1. Controversy in the Treatment of Central
Giant Cell Granuloma: In Search of
Evidence-Based Treatment
W. H. Schreuder: Department of Oral and Maxillofacial
Surgery, Academic Medical Centre/ACTA, University of
Amsterdam, Amsterdam, H. van den Berg, J. de Lange
Statement of the Problem: The central giant cell
granuloma (CGCG) of the jaw is a rare benign tumor
with unknown etiology. The conventional therapy is
surgical curettage, which is associated with a high recur-
rence rate, especially in the lesions with aggressive signs
and symptoms. In the last 2 decades pharmacologic
agents such as Interferon and Calcitonin have replaced
surgery, preventing or minimizing the former extensive
surgical procedures, often involving tooth loss and some-
times serious mutilation of the face. However, pharma-
cologic agents in CGCG have been used empirically,
with little evidence available in literature to support the
application of these drugs.
Materials and Methods: A retrospective study was
carried out in a cohort of 30 successive patients treated
for CGCG lesions of the jawbone. The mean age at
diagnosis of the primary lesions was 24.7 years (median
19 years; range 3.9-67.1 years) and the male-to-female
ratio was 14:16. At the time of initial diagnosis a hyper-
parathyroidism was ruled out in all cases. One patient
was diagnosed with Cherubism and one patient had a
medical history of parathyroidectomy because of a para-
thyroid adenoma. Patients were arranged in the follow-
ing groups according to the treatment that was received:
1) primary surgery; 2) calcitonin; 3) calcitonin and in-
terferon; 4) pharmacological treatment followed by local
curettage; and 5) any other therapy. The mean follow up
after the last intervention was 5.4 years (median 3.75
year; range 0.8-19.6 years).
Methods of Data Analysis: The ␹2 test was used to
compare the outcome of patients in the different groups.
Results of Investigation: A total of 34 primary CGCG
lesions of the jawbone were diagnosed. Three patients
were diagnosed with more than one lesion. Twenty
lesions (59%) were located in the mandible; the others
were located in the maxilla. Seven lesions were treated
primarily surgically, with a recurrence rate of 29% (2/7).
Eleven lesions were treated with Calcitonin and four
lesions were treated with a combination of Interferon
and Calcitonin. None of these lesions recurred or
showed progressive growth of the remaining lesion in
the follow-up period. Thirteen lesions needed limited
local curettage in addition to treatment with Calcitonin
(7/13), Calcitonin and Interferon (1/13), Calcitonin/
Interferon/Imatinib/Corticosteroids (2/13), Calcitonin/
Interferon/Alendronate/Sorafenib (2/13) and Calcitonin/
Interferon/Coritcosteroids in order to correct facial con-
tours or to remove a remaining lesion after stabilization
with extensive pharmacological treatment. None of
these lesions recurred in the follow-up period.
One lesion was treated with Calcitonin in combination
with corticosteroid injections, which was successful in
this one case. There is no significant difference in recur-
rence rate between the different groups (P Ͼ .05).
Conclusion: In the present study, all pharmacological
treatments lead to stabilization or regression of the tu-
mor. Sometimes additional surgery was indicated to re-
store facial contours or perform limited local curettage
of the remaining lesion, without the sacrifice of tooth
buds or the need to perform large mutilating resections.
Only the primary surgical approach showed 2 recur-
rences in the follow-up period. More extensive research
is needed in this field, in order to select the proper
pharmacological agent for each tumor before initiating
therapy.
References:
1.de Lange J, van den Akker HP, Veldhuizen van Zanten GO, et al:
Calcitonin therapy in central giant cell granuloma of the jaw: a ran-
domized double-blind placebo-controlled study. Int J Oral Maxillofac
Surg 35: 791, 2006
2. Kaban LB, Troulis MJ, Wilkinson MS, et al: Adjuvant antiangio-
genic therapy for giant cell tumors of the jaws. J Oral Maxillofac Surg
65: 2018, 2007
Oral Abstract Session 1
AAOMS • 2011 e-11