Risk Factors Analysis And Surgical Treatment Of The Recurrent Giant Cell Tumor Of Long Bone

Objective：To analyze the risk factors related to the recurrence of giant cell tumor (GCT) of longbone, and evaluate the effectiveness of microwave ablation, tumor segmental resectionwith tumor prosthesis replacement and massive bone allograft.Methods：65cases of recurrent giant cell tumor of long bone, by retrospective analysis of113cases from1992to2010, were analyzed by gender, age,1ocation of tumor, Campanacci’sradiographic grading, Jaffe’s pathology classification, pathologic fracture and methods ofprimary operation. Oncology and function analysis were made to the recurrent cases,which were treated with microwave ablation, tumor segmental resection with tumorprosthesis replacement and massive bone allograft.Results：65patients (40males and25females；average age31.9years，range16-56years) hadrecurrent giant cell tumor of the long bone in113cases. The anatomy distribution for thetumors were as follows: the proximal tibia (25cases), distal femur (18cases), proximal femur (7cases), distal radius (7cases), proximal humeral (4cases), distal humeral (1case),distal tibia (1case) and proximal fibula (2cases). According to Campanacci’s radiographicgrading:7cases were the GradeⅠ,45cases were the GradeⅡand13cases were theGradeⅢ. According to Jaffe’s pathological grade, there are50recurrent cases that showedno difference compared with primary tumors.(9cases from GradeⅠto GradeⅡ,1casechanged from GradeⅠto GradeⅢ,5cases changed from GradeⅡto GradeⅢ). In allrecurrent GCT cases,37cases had pathological fracture and32cases were treated withadjuvant treatments and intraregional excision (curettage).53cases were treated withmicrowave ablation and4cases developed recurrence (the recurrence rate was7.5％). Asto the function of limbs and joints,43cases were excellent,8cases were fine and2caseswere medium. Enneking score ranged from25to30points (average27.4). Of the6casesthat were treated with tumor segmental resection,1case had e xcellent function,4caseshad fine function and1case had medium function.Conclusion：1. There is no obvious correlation between long bone giant cell tumor recurrenceand age, sex, tumor site and pathological classification. Pathological fracture is one ofthe risk factors for recurrence, but in order to know the details further clinicalobservation and research are required. There are significantly higher recurrences in theradiographic grading higher cases. Intracapsular curettage was common in first operationbut incomplete curettage is the important factor of tumor recurrence, and adjuvanttreatments are only auxiliary treatment. Recurrences are also common when operationmethod is not strictly according to the tumor grading or staging.2. Microwave ablation has unique superiority to treat recurrent GCT patients, byachieving "the security boundary" during surgery and getting satisfactory limb and jointfunction, but in order to figure out clinical indications of application furthersummarization are required. Tumor prosthesis replacement and large allograft bone aresuitable for the cases who have higher tumor grading and difficult structure reconstruction.Amputation is only applicable to malignant cases that have wide normal tissue invasionand cannot receive limb-salvage operation.