van der Heijden Lizz, Bindt Sjaan, Scorianz Maurizio, Ng Colin, Gibbons Max C L H, van de Sande Michiel A J, Campanacci Domenico A
Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Bone Jt Open. 2022 Jul;3(7):515-528. doi: 10.1302/2633-1462.37.BJO-2022-0064.R1.
Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review.
We included 76 patients with distal radius GCTB in three sarcoma centres (1990 to 2019). Median follow-up was 8.8 years (2 to 23). Seven patients underwent curettage, 38 curettage with adjuvants, and 31 resection; 20 had denosumab.
Recurrence rate was 71% (5/7) after curettage, 32% (12/38) after curettage with adjuvants, and 6% (2/31) after resection. Median time to recurrence was 17 months (4 to 77). Recurrences were treated with curettage with adjuvants (11), resection (six), or curettage (two). Overall, 84% (38/45) was cured after one to thee intralesional procedures. Seven patients had 12 months neoadjuvant denosumab (5 to 15) and sixmonths adjuvant denosumab; two recurred (29%). Twelve patients had six months neoadjuvant denosumab (4 to 10); five recurred (42%). Two had pulmonary metastases (2.6%), both stable after denosumab. Complication rate was 18% (14/76, with 11 requiring surgery). At follow-up, median MusculoSkeletal Tumour Society score was 28 (18 to 30), median Short Form-36 Health Survey was 86 (41 to 95), and median Disability of Arm, Shoulder, and Hand was 7.8 (0 to 58).
Distal radius GCTB treatment might deviate from general GCTB treatment because of complexity of wrist anatomy and function. Novel insights on surgical treatment are presented in this multicentre study and systematic review. Intralesional surgery resulted in high recurrence-rate for distal radius GCTB, also with additional denosumab. The large majority of patients however, were cured after repeated curettage. Cite this article: 2022;3(7):515-528.
自地诺单抗应用以来，骨巨细胞瘤（GCTB）的治疗从单纯手术治疗转向多学科治疗方法，近期有人担心地诺单抗治疗后复发率会更高。我们通过严格评估的系统文献综述，评估了桡骨远端GCTB的肿瘤学、手术和功能结局。
我们纳入了三个肉瘤中心的76例桡骨远端GCTB患者（1990年至2019年）。中位随访时间为8.8年（2至23年）。7例患者接受了刮除术，38例接受了辅助刮除术，31例接受了切除术；20例使用了地诺单抗。
刮除术后复发率为71%（5/7），辅助刮除术后为32%（12/38），切除术后为6%（2/31）。复发的中位时间为17个月（4至77个月）。复发病例采用辅助刮除术（11例）、切除术（6例）或刮除术（2例）进行治疗。总体而言，84%（38/45）的患者在进行一至三次病损内手术治疗后治愈。7例患者接受了12个月的新辅助地诺单抗治疗（5至15个月）和6个月的辅助地诺单抗治疗；2例复发（29%）。12例患者接受了6个月的新辅助地诺单抗治疗（4至10个月）；5例复发（42%）。2例发生肺转移（2.6%），在地诺单抗治疗后均病情稳定。并发症发生率为18%（14/76，其中11例需要手术治疗）。随访时，肌肉骨骼肿瘤学会评分中位数为28（18至30），简短健康调查问卷-36评分中位数为86（41至95），手臂、肩部和手部功能障碍评分中位数为7.8（0至58）。
由于腕部解剖结构和功能的复杂性，桡骨远端GCTB的治疗可能与一般GCTB的治疗有所不同。这项多中心研究和系统综述提出了关于手术治疗的新见解。病损内手术导致桡骨远端GCTB的复发率较高，即使联合使用地诺单抗也是如此。然而，绝大多数患者在反复刮除术后治愈。引用本文：2022；3（7）：515-528。
