Radiation Oncology/Giant cell tumor of bone

Giant Cell Tumor of Bone

Overview

• Presents as an expanding lytic lesion with minimal bone reaction
• Metastases are rare
• Surgery is the mainstay of treatment
• RT is used as an alternative to surgery in inoperable patients (medically inoperable or unresectable location)

Radiotherapy

• Warsaw, Poland; 2010 (1985-2007) PMID 20004531 -- "The megavoltage radiation therapy in treatment of patients with advanced or difficult giant cell tumors of bone." (Ruka W, Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):494-8.)
  • Retrospective. Of 122 pts with GCTB, 77 (63%) were treated with RT; 56 - primary treatment, 21 - recurrence after previous surgery. Femur and tibia most common locations. Median 56 Gy (1.8-2 Gy/fx). Field: 3 cm longitudinal margin and 1 cm axial margin.
  • Median f/u 5 yrs. LC 84%. 12 pts with local progression, all in-field; 9 treated with successful salvage surgery (7 with amputation). PFS 83% 5 yr, 73% 10 yr. Median time to progression 27 months. Axial location of tumor unfavorable. 5-yr LPFS 70.5% (axial skeleton) vs 88% (peripheral). 3 pts developed lung metastases. Malignant transformation in 2 pts.

• MDACC; 2003 (1956-2000) PMID 12909228 -- "Radiotherapy in the management of giant cell tumor of bone." (Caudell JJ, Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):158-65.)
  • Retrospective. 25 pts treated with RT; 13 - primary treatment, 12 - recurrence after previous surgery. In 14, RT was used for treatment of gross disease, and in 11 RT was adjuvant after gross total resection (10 with positive margins). Median dose 46 Gy.
  • Median f/u 8.8 yrs. 10 pts with local recurrence (7 isolated LR, 3 LR+DM); DM in 5 (3 LR+DM; 2 DM alone). 5-yr OS 91%, DFS 58%. 5-yr LC 62%, distant met-free survival 81%.

• India; 1999 (1983-93) PMID 10192357 -- "Radiation therapy in the treatment of giant cell tumor of bone." (Nair MK, Int J Radiat Oncol Biol Phys. 1999 Mar 15;43(5):1065-9.)
  • Retrospective. 20 pts treated with RT; 14 - primary treatment, 6 - recurrence after surgery. RT dose range: 40 Gy (in 15-20 fx) to 60 Gy (in 30 fx).
  • Median f/u 4 yrs. LC in 18 of 20 pts.
  • Conclusion: RT effective at producing local control.