GIANT CELL TUMOUR of BONE

Helen Findlay

Clinical Nurse Specialist Orthopaedic Surgical Oncology

Aim •What is GCT?

•Assessment process

•Surgical management

•New developments

•Follow up pathway

•CNS responsibility

What is GCT? •Uncommon bone tumour

•Incidence – 25-40 age group

•Multinucleated giant cells

•Normally solitary lesion - benign with unpredictable behaviour

•Risk of recurrence

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

Clinical Presentation

•Pain •Swelling •Reduced ROM •Pathological Fracture

Diagnosis

•Imaging

– X-rays, MRI / CT

•Biopsy – CT guided

Pre Op Preparation

•Additional imaging if required for surgical planning

•Chest CT

Surgical Management •Intralesional resection

•High speed burring of tumour cavity

•Adjuvant treatment

•Internal fixation

New Developments

•Anti-RANKL therapy •Bone tumour micro-environmnent

•Clinical Trials • Bone Metastases

• Bisphosphonates & Denosumab

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

Clinical Nurse Specialist Responsibilities

•Surveillance

– independent out-patient clinic reviews

– functional outcomes with short & long term goals

– CXR surveillance

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