Treatment of stages 2 and 3 giant-cell tumor.

During the period from August 1986 to August 1992, we treated 23 patients with giant cell tumors stage 2 or 3, according to the classification by Campanacci et al.. We analyzed the therapeutic options, complications, local recurrence rate, and functional results after a mean follow-up of 56 months (range 31-89 months). Intralesional resections were performed in 15 and wide resections in 8 patients. The majority of intralesional resections were performed for stage 2 tumors and the majority of en-bloc resections for stage 3 tumors. The overall local recurrence rate was 8.7%, but we observed local recurrence only in intralesional resections. Our experiences suggest that a subtle surgical technique with respect to oncological requirements is the most important element in the avoidance of local recurrence. Stage 2 tumors associated with weight-bearing anatomical structures should be treated with intralesional curettage and bone cement. Stage 3 tumors are limited as to their surgical options and are determined in some cases by their localization and the degree of bone destruction. Wide resections should be reserved mainly for stage 3 tumors.