From the Guidelines
Giant cell tumor of bone should be treated with surgical intervention, with options ranging from intralesional curettage with adjuvant therapy to wide resection, and denosumab may be used for unresectable or recurrent tumors, as it inhibits RANKL, which is essential for giant cell formation and function 1.
Treatment Options
- Surgical intervention: intralesional curettage with adjuvant therapy (such as phenol, liquid nitrogen, or bone cement) or wide resection, depending on tumor location and extent
- Denosumab: for unresectable or recurrent tumors, given as a monthly subcutaneous injection after three loading doses at weekly intervals ### Important Considerations
- Radiation therapy is generally avoided due to the risk of malignant transformation
- The recurrence rate after curettage is approximately 15-50%, which is why thorough curettage with adjuvant treatment is important
- Despite being classified as benign, these tumors can occasionally metastasize to the lungs, emphasizing the need for long-term follow-up with regular imaging of both the primary site and chest ### Patient Management
- All patients with giant cell tumor of bone should be managed by a bone sarcoma multidisciplinary team (MDT) 2
- Treatment options should be individualized and reserved for complex cases following multidisciplinary discussion 1
From the Research
Giant Cell Tumor of Bone Overview
- Giant cell tumor of bone (GCTB) is a rare and unpredictable lesion, comprising up to 20% of benign bone tumors in the US 3.
- GCTB is typically locally aggressive, but metastasizes to the lung in approximately 5% of cases, with malignant transformation occurring in a small percentage of cases, usually following radiation therapy 3.
Treatment Options
- Surgical management has been the primary treatment for giant cell tumor of bone, with options including excision and filling of the osseous void with bone cement or allograft, and wide excision and reconstruction with prosthetic, structural allograft, or combined allograft prosthetic components 4.
- Denosumab, an anti-RANKL monoclonal antibody, has demonstrated beneficial clinical effect in the treatment of GCTB, particularly in cases where surgery is not possible or would be associated with excessive morbidity 3, 5.
- Curettage with adjuvant therapy is also a treatment option, with studies showing no association between type of surgery and tumour recurrence, metastasis, or outcome 6.
Outcomes and Prognosis
- The rate of local recurrence varies depending on the surgical procedure, with intralesional excision having a higher recurrence rate (75%) compared to wide resection (0%) 7.
- Functional evaluation of patients with extremity tumors shows significant correlation with the initial surgical stages, with Stage 1 having the best functional results (average score of 30) and Stage 3 having the worst (average score of 24.4) 7.
- Mortality is associated with metastasis, but not recurrence or complication, with lower haemoglobin levels and higher percentage of stage-3 tumour being risk factors for metastasis 6.