GIANT CELL TUMOR OF BONE: RESULTS AND TREATMENT COMPLICATIONS

Gigantocelularni tumor kosti (GCT) je najčešće benigni, lokalno agresivan tumor sklon recidiviranju. Liječenje GCT je u pravilu kirurško, a kirurški pristup određuje lokalizacija i lokalna agresivnost tumora. U Klinici za ortopediju KBC-a Zagreb je od 1995. do 2009. godine zbog GCT liječeno 39 bolesnika. Četiri bolesnika su izgubljena iz praćenja. U bolesnika s nižim stupnjem agresivnosti (n=12, 34 %) učinjena je marginalna resekcija, dok je u bolesnika s agresivnim GCT učinjena resekcija tumora u bloku i rekonstrukcija endoprotezom ili koštanim presatkom (n=22, 63 %). U jednog je bolesnika liječenje provedeno zračenjem. Komplikacije su se pojavile u trećine bolesnika. Najčešće su komplikacije bile lokalni recidiv tumora (n=6, 50 % komplikacija) i infekcija (n=2, 17% komplikacija). Amputacija je učinjena u dva pacijenta u kojih je u podlozi GCT otkriven osteosarkom. Ne računajući primarnu biopsiju, u 35 bolesnika učinjeno je ukupno 84 kirurških zahvata. Liječenje GCT je složeno, uz veliku mogućnosti komplikacija. Preporuča se multidisciplinarni pristup liječenju u specijaliziranim ortopedskim centrima s timom iskusnih ortopeda onkologa.Giant cell tumor of bone (GCT) is mostly benign, locally aggressive tumor with a high recurrence rate. GCT is treated primarily surgically, and the approach is determined according to localization and local tumor behavior. The aim of this study was to analyze results and complications of surgical treatment of GCT at a tertiary orthopedic clinical center in Croatia. We analyzed all patients treated at University Department of Orthopedics, Zagreb University Hospital Center, during a 15-year period. From 1995 to 2009, 39 patients were surgically treated for GCT. Four patients were lost from follow up. In patients with low-grade GCT (n=12, 34%), we performed marginal-intralesional resection, whereas in patients with locally aggressive GCT we performed en bloc resection and reconstruction with tumor endoprosthesis or bone allograft (n=22, 63%). In one patient, the only treatment was tumor irradiation. Complications were evident in one-third of our patients. The most common complications were tumor recurrence (n=6, 50% of all complications) and deep infection (n=2, 17% of all complications). We performed amputation in two patients in whom osteosarcoma was revealed under GCT radiologic and histologic appearance. We performed 84 operations in 35 patients, not counting primary biopsy. In conclusion, treatment of GCT is complex, with a high incidence of tumor recurrence. Diagnosis and treatment are best provided through a multidisciplinary approach in highly specialized centers for orthopedic oncology