Treatment of Giant Cell Tumor of Bone of the Extremities at Campanacci Stage 1 or Stage 2
Clinical Scenario
This protocol applies to patients with giant cell tumor of bone (GCTB) arising in the extremities and classified as Campanacci stage 1 or stage 2. At these stages, the extent of bone involvement allows for a joint-preserving surgical approach, making this the central consideration in treatment planning.
Why Campanacci Stage Matters
For Campanacci stages 1 and 2, curettage is recommended to preserve the joints and to achieve good postoperative function. The staging directly informs the surgical strategy and the feasibility of avoiding more extensive resection.
Surgical Approach — Partial Overview
The approach involves aggressive curettage augmented by local adjuvant techniques, followed by reconstruction of the resulting bone defect. Specific choices among adjuvant methods, filling materials, and structural fixation strategies — including particular guidance for the distal femur — are part of the full protocol. The protocol also addresses the role of preoperative systemic therapy in candidates for joint preservation.
Complete regimen details, adjuvant selection, material options, and fixation guidance are available in the structured protocol below.
References
DOI: 10.3390/curroncol31040157
- For Campanacci stages 1 and 2, curettage is recommended to preserve the joints and to achieve good postoperative function.
- The recommendation indicates aggressive curettage with a sharp curet and a high-speed burr.
- The use of adjuvants (e.g., phenol, ethanol, argon beam coagulator, microwave, cautery, and liquid nitrogen) is also recommended.
- Therefore, the use of 0.05% chlorhexidine gluconate solution for washing after the curettage of GCTB may serve as a chemical adjuvant.
- Cement, hydroxyapatite, β-tricalcium phosphate, and allograft are the materials of choice for filling bone defects.
- Filling the subchondral bone with allograft tip bone, followed by the use of cement, is recommended.
- For such patients who undergo filling with cement and do not receive bone grafting, additional plate fixation is an option.
- In the distal femur, bone chips and plate fixation can be used to reduce damage to the subchondral bone and prevent pathological fracture, respectively.
- Based on the above reports, it is not recommended to administer preoperative denosumab before the curettage of GCTB in the extremities of patients in whom joint preservation may be achieved.
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