To The Editor:
We read with interest "Treatment of Giant-Cell Tumors of Long
Bones with Curettage and Bone-Grafting" (81-A: 811-820, June 1999),
by Blackley et al. Of fifty-three patients with giant-cell tumor
who were primarily treated at our clinic, forty-seven were followed
for four to forty-three years (mean, sixteen years). In forty patients
(85 percent), the tumor was located in a long bone. Fourteen (35
percent) of these forty patients were treated with curettage and
bone-grafting; twelve (30 percent), with additional adjuvant phenol
therapy; and the remaining fourteen (35 percent), with different
therapies, including en bloc resection, endoprosthesis,
cement, or other adjuvant therapy. Seven (18 percent) of the forty tumors
recurred after four to sixty months (mean, twenty-seven months),
including three of the fourteen tumors in the group treated with curettage
and bone-grafting without phenol, three of the twelve in the group
treated with phenol, and one after en bloc resection.
All patients were disease-free at the latest follow-up. No patient
had metastases or a multicentric tumor. Despite the rates of recurrence
reported in the literature, we fully agree with Blackley et al.
that the rates of local recurrence of giant-cell tumors located
in long bones treated with or without phenol are similar. The adequate
removal of the tumor seems to be a more important predictive factor
than the use of phenol as an adjuvant therapy.
Klemens Trieb, M.D.
Peter Bitzan, M.D.
Martin Dominkus, M.D.
Rainer Kotz, M.D.
Corresponding author: Klemens Trieb, M.D.
Department of Orthopaedic Surgery
University of Vienna
Währingergürtel 18-20
1090 Vienna, Austria
H. R. Blackley, J. S. Wunder, A. M. Davis, L. M. White,
R. Kandel, and R. S. Bell reply:
We read the comments of Dr. Trieb and his colleagues with great
interest. In their analysis of fifty-three patients with giant-cell
tumor, the use of phenol did not seem to reduce the risk of recurrence.
As we stated in our study, we agree that adequate removal of the
tumor rather than the use of phenol is likely to determine the risk of
recurrence of giant-cell tumor of bone.
H. R. Blackley, M.B., Ch.B., F.R.A.C.S.
J. S. Wunder, M.D., M.Sc., F.R.C.S.(C)
A. M. Davis, B.Sc., P.T., M.Sc., Ph.D.
L. M. White, M.D., F.R.C.R.(C)
R. Kandel, M.D., F.R.C.P.(C)
R. S. Bell, M.D., F.R.C.S.(C)
Corresponding author: R. S. Bell, M.D., F.R.C.S.(C)
University Musculoskeletal Oncology Unit
University of Toronto
600 University Avenue, Suite 476
Toronto, Ontario M5G 1X5, Canada