Cement is recommended in intralesional surgery of giant cell tumors: A Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years

Figures & data

Figure 1. A. Giant cell tumor of the distal femur, treated with evacuation and cement filling. B. After 11 years, there were no signs of recurrence and no deleterious effects of the cement.

Figure 2. A. Giant cell tumor of the proximal tibia filled with autologous and allogeneous bone. B. After 6 years, there were no signs of recurrence and there was good consolidation.

Figure 3. Recurrence-free survival of 294 patients with giant cell tumors of the extremities.

Figure 4. Recurrence-free survival by margin in 292 giant cell tumors of the extremities (upper line: wider; lower line: intralesional surgery).

Table 1.  Comparison of clinical features and features of treatment with local recurrence rates

Feature	n	Local recurrence	P-value
Description		rate
All patients	294	0.22
Age			0.05^a
Under 20 years	39	0.33
20–40 years	160	0.24
Over 40 years	95	0.15
Fracture			0.07
Yes	60	0.28
No	223	0.20
Unknown	11
Surgical margin			0.007
Intralesional	200	0.27
Wider	92	0.12
Unclassified	2

^aSignificance was assessed in univariate analysis as a continuous variable.

Table 2.  Univariate and multivariate analyses of risk factors for recurrence (n = 294)

Factor	Relative risk (95% CI)	P-value
Univariate
Age, years ^a	1.0(0.96–1.0)	0.05
Sex (male = 1, female = 2)	1.2 (0.72–2.0)	0.5
Fracture at diagnosis	1.7(0.96–3.1)	0.07
Intralesional surgical margin	2.6(1.26–5.3)	0.009
Extension (intraoss. = 1, extraoss. = 3)	1.1 (0.87–1.5)	0.4
Size, cm ^a	0.9(0.83–1.1)	0.3
Multivariate
Intralesional surgical margin	2.4(1.2–5.0)	0.02
Age ^a	0.98 (0.96–1.0)	0.07
Fracture at diagnosis	1.7(0.96–3.1)	0.07

^aAssessed as a continuous variable.

Figure 5. Recurrence-free survival after intralesional surgery (filling with cement or bone) in 194 giant cell tumors of the extremities (upper line: with cement; lower line: without cement).

Table 3.  Intralesional surgery: univariate analysis of cavity filling with cement vs. other

	n	Recurrence rate	Relative risk	P-value
Cement	147	0.22	0.3 (0.2–0.6)	0.001
Other	47	0.52