Does initial surgical treatment influence the management of recurrent giant cell tumor of bone?

Purpose: The optimal management of recurrent giant cell tumor of bone (GCTB) remains controversial, particularly regarding the choice between repeat intralesional surgery and wide resection. This study aimed to analyze the effects of tumor localization, demographic factors, and surgical strategies on secondary recurrence in patients treated for recurrent GCTB. Methods: A retrospective review was conducted on 45 patients surgically treated for recurrent GCTB between 2005 and 2020. Thirteen patients were excluded due to insufficient follow-up or incomplete radiological data, leaving 32 patients eligible for analysis. Data regarding patient demographics, tumor characteristics, primary treatment center, surgical method for recurrence, neoadjuvant denosumab use, and oncologic outcomes were collected. Recurrence-free survival (RFS) was evaluated using Kaplan–Meier analysis, and factors affecting secondary recurrence were assessed using univariate statistics. Results: The mean age at recurrence surgery was 32.7 ± 9.7 years, with a mean follow-up of 87.5 months. Secondary recurrence occurred in 11 patients (34.4%) at a mean interval of 23.8 months. The secondary recurrence rate was higher in the repeat intralesional curettage group (38%) compared with the wide resection group (16%). Extracompartmental extension was significantly associated with recurrence (36% vs. 23%). Secondary recurrence developed in 28% of patients who received neoadjuvant denosumab and in 36% of those who did not. Pulmonary metastases occurred in 15.6% of cases. The 2-year and 5-year RFS rates were 84% and 72%, respectively, and the mean MSTS functional score was 25.6 (85.3%). Conclusion: Wide resection offers superior local control in recurrent GCTB compared with repeat curettage; however, extended curettage with adjuvants remains a viable joint-preserving option in selected cases. Extracompartmental extension and distal radius localization were associated with an increased risk of re-recurrence. Initial treatment quality and surgeon experience appear to influence oncologic outcomes, supporting early referral to specialized musculoskeletal oncology centers. Long-term follow-up is essential due to the risk of recurrence and pulmonary metastasis.