Surgical Management of 144 Diffuse-type TGCT Patients in a Single Institution: A 20-year Cohort Study

Overview

Journal J Surg Oncol

Specialties General Surgery
Oncology

Date 2022 Jun 23

PMID 35736790

Authors

Geert Spierenburg

Lizz Van der Heijden

Monique J L Mastboom

Kirsten van Langevelde

Robert J P van der Wal

Hans Gelderblom

Michiel A J van de Sande

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Surgery is the mainstay of treatment for tenosynovial giant cell tumors (TGCTs). However, achieving a cure through surgery alone remains challenging, especially for the diffuse-type (D-TGCT).

Methods: Our goal was to describe the surgical management of patients with D-TGCT related to large joints, treated between 2000 and 2020. We analyzed the effect of (in)complete resections and the presence of postoperative tumor (POT) on magnetic resonance imaging (MRI) on radiological and clinical outcomes.

Results: A total of 144 patients underwent open surgery for D-TGCT, of which 58 (40%) had treatment before. The median follow-up was 65 months. One hundred twenty-five patients underwent isolated open surgeries, in which 25 (20%) patients' D-TGCT was intentionally removed incompletely. POT presence on the first postoperative MRI was observed in 64%. Both incomplete resections and POT presence were associated with higher rates of radiological progression (73% vs. 44%; Kaplan-Meier [KM] analysis p = 0.021) and 59% versus 7%; KM analysis p < 0.001), respectively. Furthermore, patients with POT presence clinically worsened more often than patients without having POT (49% vs. 24%; KM analysis p = 0.003).

Conclusions: D-TGCT is often resected incompletely and tumor presence is commonly observed on the first postoperative MRI, resulting in worse radiological and clinical outcomes. Therefore, surgeons should try to remove D-TGCT in toto and consider other multimodal therapeutic strategies.

Citing Articles

Diffuse-Type Tenosynovial Giant Cell Tumor: What Are the Important Findings on the Initial and Follow-Up MRI?.

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One-Stage Synovectomies Result in Improved Short-Term Outcomes Compared to Two-Stage Synovectomies of Diffuse-Type Tenosynovial Giant Cell Tumor (D-TGCT) of the Knee: A Multicenter, Retrospective, Cohort Study.

Spierenburg G, Verspoor F, Wunder J, Griffin A, Ferguson P, Houdek M Cancers (Basel). 2023; 15(3).

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MRI of diffuse-type tenosynovial giant cell tumour in the knee: a guide for diagnosis and treatment response assessment.

Spierenburg G, Suevos Ballesteros C, Stoel B, Navas Canete A, Gelderblom H, van de Sande M Insights Imaging. 2023; 14(1):22.

PMID: 36725759 PMC: 9892412. DOI: 10.1186/s13244-023-01367-z.

Surgical management of 144 diffuse-type TGCT patients in a single institution: A 20-year cohort study.

Spierenburg G, Van der Heijden L, Mastboom M, van Langevelde K, van der Wal R, Gelderblom H J Surg Oncol. 2022; 126(6):1087-1095.

PMID: 35736790 PMC: 9796668. DOI: 10.1002/jso.26991.

References

Mastboom M, Staals E, Verspoor F, Rueten-Budde A, Stacchiotti S, Palmerini E . Surgical Treatment of Localized-Type Tenosynovial Giant Cell Tumors of Large Joints: A Study Based on a Multicenter-Pooled Database of 31 International Sarcoma Centers. J Bone Joint Surg Am. 2019; 101(14):1309-1318. DOI: 10.2106/JBJS.18.01147. View

Gelderblom H, Cropet C, Chevreau C, Boyle R, Tattersall M, Stacchiotti S . Nilotinib in locally advanced pigmented villonodular synovitis: a multicentre, open-label, single-arm, phase 2 trial. Lancet Oncol. 2018; 19(5):639-648. DOI: 10.1016/S1470-2045(18)30143-8. View

Mollon B, Lee A, Busse J, Griffin A, Ferguson P, Wunder J . The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Joint J. 2015; 97-B(4):550-7. DOI: 10.1302/0301-620X.97B4.34907. View

Bernthal N, Spierenburg G, Healey J, Palmerini E, Bauer S, Gelderblom H . The diffuse-type tenosynovial giant cell tumor (dt-TGCT) patient journey: a prospective multicenter study. Orphanet J Rare Dis. 2021; 16(1):191. PMC: 8086070. DOI: 10.1186/s13023-021-01820-6. View

Mastboom M, Verspoor F, Hanff D, Gademan M, Dijkstra P, Schreuder H . Severity classification of Tenosynovial Giant Cell Tumours on MR imaging. Surg Oncol. 2018; 27(3):544-550. DOI: 10.1016/j.suronc.2018.07.002. View

Palmerini E, Staals E, Maki R, Pengo S, Cioffi A, Gambarotti M . Tenosynovial giant cell tumour/pigmented villonodular synovitis: outcome of 294 patients before the era of kinase inhibitors. Eur J Cancer. 2014; 51(2):210-7. DOI: 10.1016/j.ejca.2014.11.001. View

Patel K, Gikas P, Pollock R, Carrington R, Cannon S, Skinner J . Pigmented villonodular synovitis of the knee: A retrospective analysis of 214 cases at a UK tertiary referral centre. Knee. 2017; 24(4):808-815. DOI: 10.1016/j.knee.2017.03.011. View

Cassier P, Italiano A, Gomez-Roca C, Le Tourneau C, Toulmonde M, Cannarile M . CSF1R inhibition with emactuzumab in locally advanced diffuse-type tenosynovial giant cell tumours of the soft tissue: a dose-escalation and dose-expansion phase 1 study. Lancet Oncol. 2015; 16(8):949-56. DOI: 10.1016/S1470-2045(15)00132-1. View

Ho J, Peters T, Dickson B, Swanson D, Fernandez A, Frova-Seguin A . Detection of CSF1 rearrangements deleting the 3' UTR in tenosynovial giant cell tumors. Genes Chromosomes Cancer. 2019; 59(2):96-105. DOI: 10.1002/gcc.22807. View

10.

Chandra A, Agarwal S, Donahue A, Handorf E, Abraham J . Arthroscopic Versus Open Management of Diffuse-Type Tenosynovial Giant Cell Tumor of the Knee: A Meta-analysis of Retrospective Cohort Studies. J Am Acad Orthop Surg Glob Res Rev. 2021; 4(12). PMC: 8667987. DOI: 10.5435/JAAOSGlobal-D-21-00217. View

11.

Verspoor F, Mastboom M, Hannink G, van der Graaf W, van de Sande M, Schreuder H . The effect of surgery in tenosynovial giant cell tumours as measured by patient-reported outcomes on quality of life and joint function. Bone Joint J. 2019; 101-B(3):272-280. DOI: 10.1302/0301-620X.101B3.BJJ-2018-0804.R1. View

12.

Barile A, Sabatini M, Iannessi F, Di Cesare E, Splendiani A, Calvisi V . Pigmented villonodular synovitis (PVNS) of the knee joint: magnetic resonance imaging (MRI) using standard and dynamic paramagnetic contrast media. Report of 52 cases surgically and histologically controlled. Radiol Med. 2004; 107(4):356-66. View

13.

Staals E, Ferrari S, Donati D, Palmerini E . Diffuse-type tenosynovial giant cell tumour: Current treatment concepts and future perspectives. Eur J Cancer. 2016; 63:34-40. DOI: 10.1016/j.ejca.2016.04.022. View

14.

Mastboom M, Palmerini E, Verspoor F, Rueten-Budde A, Stacchiotti S, Staals E . Surgical outcomes of patients with diffuse-type tenosynovial giant-cell tumours: an international, retrospective, cohort study. Lancet Oncol. 2019; 20(6):877-886. DOI: 10.1016/S1470-2045(19)30100-7. View

15.

Healey J, Bernthal N, van de Sande M . Management of Tenosynovial Giant Cell Tumor: A Neoplastic and Inflammatory Disease. J Am Acad Orthop Surg Glob Res Rev. 2020; 4(11):e20.00028. PMC: 7643913. DOI: 10.5435/JAAOSGlobal-D-20-00028. View

16.

Ushijima M, Hashimoto H, Tsuneyoshi M, Enjoji M . Giant cell tumor of the tendon sheath (nodular tenosynovitis). A study of 207 cases to compare the large joint group with the common digit group. Cancer. 1986; 57(4):875-84. DOI: 10.1002/1097-0142(19860215)57:4<875::aid-cncr2820570432>3.0.co;2-y. View

17.

Tap W . ENLIVEN study: Pexidartinib for tenosynovial giant cell tumor (TGCT). Future Oncol. 2020; 16(25):1875-1878. DOI: 10.2217/fon-2020-0307. View

18.

Verspoor F, Mastboom M, Hannink G, Maki R, Wagner A, Bompas E . Long-term efficacy of imatinib mesylate in patients with advanced Tenosynovial Giant Cell Tumor. Sci Rep. 2019; 9(1):14551. PMC: 6786996. DOI: 10.1038/s41598-019-51211-y. View

19.

Spierenburg G, Van der Heijden L, van Langevelde K, Szuhai K, Bovee J, van de Sande M . Tenosynovial giant cell tumors (TGCT): molecular biology, drug targets and non-surgical pharmacological approaches. Expert Opin Ther Targets. 2022; 26(4):333-345. DOI: 10.1080/14728222.2022.2067040. View

20.

Blay J, Honore C, Stoeckle E, Meeus P, Jafari M, Gouin F . Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol. 2019; 30(7):1143-1153. PMC: 6637376. DOI: 10.1093/annonc/mdz124. View