Giant Cell Tumour Treatment

Surgery

• Objective: Completely remove the tumor while preserving joint function and minimizing the risk of local recurrence, which is a key concern with giant cell tumours.
• Techniques:
  
  • Intralesional Curettage: Removes the tumor from within the bone cavity, followed by treatment of the cavity walls to reduce recurrence risk. This is the most common approach for giant cell tumour treatment in Delhi and Ghaziabad.
  • Adjuvant Treatment of Cavity: Techniques such as high-speed burring, phenol application, or cryotherapy are used after curettage to destroy residual tumor cells.
  • Bone Grafting or Cement Filling: The cavity left after curettage is filled with bone graft or bone cement to restore structural strength.
  • Wide Resection: Considered for aggressive or recurrent tumours, or when the joint is severely damaged, followed by reconstruction to restore function.
  • Joint-Preserving Reconstruction: Used whenever possible to maintain mobility and long-term joint function, an approach patients travelling from Ghaziabad and across Delhi frequently seek out.

Medical Therapy

• Denosumab: A targeted medication that can shrink certain giant cell tumours before surgery or manage cases where surgery carries high risk, such as tumours near critical structures.
• Role in Treatment Planning: May be used to reduce tumor size, making surgery less extensive and function preservation easier.

Radiation Therapy

• Role: Reserved for rare situations where the tumor is located in a surgically inaccessible area, such as the spine or pelvis, or when surgery is not a safe option.

[Managing Recurrence]

• Giant cell tumours have a notable tendency to recur, particularly after curettage alone, which is why adjuvant treatments and close follow-up are essential parts of care.
• Recurrent tumours may require more extensive surgery, such as wide resection, to achieve long-term control.

• Grade I (Latent): Slow-growing, well-contained tumours usually treated with simple curettage and bone grafting, with a low recurrence rate.
• Grade II (Active): More locally aggressive tumours requiring curettage with adjuvant treatment, such as burring or cryotherapy, to reduce recurrence risk.
• Grade III (Aggressive): Tumours with cortical breakthrough or soft tissue extension, often requiring more extensive surgery, such as wide resection, followed by reconstruction.
• Malignant Giant Cell Tumour: A rare, aggressive subtype requiring wide surgical resection, and in select cases, chemotherapy or radiation as part of the treatment plan.

For advanced, recurrent, or difficult-to-treat giant cell tumour cases, palliative care focuses on symptom relief and maintaining quality of life, including:

• Pain management through medications or targeted palliative radiation.
• Denosumab therapy to control tumor growth when surgery is not a safe or viable option.
• Physical and occupational therapy to help maintain joint mobility and daily function.
• Supportive care coordinated between Delhi and Ghaziabad based on the patient's convenience.

• Regular imaging, such as X-rays or MRI, to monitor for local recurrence, especially within the first two to three years after treatment.
• Physiotherapy to restore joint strength, range of motion, and function after surgery.
• Long-term monitoring, since recurrence can occur even several years after initial treatment.
• Patients from both Delhi and Ghaziabad are supported with a structured follow-up schedule to ensure early detection of any recurrence.

Giant cell tumor of bone is generally favorable with complete surgical removal and appropriate adjuvant treatment. While recurrence is possible, most patients achieve good long-term joint function and a return to normal activity with timely, well-planned treatment.