Simple Summary Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a rare disease that can be located on the knee joints'anterior and posterior sides. Surgery approaching both sides of the knee... Show moreSimple Summary Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a rare disease that can be located on the knee joints'anterior and posterior sides. Surgery approaching both sides of the knee is often performed to remove the tumor. However, there is no consensus on whether surgery on both sides should be performed during one procedure or in two separate interventions. In this retrospective, cohort study, 191 patients were included from nine sarcoma centers worldwide. The goal was to compare the short-term postoperative outcomes of two-sided surgeries for D-TGCTs of the knee, performed in either one or two stages. Surgery on the knee's anterior and posterior sides performed in one stage did not result in impaired rehabilitation compared to two-stage surgery. Additionally, patients undergoing surgery in one stage had a shorter hospital stay and no more complications. Diffuse-type tenosynovial giant cell tumors' (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion 123-120 degrees, p = 0.109; extension 0 degrees, p = 0.093). Patients undergoing two-stage synovectomies stayed longer in the hospital (6 vs. 4 days, p < 0.0001). Complications occurred more often after two-stage synovectomies, although this was not statistically different (36% vs. 24%, p = 0.095). Patients treated with two-stage synovectomies exhibited more radiological progression and required subsequent treatments more often than patients treated with one-stage synovectomies (52% vs. 37%, p = 0.036) (54% vs. 34%, p = 0.007). In conclusion, D-TGCT of the knee requiring two-side synovectomies should be treated by one-stage synovectomies if feasible, since patients achieve a similar range of motion, do not have more complications, but stay for a shorter time in the hospital. Show less
Bernthal, N.M.; Healey, J.H.; Palmerini, E.; Bauer, S.; Schreuder, H.; Leithner, A.; ... ; Sande, M. van de 2022
Background and Objectives: Diffuse-tenosynovial giant cell tumor (D-TGCT) is a rare, locally aggressive, typically benign neoplasm affecting mainly large joints, representing a wide clinical... Show moreBackground and Objectives: Diffuse-tenosynovial giant cell tumor (D-TGCT) is a rare, locally aggressive, typically benign neoplasm affecting mainly large joints, representing a wide clinical spectrum. We provide a picture of the treatment journey of D-TGCT patients as a 2-year observational follow-up. Methods: The TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study at tertiary sarcoma centers spanning seven European countries and two US sites. Histologically confirmed D-TGCT patients were categorized as either those who remained on initial treatment strategy (determined at baseline visit) or those who changed treatment strategy with specific changes documented (e.g., systemic treatment to surgery) at the 1-year and/or 2-year follow-up visits. Results: A total of 176 patients were assessed, mean diagnosis age was 38.4 (SD +/- 14.6) years; most patients had a knee tumor (120/176, 68.2%). For the 2-year observation period, most patients (75.5%) remained on the baseline treatment strategy throughout, 54/79 patients (68.4%) remained no treatment, 30/45 patients (66.7%) remained systemic treatment, 39/39 patients (100%) remained surgery. Those who changed treatment strategy utilized multimodal treatment options. Conclusions: This is the first prospectively collected analysis to describe D-TGCT patient treatments over an extended follow-up and demonstrates the need for multidisciplinary teams to determine an optimal treatment strategy. Show less
