Giant Cell Tumours of Bone-current Padigrams in Management

Abstract

Giant cell tumours (GCT) are benign to aggressive lesions which are frequently encountered in orthopaedic practice. Last two decades have envisaged technical advances in surgical management of GCTs with introduction of new techniques and improvising of the existing techniques. There is a universal consensus in favour of extended curettage with or without adjuvants even in recurrent cases. Current evidence suggests that cavities <60 cm3 do not require filling and those with <5 mm of subchondral bone are well managed with sandwich technique. Elucidation of pathway of pathogenesis of GCT and involvement of OPG-RANK-RANKL pathway has led to the introduction of newer molecular therapies of GCT in the form of denusomab and interferons. Bisphosphonates inhibit the osteoclastic activity and they have been found to have a beneficial effect on tumour size and recurrence rate. Tumour cells express calcitonin receptors, with this idea calcitonin is being tried though it is yet to taste any success. Radiotherapy should be used if it is anticipated that surgery would result in significant functional morbidity and at sites where recurrence rate is high and there is potential for significant morbidity. This editorial deals with the current padigrams in management of GCT.