Wide resection versus curettage with adjuvant therapy for giant cell tumour of bone

We read with interest the article by Kamal et al. ¹ This article claimed that the surgical options (wide resection or curettage with adjuvant therapy) for giant cell tumour of bone (GCTB) had no association with recurrence, metastasis or outcome. It is a valuable study. Nevertheless, we have several concerns need to be discussed with the authors, which are as follows:

Respective analyses of patients’ outcome in Enneking stage1, 2 and 3 are absent. Curettage with adjuvant therapy was more performed for early stage tumours, while wide resection was more for advanced tumours. ^{1 –3} So, GCTB in each stage had individual treatment option, recurrence and outcome. It would be more convincing if analysed separately.

The conclusion that metastasis was not associated with recurrence seems to be too subjective. The reason is that the sample size is too small (n = 4). A larger group of patients or multicentre study would make this conclusion more convincing.

Some of the special location of GCTB, like distal radius and proximal femur, had a higher rate of local recurrence. ⁴ In the present data, there are 16 distal radius GCTB treated with wide resection, while only one treated with curettage with adjuvant therapy. Could you explain why up to 94% patients had wide resection? If distal radius GCTB has unique clinical feature comparing with other location, we suggest respectively reanalysing the data by location as a risk factor of recurrence.