Becker Wolfgang T, Dohle Jörn, Bernd Ludger, Braun Arnim, Cserhati Miklos, Enderle Alfred, Hovy Louis, Matejovsky Zdenek, Szendroi Miklos, Trieb Klemens, Tunn Per-Ulf
Orthopädische Klinik Volmarstein, Universität Witten/Herdecke, Wetter, Germany.
J Bone Joint Surg Am. 2008 May;90(5):1060-7. doi: 10.2106/JBJS.D.02771.
The use of adjuvants after curettage has been well established for the treatment of giant cell tumor of bone. The purpose of this study was to analyze the rates of recurrence following different types of treatment as well as the influence of various factors of tumor presentation on those rates.
The data regarding benign giant cell tumors of the appendicular skeleton from ten bone tumor centers were evaluated. Axial and malignant tumors were excluded. The recurrence rates associated with the different treatment modalities were analyzed, and hazard ratios for a recurrence were calculated for multiple factors of tumor presentation.
The study included 384 surgical procedures, involving 256 primary and 128 recurrent tumors. The mean duration of follow-up was 64.2 months. Wide excision was performed in seventy-eight cases (20.3%), and an intralesional procedure was done in 306 (79.7%). Of the intralesional procedures, 103 (33.7%) were performed without the use of adjuvants, 102 (33.3%) included filling with polymethylmethacrylate, seventy-four (24.2%) included polymethylmethacrylate filling after phenolization, and twenty-seven (8.8%) included use of local toxins. The overall recurrence rate after the intralesional procedures was 49% when no adjuvants had been used, 22% when polymethylmethacrylate only had been used as an adjuvant, 27% when polymethylmethacrylate had been used after phenolization, and 15% when phenol or other local toxins had been used (without polymethylmethacrylate). The highest rate of recurrence (36%) after curettage with adjuvants was associated with extracompartmental tumors. Recurrent tumors were not at increased risk for another recurrence, even when they were extracompartmental. The recurrence rate following curettage of a primary tumor without the use of adjuvants (55%) was higher than that following the same treatment of a recurrent tumor (39%) (p = 0.033).
Use of polymethylmethacrylate as an adjuvant significantly reduces the recurrence rate following intralesional treatment of benign giant cell tumors, and it appears to be the therapy of choice for primary as well as recurrent giant cell tumors of bone. The significantly better results following treatment of recurrent tumors without adjuvants compared with the results of the same treatment of primary tumors were probably related to increased surgical thoroughness brought about by the surgeon's awareness of dealing with a riskier tumor.
刮除术后使用辅助剂治疗骨巨细胞瘤已得到充分证实。本研究的目的是分析不同治疗类型后的复发率以及肿瘤表现的各种因素对这些复发率的影响。
评估了来自十个骨肿瘤中心的关于四肢骨骼良性巨细胞瘤的数据。排除了轴向和恶性肿瘤。分析了与不同治疗方式相关的复发率，并计算了肿瘤表现的多个因素的复发风险比。
该研究包括384例手术，涉及256例原发性肿瘤和128例复发性肿瘤。平均随访时间为64.2个月。78例（20.3%）进行了广泛切除，306例（79.7%）进行了病灶内手术。在病灶内手术中，103例（33.7%）未使用辅助剂，102例（33.3%）包括用聚甲基丙烯酸甲酯填充，74例（24.2%）包括酚化后用聚甲基丙烯酸甲酯填充，27例（8.8%）包括使用局部毒素。病灶内手术后，未使用辅助剂时的总体复发率为49%，仅使用聚甲基丙烯酸甲酯作为辅助剂时为22%，酚化后使用聚甲基丙烯酸甲酯时为27%，使用酚或其他局部毒素（不使用聚甲基丙烯酸甲酯）时为15%。辅助剂刮除术后复发率最高（36%）与间室外肿瘤有关。复发性肿瘤再次复发的风险并未增加，即使它们是间室外肿瘤。原发性肿瘤未使用辅助剂刮除后的复发率（55%）高于复发性肿瘤相同治疗后的复发率（39%）（p = 0.033）。
使用聚甲基丙烯酸甲酯作为辅助剂可显著降低良性巨细胞瘤病灶内治疗后的复发率，它似乎是原发性和复发性骨巨细胞瘤的首选治疗方法。与原发性肿瘤相同治疗结果相比，复发性肿瘤无辅助剂治疗后结果明显更好，这可能与外科医生意识到处理风险更高的肿瘤而提高手术彻底性有关。
