What is the recommended treatment for benign bone tumors?

Treatment of Benign Bone Tumors

Most benign bone tumors require no intervention and can be managed with observation alone, particularly when asymptomatic and incidentally discovered. 1

Initial Assessment and Risk Stratification

The management approach depends critically on tumor type, location, symptoms, and recurrence risk 1:

• Asymptomatic lesions (enchondroma, osteochondroma, fibrous dysplasia, enostosis) generally require no intervention beyond surveillance 1
• Symptomatic lesions (osteoid osteoma, aneurysmal bone cyst, simple bone cyst) typically require percutaneous ablation or surgery 1
• Aggressive lesions (giant cell tumor of bone, osteoblastoma) require surgical intervention and potentially additional therapies 1

Specific Treatment Approaches

Giant Cell Tumor of Bone (GCTB)

Intralesional curettage is the preferred surgical approach for most stage I and II GCTB, balancing local control with functional preservation. 2

• Wide excision achieves lower recurrence rates (0-12%) but causes worse functional outcomes and more surgical complications 2
• Intralesional curettage has higher recurrence rates (12-65%) but preserves function 2
• Wide excision is reserved for aggressive stage III tumors with extraosseous extension 2
• Surgical adjuvants used with curettage show inconsistent evidence for reducing recurrence 2

For unresectable or surgically morbid GCTB, denosumab 120 mg subcutaneously every 4 weeks (with additional doses on days 8 and 15 of first month) is indicated. 2, 3

Symptomatic Benign Lesions

For osteoid osteoma, aneurysmal bone cyst, and simple bone cyst causing pain or functional impairment 1:

• Percutaneous ablation is preferred when technically feasible
• Surgical curettage for lesions not amenable to ablation
• Extended curettage alone (without bone grafting) can be sufficient for selected benign lytic lesions, particularly those with volume <70 cm³ 4

Surveillance Strategy

All benign bone tumors require monitoring with serial imaging to detect rare malignant transformation, even when not requiring active treatment. 1

• Regular follow-up imaging is essential for lesions managed conservatively 1
• Hereditary multiple osteochondromas require particularly vigilant surveillance due to 5-6% malignant transformation risk (versus <1% for solitary lesions) 5

Critical Pitfalls to Avoid

Any suspected primary bone tumor must be referred to a bone sarcoma reference center BEFORE biopsy, as inappropriate biopsy techniques can irreversibly compromise limb salvage or cure. 2

• Benign bone tumors are numerically more common than malignant tumors but can present similarly 2
• Non-mechanical pain or night pain around the knee (any age) warrants immediate investigation 2
• Radiographic evaluation is essential to distinguish aggressive from non-aggressive features before proceeding 2

For lesions requiring curettage, avoid filling defects >70 cm³ volume without grafting, as these have higher complication rates including pathologic fracture. 4