gct tumor in toto

1. Management Of Campanacci Type III GCT
Of Bone
With Extended Intralesional Curettage
Presented By
Dr R. C. MEENA
Past President -Indian Orthopedic Association
Professor
Department Of Orthopedics
SMS Medical College And Attached Hospitals
Principal & controller
Govt Medical College karauli, Raj. India.
IOACON2022

2. Giant Cell Tumor
• Benign Aggressive Tumor
• 5% of all bone tumor
• 70% of tumor in 20-40 yrs age grp
• Most common : knee

3. Campanacci Radiological Grading
Type 1
Grade 1 Grade 2
Grade 3

4. GIANT CELL TUMOR
• Type 1 and 2
• Extended Curettage with bone cement/graft
• Type 3
• wide excision and reconstruction
• Biological
• Autograft arthrodesis
• Vascular fibula
• Allograft
• Bone transport
• Endoprosthetic reconstruction

5. Complications of endoprosthesis

6. Recurrence rate
• Extended curettage
• Type 3 36%
• Type 2 20%
• Type 1 6-12%
M. Balke, L. Schremper, C. Gebert, H. Ahrens, A. Streitbuerger, G. Koehler, et al., Giant cell tumor of bone:
treatment and outcome of 214 cases, J. Cancer Res. Clin. Oncol. 134 (9) (2008) 969–978.

7. • The Most Significant factor for local recurrence in Grade 3
GCT is soft tissue expansion of tumor
Reactive zone
A Discolored area around a tumor
observable by gross inspection which
is composed of haemorrhagic tissue,
degenerated muscle, edema or THE
TUMOR PSUEDO-CAPSULE
L. van der Heijden, M. Van de Sande, P. Dijkstra, Soft tissue extension increases the risk of local recurrence after curettage with adjuvants for giant-cell tumor of
the long bones: a retrospective study of 93 patients, Acta Orthop. 83 (4) (2012) 401–405.

8. Marginal Excision
• Tumor with surrounding reactive zone
is removed.
• GCT grade III is unique
• One sided bone
• Other side reactive zone/psuedocapsule

9. Hypothesis
• Would Extended curettage along with Marginal Excision in GCT
Campanacci Type 3 be able to decrease chances of RECURRENCE ?
• If this is true then complications of wide excision can be preventable

10. Study
• A retrospective single group cohort study was conducted at SMS
medical college , a tertiary care institute
• Study duration-1st January 2014 to july 2020
• All biopsy proven GCT grade III, patients who were treated with
Extended Curettage with Marginal Excision irrespective of
reconstruction method were included

11. Marginal Excision: Concept
• 21 years old male
• Right knee swelling at popliteal fossa
• Lytic lesion proximal tibia, medial condyle
• Campanacci grade I ?

12. Biopsy: GCT

15. Take home message

17. Making large bone window High speed burring: breaking all septa
Phenol , hydrogen peroxide, pulse lavage Bone cement + T plate stabilisation

18. 3 months 18 months

20. • 34 year old male
• Grade 3 GCT at Left
proximal Tibia

23. 2 years

24. 22 year old female
left distal radius

25. 8 months 20 months

27. • 23 years old washerwoman
• Right dominant hand

32. PATIENT DEMOGRAPHY
Primary
GCT
Reccurent
GCT
Curettage +
PMMA
Curettage
+bone graft
Pathological
fracture
SEX
MALE 35 1
FEMALE 42 4
LOCATION
PROXIMAL HUMERUS 12 - 12 -
DISTAL HUMERUS 2 - 2 -
DISTAL RADIUS 11 1 12 -
PROXIMAL FEMUR 9 - - 9 1*
DISTAL FEMUR 25 3 23 5 7
PROXIMAL TIBIA 17 1 15 3
CALCANEUM 1 - 1 -
77 5 65 17

33. RESULTS
• Mean follow up 34 months
• Recurrence – 2 cases
1. Osteosarcoma in second biopsy
2. Spindle cell sarcoma on second recurrence
• Infection 2 cases…both tibia ..medial condyle

34. Recurrence rate
Procedure GCT Grade Recurrence Rate Referrence
Ext. Curettage & Bone
Grafting
Type 1,2,3 27-65% Campanacci et al. 1987
Balke et al. 2008
Ext. Curettage with
Adjuvants
Type 1,2,3 12-27% Balke et al. 2008
Becker et al. 2012
Kivioja et al. 2017
Ext. Curettage with
Marginal Excision
(Bone Grafting/
Adjuvants)
Only Type 3 2.43% Our study

35. Conclusion
• Increasing grade of GCT is not a reflection of the biologic
aggressiveness of the tumor
• Psuedocapsule needs more concern
• Recurrence rate can be reduced by Marginal Excision along with
Extended curettage with adjuvants .

36. ACKNOWLEDGEMENT
•Dr Rajkumar Harshwal
Associate professor
Deptt. of orthopedics
SMS Medical College Jaipur

37. Thank you

39. Management of bone tumor
• Intralesional (Benign)
• Marginal
• Wide resection (Malignant)
• Radical resection