Tag Archive for: adjuvant

Intralesional Curettage technique for Giant cell tumor of bone – current concepts and evidence

Volume 3 | Issue 1 | May- Aug 2017 | Page 7-12 | Manish Agarwal

Authors: Manish Agarwal [1]

[1]Department of Surgical Oncology, P.D Hinduja Hospital & Medical Research Centre, Veer SavarkarMarg, Mahim, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Manish Agarwal,
P.D Hinduja Hospital & Medical Research Centre,
Veer SavarkarMarg, Mahim, Mumbai – 400 016, Maharashtra, India.
E-mail: mgagarwal@gmail.com


Intralesionalsurgery is the most favored kind of surgery for giant-cell tumors of the bone. A good surgical technique helps minimize the risk of local recurrence. A good exposure followed by meticulous curetting aided by a high-speed burr is the backbone of this surgery. The role of chemical and thermal adjuvants is discussed with the evidence. The best way to reconstruct the cavity after curettage has been hotly debated. This article discusses the role of bone, cement, as well as a combination “sandwich” technique.
Keywords: Intralesional surgery, curettage, giant-cell tumor, adjuvant, “sandwich” reconstruction.


1. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res. 1995 Dec (321):245–50.
2. Malawer MM, Dunham W. Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop Relat Res [Internet]. 1991 Jan ;(262):42–57.
3. Blackley HR, Wunder JS, Davis a M, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am. 1999;81(6):811–20.
4. Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am [Internet]. 1970 Jun [cited 2016 Apr 10];52(4):619–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/5479455
5. Ward WG, Li G. Customized Treatment Algorithm for Giant Cell Tumor of Bone : 2002;(397):259–70.
6. Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK. Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res. 1998;1998(347):250–60.
7. Salai M, Rahamimov N. Prevention of recurrent giant-cell tumors of long bones a new surgical technique. J Surg Oncol. 1999;72(1):37–8.
8. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri B a, et al. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002;(397):248–58.
9. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, And MD~, Huvos AG. Cryosurgery in the treatment of giant cell tumors of bone. A Report of 52 Consecutive Cases. Cancer 41:957-969, 1978
10. Bickels J, Kollender Y, Merimsky O, Isaakov J, Petyan-Brand R, Meller I. Closed argon-based cryoablation of bone tumours. J Bone Jt Surg [Internet]. 2004;86(5):714–8. Available from: http://www.bjj.boneandjoint.org.uk/cgi/doi/10.1302/0301-620X.86B5.14416
11. Meller I, Weinbroum A, Bickels J, Dadia S, Nirkin A, Merimsky O, et al. Fifteen years of bone tumor cryosurgery: A single-center experience of 440 procedures and long-term follow-up. Eur J Surg Oncol. 2008;34(8):921–7.
12. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. A long-term followup study. Clin Orthop Relat Res. 1999;1999(359):176–88.
13. Veth R, Schreuder B, van Beem H, Pruszczynski M, de Rooy J. Cryosurgery in aggressive, benign, and low-grade malignant bone tumours. Lancet Oncol. 2005;6(1):25–34.
14. Quint U, Vanhöfer U, Harstrick a, Müller RT. Cytotoxicity of phenol to musculoskeletal tumours. J Bone Joint Surg Br. 1996;78(6):984–5.
15. Quint U, Müller RT, G M. Characteristics of phenol. Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma. Arch Orthop Trauma Surg. 1998;117(1–2):43–6.
16. Toy PC, Heck RK.. General Principles of tumors. In: Campbells operative orthopaedics. 2012. Ch. 24. Canale ST, Beaty JH, editors. St. Louis: Elsevier Health Sciences; 2012.
17. Nithyananth M, Priscilla AJ, Boopalan P, Titus V, Lee VN. Time required for effective action of phenol against giant cell tumour cells. J Orthop Surg. 2014;22(1):104–7.
18. Schiller C, Ritschl P, Windhager R, Kropej D, Kotz R. [The incidence of recurrence in phenol treated and non-phenol treated bone cavities following intralesional resection of non-malignant bone tumors]. Z Orthop Ihre Grenzgeb [Internet]. [cited 2016 Aug 1];127(4):398–401. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2815940
19. Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ. Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res. 2005;438(438):123–7.
20. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Phenol (Update). 2008.
21. Teixeira LEM, Miranda RH, Druda OL, Azevedo Neto JG, Rajão GDS. Isolated cauterization as an adjuvant in the treatment of benign bone tumors. Acta Ortop Bras. [online]. 2011; 19(4):198-201. Available from URL: http://www.scielo.br/aob.
22. Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S. Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res. 2004;(424):221–6.
23. Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res [Internet]. 2006;453(453):328–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16936591
24. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: Treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 2008;134(9):969–78.
25. Lewis VO, Wei A, Mendoza T, Primus F, Peabody T, Simon M a. Argon beam coagulation as an adjuvant for local control of giant cell tumor. Clin Orthop Relat Res. 2007;454(454):192–7.
26. Ofluoglu O. Aggressive treatment of giant cell tumour with multiple local adjuvants. Acta Orthop Belg. 2008;74:831–6.
27. Benevenia J, Patterson FR, Beebe KS, Abdelshahed MM, Uglialoro AD. Comparison of phenol and argon beam coagulation as adjuvant therapies in the treatment of stage 2 and 3 benign-aggressive bone tumors. Orthopedics [Internet]. 2012;35(3):e371-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22385449
28. Algawahmed H, Turcotte R, Farrokhyar F, Ghert M. High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis. Hindawi Publishing Corporation Sarcoma; 2010;586090(5).
29. Frassica FJ, Gorski JP, Pritchard DJ, Sim FH, Chao EY. A comparative analysis of subchondral replacement with polymethylmethacrylate or autogenous bone grafts in dogs [Internet]. Clin Orthop Relat Res. 1993. p. 378–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8339507
30. Von Steyern F V., Kristiansson I, Jonsson K, Mannfolk P, Heinegard D, Rydholm A. Giant-cell tumour of the knee: The condition of the cartilage after treatment by curettage and cementing. J Bone Jt Surg – Br Vol . 2007;89–B(3):361–5.
31. Tejwani SG, Hame SL, Eckardt JJ. Subchondral giant-cell tumor of the proximal tibia: Arthroscopic treatment for accelerated articular cartilage and meniscal degeneration in two patients. Arthrosc – J Arthrosc Relat Surg. 2004;20(6):644–9.
32. Chen TH, Su YP, Chen WM. Giant cell tumors of the knee: Subchondral bone integrity affects the outcome. Int Orthop. 2005;29(1):30–4.
33. Buecker PJ, Gebhardt MC. Are Fibula Strut Allografts a Reliable Alternative for Periarticular Reconstruction after Curettage for Bone Tumors? Clin Orthop Relat Res [Internet]. 2007;461(Aug):170–4.

How to Cite this article:  Agarwal M. Intralesional Curettage Technique for Giant-cell Tumor of Bone – Current Concepts and Evidence. Journal of Bone and Soft Tissue Tumors May-Aug 2017;3(1): 7-12.

  (Abstract    Full Text HTML)      (Download PDF)