GCT of the bone often destroys healthy bone, damages joints, and grow to a large size. Surgery is the standard of care and first-line approach. There is no consensus on the optimal surgical approach. Surgery attempts to remove the tumor and damaged portions of the bone while preserving as much of the anatomy as possible. Depending on the extent of damage to bone and cartilage, your surgeon may also repair those during the procedure. Various surgical approaches are used and will be discussed with you by your healthcare provider. There are two main tumor resection techniques: the curettage and segment resection.
Hu et al. 2016. Recurrence Rates and Risk Factors for Primary Giant Cell Tumors around the Knee: A Multicentre Retrospective Study in China. Scientific Reports 6(1):36332
A curettage is a surgical technique where the tumor is scrapped from the bone using a curette. The remaining region of the damaged bone can be filled with a bone graft or cement. A bone graft is the transplantation of patient's healthy bone to repair and rebuild the damaged bone. Cement, commonly polymethylmethacrylate (PMMA), is a substance that hardens in a process that generates heat. This bone cement can be used in place of bone (1).
Curettage is the least invasive surgical option and allows preservation of the bone anatomy (2).
Many early studies showed that the recurrence rate after curettage were 25-50%, however, the improved diagnostic imaging and addition of bone cement, ablation (the use of heat to reduce recurrence), liquid nitrogen (the use of extreme cold to reduce recurrence), phenol, hydrogen peroxide, and other additives has improved outcomes for some patients (3,4). This is now the most common surgical technique used to treat GCT of the bone.
He et al. 2019. Surgical Treatment Options for Giant Cell Tumors of Bone Around the Knee Joint: Extended Curettage or Segmental Resection? Frontiers in Oncology. DOI:10.3389/fonc.2019.00946
Segment resection (also known as en bloc excision) is a type of surgical technique that requires reconstruction procedures to preserve limb function. Segment resection intends to remove the entirety of the tumor by fully removing the bone it grows in. This is a more aggressive surgery and often is required for advanced disease. Segment resection generally requires prosthetics, such as hardware implants. Arthroplasty (joint replacements) and massive allografts (a tissue graft from a donor) may be necessary.
Segment resection has been associated with higher rates of post-operative complications and functional impairment (5).
In hard-to-treat cases due to recurrence and/or an inoperable tumor, medications will be used.
It is currently unestablished which surgical technique reduces the risk of recurrence and leads to improved patient prognosis. Therefore, surgical technique and additives (ex. ablation) are dependent on individual patient circumstances, history, bone damage, and GCT location.
Embolization, often used in pelvic, spine, and sacral GCT of the bone, can be used to manage unresectable GCT of the bone. Embolization is a procedure which cuts off the blood supply to the tumor. This procedure often must be repeated, sometimes monthly, to reduce patients' symptoms (6). This is due to the blood flow being restored to the tumor over time. Additionally, this procedure can be used prior to surgery to reduce blood loss.
Surgical technique depends on position and size of the tumor, whether it has spread, the general health and well-being of the patient. NCCN offers guidelines on surgical treatment options.