|
Year |
2002 |
|---|---|
|
Question Number |
39. |
|
Category |
Orthopaedic Disease |
Question
A 50 y/o patient undergoes a core biopsy for a proximal tibial lesion. Biopsy results are consistent with a giant cell tumor of bone (GCT). The next most appropriate step in management should consist of
1. radiation therapy.
2. a repeat radiograph in 3 months.
3. administration of bisphosphonate.
4. curettage with local adjuvant.
5. extra-articular knee resection.
Figures
Answer (click for answer)
Preferred answer: 4
Discussion: The gold standard for treatment of GCT is bone curettage with bone grafting and adjuvant therapy using liquid nitrogen, phenol, hydrogen peroxide, or bone cement. The recurrence rate with just curettage alone was 45% and was only 17% with use of one adjuvant therapy. The recurrence rate with bone curettage, phenol, and bone cement was only 3%. Therefore #4 is the correct answer. Radiation therapy can be used to treat these tumors however the studies have shown a 15% incidence of late conversion to malignant tumor such as a high-grade osteosarcoma. This therapy is restricted to use in the pelvis and spine. So, #1 is not absolutely wrong but would be inappropriate for the location of this lesion. Answer #2 is wrong because serial radiographs will help in diagnosing these tumors. We already have the diagnosis and continued x-rays will not address the tumor. Answer #5 is OVERKILL!! The reference did not mention biphosphonates as an accepted treatment of GCT.
Reference: Menendez LR (ed): Orthopaedic Knowledge Update: Musculoskeletal Tumors. Rosemont, IL, American Academy of Orthopaedic Surgeons 2002, pp 113-118.