骨骼巨大細胞瘤

Giant Cell Tumor of Bone

10.6200/TCMJ.2015.12.2.04

林聖傑(Sheng-Chieh Lin)；傅紹懷(Shau-Huai Fu)；張宗訓(Chung-Hsun Chang)；吳凱文(Karl Wu)；楊榮森(Rong-Sen Yang)

骨性巨大細胞瘤 ； 局部刮除 ； 癌骨瓦 ； giant cell tumor of bone ； curettage ； anti-RANKL antibody

北市醫學雜誌

12卷2期（2015 / 06 / 30）

22 - 32

繁體中文

骨骼巨大細胞瘤（giant cell tumor of bone），好發於20至40歲之間，且最常見於膝關節周邊，包含遠端股骨及脛骨上端，它是一個相當常見的良性骨腫瘤，但同時也具有局部的侵犯性及高復發率的特性。少數病人可能有惡性化、甚至肺部轉移的可能性。目前的治療趨勢為手術，於腫瘤處進行局部刮除（curettage）、輔助性療法（酒精燒灼），最後再加上骨水泥（bone cement, polymethyl methacrylate, PMMA）填塞空腔固定，另有使用骨移植的手術方式，包括自體骨移植、異體骨移植及人工合成骨移植等。術後使用anit-RANKL抗體藥物癌骨瓦（denosumab），經這樣連續性的治療後，可以有效地控制復發率。台大醫院，進行完整腫瘤刮除、酒精燒灼輔助、在合併骨水泥填塞，並於門診注射癌骨瓦，提供病人更有效的腫瘤控制。

Giant cell tumor (GCT) of bone causes disability in the third and fourth decade of life, and is most commonly found in the distal femur and proximal tibia. GCT of bone is a type of benign bone tumor quite commonly encountered by orthopedic surgeons. GCT of bone is typically locally aggressive and with possibility of local recurrence. Malignant transformation may occur in a small portion of the patients, and the lung metastasis may also occur in less than 5% of cases. Currently, GCT of bone is treated primarily with surgery. Extended intralesional curettage with or without adjuvant therapy, and polymethyl methacrylate (PMMA) cement packing within defect are the primary treatments of choice. Besides from PMMA impaction, bone grafting is another choice, and the methods include autograft, allograft, artificial bone grafting, etc. Use of anti- RANKL monoclonal antibody (denosumab) after operation has demonstrated a beneficial clinical effect to the patients. After a serial of treatments, the local recurrence is well controlled. In NTUH, we perform complete tumor curettage, adjuvant therapy, and then with PMMA augmentation for patients with GCT of bone. We also give denosumab for the patients with recurrence at out-patient clinic in order to achieve a better tumor control.