Unraveling the mystery: A comprehensive review of multidisciplinary strategies for managing giant cell tumor of the bone

Abstract

This review article provides a comprehensive overview of the multidisciplinary management of giant cell tumors of the bone (GCTB). GCTB is a rare, intermediate-grade, benign, locally aggressive osteolytic neoplasm that primarily affects the epiphyses of long bones in individuals aged 20–45, with a female predominance. The article discusses the epidemiology, clinical features, and various management approaches for GCTB.The article highlights the importance of GCTB, which can resemble other bone lesions, so an accurate diagnosis is essential. A biopsy is a definitive way to diagnose GCTB. While, radiography includes MRI, PET scans, and bone scans to help diagnose and stage GCTB. The Campanacci grading system, based on radiographic appearance and soft tissue involvement, is commonly used to stage GCTB.Surgical management options for GCTB include intralesional curettage, wide marginal resection, and en-bloc resection, depending on the location and extent of the tumor. In challenging anatomical locations, such as the axial skeleton, intralesional curettage may be the only viable option to preserve function and minimize surgical morbidity. However, it is associated with a high rate of local recurrence. Wide marginal resection is effective in reducing recurrence rates but may result in significant morbidity and require bone defect reconstruction. En-bloc resection is preferred for tumors with soft tissue extension or involvement of expendable bones.In cases where complete surgical resection is not feasible or carries a high risk of morbidity, alternative treatment options such as radiation therapy, arterial embolization, and systemic therapy with bisphosphonates (zoledronic acid) and denosumab are valuable tools in achieving disease control and improving patient outcomes. Radiotherapy is employed for cases where the disease has recurred locally and cannot be removed surgically. Arterial embolization involves interrupting the blood supply to tumors in areas that cannot be operated on. Bisphosphonates are drugs that can be given before or after surgery to reduce the chances of recurrence by inhibiting osteoclast activity.Denosumab, a monoclonal antibody that targets RANKL, has shown promising results in reducing tumor size, facilitating surgical treatment, and improving outcomes. In conclusion, this review provides valuable insights into the epidemiology, clinical features, and multidisciplinary management approaches for GCTB. Accurate diagnosis, appropriate staging, and individualized treatment strategies are essential for optimizing patient outcomes in GCTB management.