Effect of Surgical Adjuvants on Recurrence of Giant Cell Tumor of Bone After Curettage: A Network Meta-Analysis

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Abstract

Effect of Surgical Adjuvants on Recurrence of Giant Cell Tumor of Bone After Curettage: A Network Meta-Analysis

Introduction:
Giant cell tumor of bone (GCTB) is a benign but locally aggressive neoplasm with local recurrence (LR) rates reaching up to 65% after curettage. Surgical adjuvants (SA) aim to reduce this risk; however, there is no consensus on which are the most effective.

Objective:
To evaluate the effectiveness of different surgical adjuvants or their combinations in reducing LR in GCTB following curettage.

Methodology:
A systematic literature review and network meta-analysis were conducted using a random-effects model. Odds ratios (OR) with 95% confidence intervals were calculated to compare LR among SAs using the MetaInsight platform.

Results:
Out of 217 articles reviewed, 24 met the inclusion criteria. Fourteen different SAs or combinations were identified. The combinations of high-speed burring (HSB) + phenol + polymethylmethacrylate (PMMA), HSB + hydrogen peroxide (H₂O₂) + PMMA, and HSB + PMMA showed a significant reduction in LR, with ORs of 0.10, 0.12, and 0.14, respectively. In contrast, the isolated use of phenol or H₂O₂ did not show significant differences compared to no adjuvant use.

Conclusions:
The combination of HSB with phenol or H₂O₂ and reconstruction with PMMA demonstrated enhanced effectiveness in reducing LR after curettage of GCTB, compared to isolated adjuvants or no adjuvants.

Key words:

Giant cell tumor of bone, adjuvants, local recurrence.