giant cell tumour of bone - anzona•szendroi m 2004 giant cell tumour of bone jbjs (br) vol 86b no...
TRANSCRIPT
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