Treatment and follow-up

How does the treatment proceed?

reusceltumor in the bone is preferably treated surgically By scraping away the tumour (curettage) or the bone completely removeWhen the localisation of the tumour surgical treatment hinderingthe doctor will give you a bone-strengthening medication proposalsdenosumab named. 

At a giant cell tumour at the week parts treatment is not always necessary. The doctor will suggest you be monitored on a regular basis with ultrasound or MRI. Only when the growth is giving you symptoms or if it grows too far locally into the surrounding area and/or bone, then it is better to the surgically remove or initiate systemic treatment.  

Systemic treatment

For giant celltumours of bone: Denosumab 

If the tumour is in a place that is difficult to reach, or if the consequences of completely removing the affected bone are very great, the treatment team will suggest you to denosumab to boot. Denosumab is a RANKL inhibitor that interrupts the signals that prompt tumour cells to break down bone. It is administered by subcutaneous injections. The use of this medication strengthens the bone back on and pain reduction is expected. The effects of treatment are monitored by MRI examinations on a regular basis.  

The use of denosumab however, has a lot of side effects. Your doctor will discuss this with you.  

Since the effects of this medication on an unborn child are not known, you should not become pregnant during this treatment. 


For giant cell tumours of the weekly parts can also a recent systemic treatment be initiated, e.g. Pexidartinib. Your attending physician can explain more about the indications, side effects and expected effects. 

Surgical treatment (curettage)

If your bone is not broken and is not in the vertebral column, the surgeon will try to scrape away the growth (curettage): a hatch is first provided in the bone and then the tumour is gradually removed with several sharp spoons. A high-speed router is used to remove all the tumour's outliers from the walls and the cavity in the bone is treated with a substance (liquid nitrogen or phenol).  

To strengthen the bone, the cavity is refilled. There are two options here: inserting bone cement or from pieces (artificial) bone 

Using cement has the advantage that you can almost immediately use and lean on your limb again. It also offers the possibility of a recurring giant cell tumour more noticeable because the tumour grows around the cement and not in it. When filling with (artificial) bone, you have to be patient for several weeks to months before it has grown in. When the tumour grows back, it is more likely to grow into the (artificial) bone which is less visible. 

However, cement is not a durable solution. After one to two years, a second operation is needed to remove the cement. Once one is sure that the giant cell tumour completely disappeared, the cavity can be filled with pieces of (artificial) bone after which the bone can regenerate again. 

If a bone is affected ...

If the bone is too badly affected or broken, or if the surgeon is sure that a curettage will be insufficient, then it is sometimes better to remove this bone. 

Then there are 2 options for surgery: remove the bone without replacing it (for smaller growths in non-bearing bones) or remove it with reconstruction. 

Usually, the bone is replaced, either by another bone (biological reconstruction) or by an internal prosthesis.  

Biological reconstruction is preferred. This can be done by 'recycling' the affected bone: the affected bone is removed and treated by radiation or another sterilisation technique to kill the tumour cells. Afterwards, the treated bone is replaced and screwed back in place. This bone is then transformed by the body into new, living bone, providing a durable solution. An alternative is to use a bone from the tissue bank, sourced from a donor. These bones are extensively tested so that no diseases are transferred from the donor. 

If a joint is affected ...

then restoration of the joint is almost only possible with a prosthesis. These prostheses should not be compared to the classic prostheses placed on patients with wear and tear on these joints.

Reconstructive prostheses are much larger as a large part of the bone is replaced, not just the worn cartilage. These prostheses have a limited lifespan as they usually involve young, active patients. Prostheses with a biological fixation system are preferred, which reduces the risk of loosening. 

If the soft tissue is affected ...

If you have too many symptoms, it is better to surgically remove the tumour. The chances of a giant cell tumour of soft tissue recurrence after removal is high, up to 30% for the localised form and up to 50% for the diffuse form. If the tumour is removed open (=with an incision), it is less likely to return than if removed by keyhole surgery. 

If it is localised, the surgeon will remove the tumour with a small margin of normal tissue, but without affecting your function. That is, the surgeon will not remove essential tendons, nerves or blood vessels. If it is a diffuse form, the surgeon will remove a slightly larger margin of normal tissue, and if possible also without affecting your function. This is because this shape recurs more quickly because it is less nicely demarcated from its surroundings, and therefore needs to be treated more aggressively. In extreme cases, it is even necessary to after radiate or to systemic treatment start up to get the tumour under control. 


A particular concern is that no matter which reconstruction technique is used, the treated bone remains very sensitive to inflammations. Due to limited blood flow around the prosthesis or the botent the antibiotics may not reach the germs that settled on the prosthesis or bone, or may reach them with difficulty. In case of an uncontrollable infection, additional surgery is required and sometimes amputation is necessary in the second instance. Your doctor may recommend that you take antibiotics at the slightest sign of bacterial infection or dental treatment for the rest of your life. 


What about your functionality?

Removing part of the bone or soft tissue usually results in a more or less strong impairment of your job. Your doctor will discuss this well with you beforehand to give you a clear picture of what to expect and to avoid unrealistic expectations. Additional explanations are sometimes needed at a later date, with specialised doctors (e.g. an amputation rehabilitation doctor) or with fellow sufferers. The aim of rehabilitation is to restore your daily activities as much as possible. Sometimes it can be difficult to accept that your normal function will remain limited for life. This limitation affects your psychosocial and economic functioning. 

How does the follow-up work?

When are you cured?

If the option to wait and see was chosen, the difficult to predict when exactly you will be cured. As long as the giant cell tumour grows, you will be followed up further. The higher the growth rate of the tumour is, the more regular examinations will be scheduled.  

The likelihood of a giant cell tumour return after surgical treatment is high. Therefore, you will have to undergo an MRI at regular intervals to see in time whether the giant cell tumour develops back.  

If the giant cell tumour has not returned after a lapse of 3 to 5 years, then your doctor will declare you cured. 

What if the giant cell tumour has returned?

Your doctor will tell you what treatment options are available to you, after consulting the multidisciplinary team. Basically, the same options remain open, namely wait and see, surgical resection and possible post-surgery, or starting systemic treatment. 

How is rehabilitation going?

After an operation, you need a period of rehabilitation anticipated. The more severe the surgery, the longer usually the period of rehabilitation. It is important to follow the surgeon's guidelines carefully to avoid complications. A physiotherapist or physiotherapist can certainly guide and support you in the rehabilitation process.