Management of giant cell tumor of the distal end radius: extended curettage and adjuvant therapy versus wide resection and reconstruction: a systematic review and meta-analysis

Background
Giant cell tumors (GCTs) in the distal end of the radius present unique challenges in balancing oncological clearance with preserving functional capabilities. This study aims to provide a comprehensive comparison between extended curettage with adjuvants and wide resection with reconstruction for GTCs of the distal radius, addressing outcomes such as recurrence rates, functional scores, and complications.
Patients and methods
A systematic review of the literature was conducted, involving databases such as MEDLINE, Cochrane library, and PubMed. Inclusion criteria comprised comparative cohort studies in English, comparing extended curettage with adjuvants versus wide resection with reconstruction in patients with GCTs of the distal end radius. Outcome measures included functional outcomes (Musculoskeletal Tumor Society, disabilities of the arm, shoulder, and hand), recurrence, metastasis, postoperative complications, and quality of life.
Results
The literature search identified 17 retrospective comparative cohort studies that met the inclusion criteria. The studies included 527 procedures, with an average participant age of 33.49 years and a mean follow-up of 7.1 years. The pooled estimate showed a significantly lower recurrence rate with wide resection (7.7%) compared with extended curettage with adjuvants (28.4%). Functional outcomes favored extended curettage in terms of visual analog scale pain scale and disabilities of the arm, shoulder, and hand score, with no significant difference in range of motion but higher grip strength in the curettage group. Complication rates were higher with wide resection.
Conclusion
While extended curettage with adjuvants may pose a higher risk of recurrence, it demonstrates promise for improved functional outcomes. The study suggests that extended curettage leads to reduced pain and disability scores compared with wide resection, with a higher grip strength. The findings contribute to the ongoing discussion on the optimal management of GCTs in the distal radius, highlighting the importance of balancing oncological considerations with functional outcomes. However, study limitations, including retrospective designs and potential selection bias, should be considered in interpreting the results.