for better local control, and treatment of pulmonary metastases is mandatory for overall prognosis.
对于Ⅲ期或侵袭性骨巨细胞瘤的外科治疗，是进行病灶内切除还是整块切除仍存在争议。本研究的目的是确定整块切除对该疾病局部控制和最终肿瘤学结局的有效性。
回顾性分析20例连续的Ⅲ期骨巨细胞瘤患者的数据，以确定广泛切除术后的局部控制和肿瘤学结局。
大多数患者就诊较晚，平均症状持续时间为24个月，4例患者出现复发。除2例因主要神经血管受累而接受消融手术的患者外，所有患者均接受了广泛切除。10例患者需要游离带血管组织移植来覆盖巨大的软组织缺损。1例患者发生局部复发，再次接受广泛切除和带血管皮瓣治疗。6例患者出现肺转移。2例可切除疾病的患者接受了胸腔镜手术，术后36个月仍无疾病。2例多发肺转移患者接受化疗，疾病无进展。其余2例拒绝化疗的患者出现影像学进展，1例因大量咯血死亡。
侵袭性骨巨细胞瘤应采用广泛切除以更好地进行局部控制，对于总体预后而言，肺转移的治疗是必需的。
