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GIANT CELL TUMOUR of BONE
Helen Findlay
Clinical Nurse Specialist Orthopaedic Surgical Oncology
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Aim •What is GCT?
•Assessment process
•Surgical management
•New developments
•Follow up pathway
•CNS responsibility
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What is GCT? •Uncommon bone tumour
•Incidence – 25-40 age group
•Multinucleated giant cells
•Normally solitary lesion - benign with unpredictable behaviour
•Risk of recurrence
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Diagram shows common locations of tumors and tumorlike conditions in transverse and longitudinal dimensions of a long bone.
Miller T T Radiology 2008;246:662-674
©2008 by Radiological Society of North America
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Clinical Presentation
•Pain •Swelling •Reduced ROM •Pathological Fracture
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Diagnosis
•Imaging
– X-rays, MRI / CT
•Biopsy – CT guided
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Pre Op Preparation
•Additional imaging if required for surgical planning
•Chest CT
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Surgical Management •Intralesional resection
•High speed burring of tumour cavity
•Adjuvant treatment
•Internal fixation
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New Developments
•Anti-RANKL therapy •Bone tumour micro-environmnent
•Clinical Trials • Bone Metastases
• Bisphosphonates & Denosumab
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Follow up pathway •Post op to 8 weeks
– wound care – protected weight bearing – physiotherapy & ROM increase – x-rays
•3 – 6 months – independently mobile – increased ROM – CXR surveillance (every 3 months) – follow up for 2 years or longer
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Clinical Nurse Specialist Responsibilities
•Surveillance
– independent out-patient clinic reviews
– functional outcomes with short & long term goals
– CXR surveillance
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References •Gaston C L et al 2011 Does the addition of cement improve the rate of local recurrence after curettage of giant cell tumours of bone. JBJS (Br) Vol 93B No 12 December
•Gortzak Y et al 2010 The efficacy of chemical adjuvants on GCT. JBJS (Br) Vol 92B No 10 October
•Szendroi M 2004 Giant Cell Tumour of Bone JBJS (Br) Vol 86B No 1 January
•Balke M 2010 Bisphosphonate treatment of aggressive primary, recurrent & metastatic GCT of bone BMC Cancer 10: 462
•Jeys L M et al 2006 Impending fractures in GCT in distal femur; incidence & outcome International Orthopaedics 30(2): 135-8 April
•Heymann D 2012 Anti-RANKL therapy for bone tumours: basic, pre-clinical & clinical evidences Journal of Bone Oncology 1 (2012) 2-11