Campanacci and colleagues reviewed the Istituto Rizzoli experience with giant‑cell tumor of bone, relating local recurrence to the surgical margin obtained and to their radiographic grade.
Single‑center Rizzoli series of 327 patients, 293 treated there and 280 followed 2 to 44 years.
Methods
Design
Retrospective single‑institution series
Data source
Istituto Rizzoli, Bologna
Patients
327 patients seen
293 treated at the Institute
280 with adequate follow‑up
266 graded radiographically before treatment
Exposure
331 procedures in 280 patients
Intralesional (151)
Marginal excision (122)
Wide or radical (58)
Follow-up
2 to 44 years
Outcomes
Local recurrence by surgical margin
Radiographic grade before treatment
Lung metastases
Sarcoma after adjuvant radiation
Key Findings
Local recurrence appeared to track the surgical margin obtained and did not correlate with the lesion's radiographic grade.
Before treatment, 74% of 266 patients had Grade II lesions, 22% Grade III and 4% Grade I.
90% of the 51 recurrences after Rizzoli treatment showed up within 3 years of surgery, and the remainder up to 9 years later.
Sarcoma developed in 8 of 27 patients (27%) given 4000 to 6000 rads as an adjuvant to intralesional surgery.
Lung metastases occurred in 6 patients (2%), proved histologically in 3, and every one of the 6 had a favorable outcome.
A pathological fracture was visible at presentation, on the first radiograph, in 9% of patients.
Board pearl
Giant‑cell tumor usually involved both metaphysis and epiphysis and lay next to an open growth plate in only 2% of this series.
Campanacci radiographic gradesCampanacci, J Bone Joint Surg Am 1987
Grade I
Well‑marginated border with a thin rim of mature bone. Cortex intact or slightly thinned, not deformed
Grade II
Relatively well‑defined margins but no radiopaque rim. Cortex and reactive rim thin and moderately expanded but still present
Grade II with fracture was graded separately.
Grade III
Fuzzy borders. Tumor bulges into soft tissue not contained by a shell of reactive bone
Authors' conclusion
The factor that definitely seems to influence the outcome is the surgical margin.
Campanacci and colleagues reviewed the Istituto Rizzoli experience with giant‑cell tumor of bone, relating local recurrence to the surgical margin obtained and to their radiographic grade.
Single‑center Rizzoli series of 327 patients, 293 treated there and 280 followed 2 to 44 years.
Methods
Design
Retrospective single‑institution series
Data source
Istituto Rizzoli, Bologna
Patients
327 patients seen
293 treated at the Institute
280 with adequate follow‑up
266 graded radiographically before treatment
Exposure
331 procedures in 280 patients
Intralesional (151)
Marginal excision (122)
Wide or radical (58)
Follow-up
2 to 44 years
Outcomes
Local recurrence by surgical margin
Radiographic grade before treatment
Lung metastases
Sarcoma after adjuvant radiation
Key Findings
Local recurrence appeared to track the surgical margin obtained and did not correlate with the lesion's radiographic grade.
Before treatment, 74% of 266 patients had Grade II lesions, 22% Grade III and 4% Grade I.
90% of the 51 recurrences after Rizzoli treatment showed up within 3 years of surgery, and the remainder up to 9 years later.
Sarcoma developed in 8 of 27 patients (27%) given 4000 to 6000 rads as an adjuvant to intralesional surgery.
Lung metastases occurred in 6 patients (2%), proved histologically in 3, and every one of the 6 had a favorable outcome.
A pathological fracture was visible at presentation, on the first radiograph, in 9% of patients.
Board pearl
Giant‑cell tumor usually involved both metaphysis and epiphysis and lay next to an open growth plate in only 2% of this series.
Campanacci radiographic gradesCampanacci, J Bone Joint Surg Am 1987
Grade I
Well‑marginated border with a thin rim of mature bone. Cortex intact or slightly thinned, not deformed
Grade II
Relatively well‑defined margins but no radiopaque rim. Cortex and reactive rim thin and moderately expanded but still present
Grade II with fracture was graded separately.
Grade III
Fuzzy borders. Tumor bulges into soft tissue not contained by a shell of reactive bone
Authors' conclusion
The factor that definitely seems to influence the outcome is the surgical margin.