The impact of curettage technique on local control in giant cell tumour of bone
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REVIEW ARTICLE
The impact of curettage technique on local control in giant cell tumour of bone Gennady N. Machak 1
&
Andrey I. Snetkov 1
Received: 23 September 2020 / Accepted: 16 October 2020 # SICOT aisbl 2020
Abstract Introduction Although consensus has been reached regarding the main aspects of intralesional surgery for giant cell tumour of the bone (GCTB), debates continue about the most effective combination of local adjuvants. The purpose of study was to analyze the previous experience and determine the most effective curettage approach for GCTB. Methods We summarized the findings from 89 papers published from 1962 to 2020 related to this subject. Database consisted of 137 treated groups that included 6441 patients who underwent different curettage techniques without pre-operative administration of bisphosphonates or RANKL inhibitors. Results Recurrence rates after simple curettage ranged between 27 and 82% with a median value at 47%. The use of one or two local adjuvants reduced the incidence of recurrences approximately by 50% when compared with simple curettage. High-speed burring combined with chemical adjuvants or followed by poly(methyl methacrylate) cementation with or without bone grafting further improved the local control leading to good and excellent results; however, these were not documented in all studies. Simultaneous use of burring, chemical adjuvants, and cementation, which we named here as combined curettage, allowed to down local relapses to the range of 0–26%, with a median at 11%. Oncologic outcomes after combined curettage are significantly better when compared with simple curettage (p < 0.0001) and other variants of enhancement (p = 0.001). Conclusions Combined curettage appears to provide the most potent and comprehensive impact on residual tumour cells located in risk zones. This approach should be considered for locally advanced tumours when function-preserving surgery is planned. Additional comparative studies are required to define the optimal curettage enhancement for each individual patient. Keywords Bone tumours . Giant cell tumour . Curettage . Adjuvants . Recurrence
Introduction Despite the increased risk of tumour recurrence, most surgeons prefer to perform curettage for primary or recurrent GCTB because it allows to preserve the adjacent joint and to avoid the use of osteo-articular allograft or endoprosthesis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00264-020-04860-y) contains supplementary material, which is available to authorized users. * Gennady N. Machak [email protected] Andrey I. Snetkov [email protected] 1
Priorov Central Institute for Traumatology and Orthopedics, Moscow, Russian Federation
providing better functional outcomes [1–4]. The safe use of intralesional surgery would not be possible without its combination with physical (mechanical/thermal) or chemical adjuvants (CHA). Rarity of the tumor and variety of used surgical approaches make it difficult to outline the most adequate curet
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