1) Curettage with adjuvant therapies like phenol, liquid nitrogen or cementing is recommended for treating giant cell tumors to reduce local recurrence rates. 2) Cementing after curettage provides immediate stabilization and fixation while also having local tumorcidal effects from the heat of polymerization. 3) The key to success is adequate and thorough curettage of the tumor, while cement only serves as an adjuvant therapy not the primary treatment.

1. Giantcell tumour Surgical Technique of Curettage Vinod Naneria, G. Yeotikar, A. Wadhwani Choithram Hospital & Research Centre, Indore, India

3. Intra-lesional Curettage and Wide Window cementing

5. Intralesional surgery should be the first choice in most giant cell tumors, even in the presence of a pathological fracture. After thorough evacuation, the cavity should be filled with cement. Acta Orthop. 2008 Feb;79(1):86-93. Cement is recommended in intralesional surgery of giant cell tumors: a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Kivioja AH , Blomqvist C , Hietaniemi K , Trovik C , Walloe A , Bauer HC , Jorgensen PH , Bergh P , Follerås G . Cement is recommended Acta Orthop. 2008 Feb

6. Use of polymethylmethacrylate as an adjuvant appears to be the therapy of choice for primary as well as recurrent giant cell tumors of bone. J Bone Joint Surg Am. 2008 May;90(5):1060-7. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. Arbeitsgemeinschaft Knochentumoren , Becker WT , Dohle J , Bernd L , Braun A , Cserhati M , Enderle A , Hovy L , Matejovsky Z , Szendroi M , Trieb K , Tunn PU . Cement as Adjuvant Therapy J Bone Joint Surg Am. 2008 May

9. Heat above 60 ° produced during polymerization lasted for about 10 min. After heat treatment at 60 ° for 10 min, no cells could have survived. This study has clarified the tumoricidal effect of methyl methacrylate by hyperthermia from the heat caused by polymerization. Heat Of Polymerization of Cement Arch Orthop Trauma Surg (1993)

10. Curettage, high-speed burring with added phenol/liquid nitrogen treatment and cementation is a useful and safe method in the treatment of giant cell tumors. The advantages include a low recurrence rate, as well as immediate stabilization allowing early mobilization. Patients who have Campanacci grade I tumors have the highest chance of being disease-free after the first operation. Ann Acad Med Singapore. 2005 Apr;34(3):235-7. Treatment of benign giant cell tumors of bone in Singapore. Lim YW , Tan MH . Department of Orthopaedic Surgery, Changi General Hospital, Singapore. yeow_1@yahoo.com Intralesional Curettage

11. A 30yr, female with biopsy proved Giantcell tumour

13. Under Tourniquet

14. Skin Incision

22. Dental Burr

25. Pulse Lavage + H2O2

28. Cementing

30. Post-op X-ray

31. 1997

34. Stress fracture

35. 2006

67. The most important factor for local recurrence appeared to be inadequate curettage with similar recurrence rates regardless of the type of bone graft used. A careful approach to the surgical margin including use of a dental burr and local adjuvant treatment with phenol, the rate of local recurrence may be decreased. Changgeng Yi Xue Za Zhi. 1996 Mar;19(1):16-23. Treatment of giant cell tumor of long bone. Shih HN , Chen YJ , Huang TJ , Ho WP , Hsueh S , Hsu RW . Department of Orthopedic Surgery, Chang Gung Medical College, Taoyuan, Taiwan, R.O.C. Prevention of recurrence – literature

69. This study demonstrates that either curettage and packing with cement or wide resection are effective in treatment of giant cell tumor of bone. There is, however, a better functional result after curettage and packing with cement than following wide resection. We recommend curettage and cement packing for giant cell tumor of bone whenever it is technically feasible Changgeng Yi Xue Za Zhi. 1998 Mar;21(1):37-43. Treatment of giant cell tumor of bone: a comparison of local curettage and wide resection. Liu HS , Wang JW . Recommendation - literature