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Treatment for a giant cell tumor

Treatment for a giant cell tumor/Treatment for Osteoclastoma

Specific treatment for a giant cell tumor be determined by your child's physician based on:
  • Your child's age, overall health, and medical history
  • Extent of the disease
  • Proximity of the tumor to the growth plate
  • You or your child's tolerance for specific medications, procedures, or therapies
  • How your physician expects the disease may progress
  • Your opinion or preference
Treatment of a giant cell tumor may involve one or a combination of the following surgical procedures performed by a pediatric orthopaedic surgeon:

Curettage: This is the most common form of treating a giant cell tumor. Curettage is an operation during which the tumor is scraped out of the bone, usually with a special instrument called a curette that has a scoop, loop or ring at its tip. A powered instrument, called a burr, is also sometimes used in addition to the curette. For this procedure, surgeons make an incision in the bone to create a window to expose the entire tumor... The tumor is then completely curetted.

Cryotherapy: This may used to supplement curettage. Surgeons fill the cavity that remains after curettage with liguid nitrogen to freeze the area. The area is then thawed out and may be frozen again. The freeze and thaw cycle, which would help prevent any missed remnants of the tumor from growing, is repeated once or twice. This technique is associated with serious potential complications such as fracture and nerve injury and is not usually considered as primary treatment in most centers.
Bone Grafting or Cement Packing: Sometimes the remaining cavity is packed with donor bone tissue (allograft), bone chips taken from another bone (autograft), or other materials, including bone cement (the same material used in total joint replacements), depending on the preference of the surgeon.
En bloc resection: If more aggressive resection of the tumor is warranted, the operation will likely involve en bloc resection, which is the surgical removal of bone containing the tumor, rather than curettage. Internal fixation, with pins, may be required to restore the structural integrity of the bone. If significant bone loss results, allograft transplants or metallic replacements are used to reconstruct the defects. Although common in the past, these procedures are not commonly used as the initial treatment today.

Treatment of giant cell tumors is by surgery only. Intralesional excision by "extended" curettage is the treatment of choice. Curettage alone is associated with a high recurrence rate, and this can be decreased with the addition of chemical cautery using phenol, multiple freeze-thaw cycles using liquid nitrogen, and treating the walls of the cavity with a high-speed rotary burr. Local recurrence after curettage alone is thought to lead to recurrence in 50% of cases. Recurrence after extended curettage is approximately 10 percent.

The tumor cavity may be filled with polymethyl methacrylate cement or bone graft, according to the surgeon's preference. Some believe that the polymethyl methacrylate cement lowers the risk of a local recurrence due to the large amount of heat given off during hardening. Recurrences are normally treated with a second interlesional surgery. Bone graft may allow for more favorable biomechanics of load inthe nearby joint. The early signs of local recurrence may be more difficult to detect in cases treated with bone graft.