Giant Cell Tumor (GCT)

Surgical Treatment

Surgery is the mainstay of GCT treatment, with techniques depending on the tumor’s size, location, and aggressiveness.

• Curettage with Adjuvants:
  • Procedure: The tumor is scraped out, and the cavity is treated with adjuvants (agents such as liquid nitrogen, phenol, or bone cement) to destroy residual tumor cells.
  • Bone Reconstruction: The cavity may be filled with bone grafts or bone cement (polymethylmethacrylate or PMMA) to provide structural support.
  • Indication: Preferred for most cases, especially when preserving joint function is a priority.
• Wide Resection:
  • Procedure: The affected bone segment is completely removed and replaced with a prosthesis, bone graft, or reconstruction technique.
  • Indication: Used for more aggressive tumors or when curettage cannot ensure complete removal.
• Joint Reconstruction:
  • For tumors near joints, prosthetics or other techniques may be used to maintain joint mobility.

Non-Surgical Treatments

Denosumab Therapy:

1. • What It Is: Denosumab is a monoclonal antibody that inhibits RANKL, a protein involved in the formation of giant cells.
   • Use:
     • Shrinks the tumor preoperatively to facilitate surgery.
     • An option for inoperable cases or patients with high surgical risks.
     • Controls pain and reduces bone destruction.
   • Administration: Subcutaneous injection.
2. Radiation Therapy:
   • Rarely used, as GCTs are not highly sensitive to radiation, and there is a risk of malignant transformation.
   • Indication: Reserved for inoperable cases or where surgery is contraindicated.

• Recurrence: Treated with repeat surgery (curettage or wide resection) and possibly adjuvant therapies like denosumab.
• Metastasis:
  • Lung metastases are rare but may require surgical resection or systemic therapy.
  • Denosumab can be considered for metastatic disease management.

• Rehabilitation: Physical therapy is essential after surgery to restore mobility, strength, and function.
• Follow-Up:
  • Regular imaging (X-rays or MRIs) to monitor for recurrence.
  • Monitoring for side effects if denosumab is used, such as hypocalcemia or osteonecrosis of the jaw.

• Local Recurrence: Recurrence rates are higher with curettage alone, hence the use of adjuvants.
• Joint Dysfunction: Tumors near joints can lead to stiffness or reduced mobility, requiring prosthetic reconstruction.
• Malignant Transformation: Rare, but some GCTs can evolve into sarcomas, particularly after radiation therapy.

The treatment of giant cell tumors of bone is highly individualized, focusing on complete tumor removal and preserving function. Advances in surgical techniques and the introduction of targeted therapies like denosumab have significantly improved outcomes, offering effective options even for complex cases. Regular follow-up is critical to manage potential recurrences and complications.