Giant Cell Tumors of the Tibia: Treatment Options and Recurrence Risks

Tibial tumor

Dr.
Shih: Hello, Dr.
Shih! I have developed a tumor on my proximal tibia.
In October, I underwent surgery with Professor Yang Rong-Sen at National Taiwan University Hospital.
My tumor is a benign giant cell tumor of bone.
Dr.
Yang recommended that I start treatment with denosumab as soon as possible after the surgery.
However, on October 30, the oncologist informed me that there is a 50% chance of recurrence after the injection, and it would cost NT$100,000 out of pocket.
Therefore, we decided not to proceed with the injection at that time.
On December 14, an X-ray revealed that the tumor had recurred, increasing by 0.3 cm along the bone cement.
On December 16, I consulted the oncologist again, and he stated that I would need a second surgery.
However, to ensure complete removal, my left proximal tibia would need to be excised, and if I choose to receive the injection, it would be a lifelong treatment.

1.
Dr.
Shih, do you think I must receive denosumab, or are there other treatment options available? What methods would you recommend to prevent the proliferation of giant cell tumors? What should I do? Thank you, doctor.

Jia Yu, 20~29 year old female. Ask Date: 2020/12/18

Dr. Shi Guozheng reply Orthopedics

Dr.
Yang is an expert in bone tumors in Taiwan, so it is advisable to consider his opinion.
He has extensive experience in treating this type of tumor.
It is important to have a thorough discussion with him before deciding on the treatment approach.

Reply Date: 2020/12/18

More Info

Giant cell tumors of the bone, particularly those located in the tibia, are a unique type of benign tumor that can exhibit aggressive behavior, particularly in terms of recurrence. These tumors are characterized by the presence of multinucleated giant cells and are most commonly found in young adults. While they are classified as benign, they can cause significant local destruction and have a notable tendency to recur after treatment.

Treatment Options
The primary treatment for giant cell tumors is surgical intervention. The goal of surgery is to remove the tumor completely while preserving as much surrounding healthy bone as possible. This is often achieved through curettage, where the tumor is scraped out, followed by the application of a bone graft or bone cement to fill the defect left behind. In some cases, more extensive procedures, such as resection of the affected bone, may be necessary, especially if the tumor is large or has recurred.

In addition to surgical options, adjuvant therapies may be considered to reduce the risk of recurrence. One such treatment is the use of bisphosphonates, like denosumab (often referred to as "cancer bone cement" in your context), which can help inhibit the activity of the osteoclasts (the cells that break down bone) and may reduce the likelihood of recurrence. However, as you mentioned, this treatment can be costly and may require long-term administration.

Recurrence Risks
The recurrence rate for giant cell tumors can vary significantly based on several factors, including the completeness of the surgical excision and the tumor's location. Studies suggest that the recurrence rate can be as high as 20-50% after curettage alone, particularly if the tumor is not completely removed. The use of adjuvant therapies, such as denosumab, has been shown to reduce recurrence rates, but the decision to use such treatments should be made in consultation with your healthcare provider, considering the potential benefits and costs.

Considerations Moving Forward
Given your situation, where the tumor has recurred after initial surgery, it is crucial to have a thorough discussion with your orthopedic oncologist about the best course of action. Here are some points to consider:
1. Surgical Options: If the tumor has recurred, a second surgery may be necessary. Your doctor may recommend a more aggressive approach, such as resection of the affected bone, especially if the tumor is causing pain or functional impairment.

2. Adjuvant Therapy: Discuss the potential benefits and drawbacks of using denosumab or other adjuvant therapies. While it may seem daunting to consider lifelong treatment, it could significantly reduce the risk of recurrence.

3. Monitoring: Regular follow-up with imaging studies (like X-rays or MRIs) is essential to monitor for any signs of recurrence. Early detection of recurrence can lead to more effective management.

4. Lifestyle and Support: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can support your overall health and recovery. Additionally, consider seeking support from patient advocacy groups or counseling services to help navigate the emotional aspects of dealing with a tumor diagnosis and treatment.

In conclusion, while giant cell tumors of the tibia are typically benign, their potential for recurrence necessitates a proactive approach to treatment and monitoring. Engaging in open discussions with your healthcare team about the risks and benefits of various treatment options will empower you to make informed decisions about your care.

Similar Q&A

Understanding PVNS: Treatment Options and Risks for Knee Recurrence

Hello Doctor: I have undergone MRI scans at China Medical University in Taichung and Taipei Veterans General Hospital, both confirming a diagnosis of pigmented villonodular synovitis (PVNS). Previously, I had an arthroscopy performed at China Medical University, followed by debri...

Dr. Shi Guozheng reply Orthopedics
1. PVNS often recurs; it has been over six months since the surgery in October, and it should still be manageable unless the symptoms are severe and affect function. 2. If the articular cartilage is ultimately damaged, there is a higher likelihood of needing knee arthroplasty co...

Understanding Giant Cell Tumors on the Spine: Risks, Treatments, and Surgical Options

After undergoing an MRI and biopsy, I was diagnosed with a giant cell tumor at the lumbar spine L3. Currently, my symptoms include occasional weakness in my legs, along with soreness in my lower back, thighs, and near the anal area. These symptoms are not constant; they vary, oft...

Dr. Chen Bochen reply Orthopedics
First, an incision will be made on the side to remove the tumor and perform spinal reconstruction, followed by another incision in the back to insert screws. This is the standard procedure. The surgeons who operate on the spine and those who specialize in bone tumors are usually ...

Understanding Tenosynovial Giant Cell Tumor: Surgery, Recurrence, and Costs

Hello, Doctor. I would like to inquire about the surgical approach for giant cell tumor of the tendon sheath. Is there a possibility of recurrence after the surgery? Additionally, could you please provide an estimate of the surgical costs?

Dr. You Dianqi reply Orthopedics
Hello, I recommend that you first visit an orthopedic specialist. After the outpatient physician evaluates your condition, we can discuss treatment options and other details. Thank you.

Understanding Tibial Tumor Surgery: Risks, Recovery, and Rehabilitation

Hello: I recently confirmed that I have a tumor on my tibia and I am scheduled for surgery. However, I am unsure about any potential complications or side effects. Will I need another surgery to remove the bone graft? Will I need to undergo rehabilitation? Are there any foods I s...

Dr. Xu Xijing reply Orthopedics
Please visit the outpatient clinic for a consultation.