The Treatment And Selection Of Giant Cell Tumor In Extremities And Joints

Research Background and Motivation:The giant cell tumor has been commonly recognized as a essential bone tumorwith aggressive and metastases. Both its basic and clinical research obtainedhuge accomplishment during the past hundreds of years since it had beenidentified; nevertheless the origin of GCT organization was still not quiteclearly stated.At the meantime, there were still series problems attracting researchers’attentions such as how pathology relating to clinical prognosis, the relationbetween chosen of therapeutic methodology and recurrence, etc.So far, the main therapeutic methodology to cure GCT is still surgery inabroad, which leads to a popular discussion that is what type of surgery is thebest. How to choose an appropriate type of surgery to rebuild patient’s bodyfunction with minimal recurrence is still a difficult problem that needs to besolved in clinical field.The lesion wide resection and curettage filled bone defection and internalfixation and the tumor wide resection and function of joint rebuilding are twoof the most popular types of surgeries. This research will review all43casesfrom Jan.2008to Dec.2012who had been taken surgeries in our hospital and had relatively complete follow up data. Twenty-five of them were taken thelesion wide resection and curettage filled bone defection and internal fixation,others were taken the tumor wide resection and function of joint rebuilding.Based on observing the recurrence of tumor, postoperative complications andthe recovering of body function, we will then discuss how to choose anappropriate surgery type.MethodologyBefore the surgery, we will need to complete all relative check includingpartial X-Ray, MRI, CT and chest X-Ray or bone scanning. With these datawe can then estimate the range of bone tumor and possible metastases. Also,the Jaffe classification, Enneking classification, and Campanacci classificationwill be done at the mean time. All cases will be divided into two groups basedon the types of surgeries they are taken. After the surgery, we will utilizeMSTS system to evaluate patients randomly and conduct statistical analysiswith the probability of recurrence and complication.Results1. There are8recurrences, which is about18.6%of all the cases.6ofthem are from group one, and the recurrences rate is24%. Other2arefrom group with recurrences rate at11.11%, the comparison betweenthese two groups of data has no statistical meaning (X2=1.148，P=0.29>0.05). The recurrences rate of campanacci I and II in bothgroups are as following, group1has10.52%and group2has8.33% which has no statistical difference (X2=0.04，P=0.834>0.05); therecurrences rate of campanacci III are66.6%and16.67%for eachgroup and has no statistical difference either, but it has a obviouslyincreasing comparison to campanacci I and II.2. There are2complication in group1which is about8%and6in group2which is33.3%. They do have statistical difference (X2=4.435，P=0.037<0.05)3. In the aspect of function rebuilding after surgery, among group1,20cases had perfect results which is80%of it,3had good results,2moderate results and0bad result. Total satisfaction rate is92.0%andaverage score is26.7. For group2,9cases had perfect results, which is50%of it,7had good results,3had moderate results and0bad result.Total satisfaction rate is88.8%and average score is25.2. After thestatistical analysis, these two groups’ data have statistical meaning（X2=4.289，P=0.041<0.05）and the campanacci I and II’s satisfactionrate for group1is94.7%, for group2it is83.3%. Campanacci III’ssatisfaction rate is83.3%for both groups.Conclusion1. Overall, the recurrence rate, complication rate and function rebuildingafter surgery can be used as major criteria to evaluate GCT. Based onthese we think the overall effectiveness of the treatment from method1is better than that is from method2. 2. Patients with Campanacci I and II whom taken The lesion wideresection and curettage filled bone defection and internal fixation withauxiliary treatment had lower recurrence rate, complication rate andbetter function rebuilding after surgery than those who were taken thetumor wide resection and function of joint rebuilding. For those whohad Campanacci III, the tumor wide resection and function of jointrebuilding can reduce the recurrence rate significantly and the results offunction rebuilding after surgery and oncology were relatively great,which demonstrates thatthe tumor wide resection and function of jointrebuilding is an effective treatment method for this period.3. GCT should be analyzed from many fields such as its origin, pathology,image, clinical performance, etc. Then we can get reliable estimationafter surgery and finally improve clinical treatment furthermore.