As reviewed by Robert Turcotte in the referenced article, the most common locations for giant cell tumor of bone to occur are about the distal femur/proximal tibia, distal radius, and the sacrum. The spine is an uncommon location for giant cell tumors, and when they occur, they usually occur in the vertebral body, not the posterior elements. In the axial skeleton, the sacrum is a common location for giant cell tumor of bone. Outside of the sacrum, giant cell tumor of bone is characteristically an epiphyseal/metaphyseal lesion. As discussed in the in vitro study by Gortzak et al, treatment of giant cell tumor of bone includes aggressive intralesional curettage augmented with adjuvant treatment like hydrogen peroxide, argon beam, liquid nitrogen, or phenol. Due to the morbidity of the surgical treatment, and the less than perfect long term outcome, adjuvant therapy with an antibody against RANKL called denosumab is currently being investigated in multiple centers across North America as described by Thomas et al in their phase 2 study. Denosumab inhibits osteoclast mediated osteolysis and treatment is associated with improved bone stock and sclerosis of the GCT lesions. While denosumab doesn't obviate the need for surgical excision, the resulting surgical procedure is less extensive and early data may suggest a decreased risk of local recurrence. While giant cell tumor of bone is a benign condition, there is a small chance for pulmonary seeding of giant cell metastases. This occurs in somewhere between 2-5% of patients with primary giant cells and occurs more often in patients with recurrent disease.
Unni, KK: Giant Cell Tumor Chapter ; Dahlin’s Bone Tumor, 1996
Gortzak Y, Kandel R, Deheshi B, Werier J, Turcotte RE, Ferguson PC, Wunder JS. The efficacy of chemical adjuvants on giant-cell tumour of bone. An in vitro study. J Bone Joint Surg Br. 2010 Oct;92(10):1475-9.
PMID:21089702 (Link to Abstract)
Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am. 2006
PMID:16311110 (Link to Abstract)
Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon A, Blay JY, Roudier M, Smith J, Ye Z, Sohn W, Dansey R, Jun S. Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol. 2010 Mar;11(3):275-80.
PMID:20149736 (Link to Abstract)