They note that TGCT can involve any joint but is most common around the knee. Complete or marginal excision is usually sufficient for local control, but refractory cases may need joint replacement or even amputation.

When patients have "extensive or multiple local relapses or when surgery alone would result in a large burden of residual disease or major functional loss, the addition of moderate-dose adjuvant radiotherapy provides excellent local control while maintaining good function with low treatment-related morbidity," Dr. Brian O'Sullivan of the University of Toronto told Reuters Health by email.

He and his colleagues had previously reported preliminary results of external-beam radiotherapy. In the current study, published online January 26 in Cancer, they update their experience with 50 patients who received radiotherapy and surgery from 1972 to 2006.

Forty-nine patients had diffuse TGCT with both intra-articular and extra-articular disease; one patient had malignant TGCT. Thirty patients had at least two operations before radiotherapy.

The mean dose of radiation delivered was 39.8 Gy. Radiation toxicities were relatively mild, according to the authors.

At a mean follow-up of almost eight years, 47 patients had stable disease or no recurrence. The three local recurrences were all in patients who received 35 Gy, but this finding was not statistically significant.

Two patients required subsequent total hip arthroplasty because of progressive osteoarthritis after treatment, and there were four cases of avascular necrosis.

Functionally, overall, seven patients were rated as excellent, 34 as good, five as fair, and four as poor.

Given these findings, the researchers conclude, "For those patients with extensive or multiple local relapses or in those for whom surgery alone would result in a large burden of residual disease or would not be possible without major functional loss, combined-modality therapy remains our treatment protocol of choice."

The researchers acknowledge that molecularly targeted agents such as imatinib can also help these patients, but they can be toxic. (See Reuters Health report of August 15, 2011.)

Dr. O'Sullivan added, "Given the excellent control rates observed with surgery and radiotherapy that can prevent significant disability such as amputation and limb dysfunction, we feel that these targeted approaches are generally applicable to situations in which surgery and radiotherapy are not feasible and permanent control of the disease is considered an implausible outcome."

By David Douglas

Source: http://bit.ly/weY3dn

Cancer 2012.

Last Updated: 2012-02-23 16:15:23 -0400 (Reuters Health)

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