Surgical Strategy And Clinical Study Of Bisphosphonates For Treating Gaint Cell Tumor In Extremity

BackgroundGiant cell tumors of bone is the most common invasive benign tumor. Basic andclinical research have made great achievements since it was discovered more than200yearsago, The understanding of the tumor is made gradually, but so far there have a lot ofquestions not been clearly knowing, such as organization origin of tumor, the relationshipamong the treatment, recurrence, prognosis. The surgery is still the main treatment for GCT,but there is no consensus about the deal of reduceing the recurrence rate in the same timemantain the limb function best,so that it is very difficult to choose operation method. therecurrent GCT will make malignant degree upgrading usually, bringing the hugepsychological burden and material pressure to the patient how to reduce the recurrence ofGCT is a huge challenges to the doctors from social-mental-state medical treatment modeanalysis. The achievement of basic research and clinical application in GCT ofbisphosphonates is a new direction.Purpose:22cases of GCT in our hospital from February2006to July2011wereretrospectively analyzed. the follow-up data is relatively complete discussing the surgerystrategy, evaluating the value of bisphosphonates in treatmenting GCT.Methods:all patients with diseased were accepted chest X-ray, CT scan, biopsy preoperatively.The Campanacci image grade,Enneking clinical surgical stage and tumor histopathologystandard were made as patient coming. preoperative pain scores VAS visual score and theEnneking functional score were record., patients were received bisphosphonates zoledronicacid injection therapy in Drug treatment group. All patients underwent surgery: curettage fortumor in capsule in addition to autogenous bone or mixed with allograft bone, extracapsulartumor cut with the artificial joint reconstruction.Results:(1) Oncology treatment results:7cases of local recurrence in22cases, with anaverage recurrence rate was31.82%, the average time to recurrence was21months.10%relapse rate of drug treatment group,50%of without drug treatment group, the difference was statistically significant ((X~2=4.023，p=0.045)).there was no recuttence in Campanaccigrade I.In Campanacci grade II,recurrence rate were42.8%of without drug treatment group,0%of drug treatment group; Campanacci grade III recurrence rate:no drug treatmentgroup was75%,51.7%of the drug treatment group. The incidence of postoperativecomplications:50%of the no drug treatment group,10%of the drug treatment group.thedifference was statistically significant (X~2=4.023, p=0.045).No deaths in the follow-up.(2) complications rate: the rate of no drug group was50%, the rate of drug groupthewas10%, the difference was statistically significant (X~2=4.023, p=0.045).(3) VAS score: drug group:2.5(1.8~3.1), no drug group:3.6(3.4-5.1), the differencewas statistically significant (X~2=4.09, p=0.039).(4) Enneking functional score: no drug group scored an average of26.2(26~28.7),satisfaction rate is81%; The drug therapy group scored an average of28.5(26.3~29),satisfaction rate is94%, and the difference have statistical meaning (X~2=3.92, p=0.041).Conclusion(1)It was conductive for the estimate of the factors from clinical, radiological andpathological preoperatively to select the surgical approach.(2) To be a adjuvant treatmentmethod,zoledronic acid of bisphosphonates may reduce the recurrence rate of GCT, andhelp raise the level of treatment comprehensively (3) it may beneficial for the patient ofGCT in extremity by intracapsular surgery such as curettage assisting the phenol and argonbeam processing the tumor bed, with autogenous bone or bone allograft, and extracapsularsurgery such as tumor resection, with customized prosthesis (4) The tumor recurrencerates, Enneking limb function, VAS visual pain score and postoperative complications,are contribute to evaluate effectiveness of surgical methods.