Efficacy of Hydrogen Peroxide as Adjuvant in Preventing Recurrence of Giant Cell Tumor of Bone

Vol 32 | Issue 3 | Oct-Dec 2017 | page: 17-21 | Rohan Jain, Sandeep Kumar, Anuj Gupta, Arunim Swarup, Rimjhim Shrimal.

Authors: Rohan Jain [1], Sandeep Kumar [1], Anuj Gupta [1], Arunim Swarup [1], Rimjhim Shrimal [1].

[1] Department Of Orthopedics, Subharti, Medical College, Meerut , India.

Address of Correspondence
Dr. Sandeep Kumar,
A GF 90, Ansal town, modipuram, meerut-250110 U.P.
E-mail: drbaliyan051284@gmail.com


Aim: To study the effect of hydrogen peroxide (3%) as an adjuvant in preventing local recurrence of giant cell tumor of bone.
Material & Methods: 32 cases of giant cell tumor treated during 2010 -16 were taken in this study initially. 3 cases which could not be followed for minimum of 2 years and 6 cases which were lost to follow up were excluded from study. Also cases involving spine, pelvis and other inaccessible sites were not taken. Thus the present study includes 21 cases of giant cell tumor. The age of patient varies from 18 to 45 yrs. Most patients belong to age group 20-30. Male: Female ratio was 12: 9. In our study, distal femur and distal end radius were the most commonly affected sites (n- 7) each. Lesions around knee(distal femur and proximal tibia) constitutes nearly half of cases. The commonest presenting symptom was swelling associated with pain. All the cases were managed by curettage/en-bloc resection followed by irrigation of cavity with hydrogen peroxide 3%, which was left for 2 minutes .The cavity was thoroughly irrigated with normal saline and filled using bone graft and /or bone graft substitutes or reconstructed using autologous bone.
Results: In total 5 patients showed recurrence, 4 in first year and 1 in second year of follow up. 4(25%) of 16 treated by curettage and G bone/autogenous bone grafting showed recurrence. Out of 5 cases of en-bloc resection with/without reconstruction 1 (20%) recurred.
Conclusion: We conclude that hydrogen peroxide is a cheap, easily available and effective adjuvant for giant cell tumor bone. It reduces recurrence and results are comparable to PMMA, phenol and cryotherapy. The combination of adjuncts (PMMA, burring, H2O2) reduces the likelihood of recurrence compared to curettage alone and therefore should be recommended as the standard treatment.
Keyword: giant cell tumor, hydrogen peroxide, extended curettage


1. Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, et al. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev 2010;36:1-7.
2. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: Treatment and outcome of 214 cases. J Cancer Res Clin Oncol 2008;134:969-78.
3. Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S. Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res 2004;424:221-6.
4. Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, et al. Giant cell tumor of the extremity: Retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am 2012;94:461-7.
5. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006;37:35-51.
6. Deheshi BM, Jaffer SN, Griffin AM, Ferguson PC, Bell RS, Wunder JS, et al. Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res 2007;459:96-104.
7. Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, et al. En bloc resection of primary sacral tumors: Classification of surgical approaches and outcome. J Neurosurg Spine 2005;3:111-22.
8. Lackman RD, Crawford EA, King JJ, Ogilvie CM. Conservative treatment of campanacci grade III proximal hummers giant cell tumors. Clin Orthop Relat Res 2009;467:1355-9.
9. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.
10. Eckardt JJ, Grogan TJ. Giant cell tumor of bone. Clin Orthop Relat Res 1986;204:45-58.
11. Roeder F, Timke C, Zwicker F, Thieke C, Bischof M, Debus J, et al. Intensity modulated radiotherapy (IMRT) in benign giant cell tumors – A single institution case series and a short review of the literature. Radiat Oncol 2010;5:18.
12. Ravi V, Wang WL, Lewis VO. Treatment of tenosynovial giant cell tumor and pigmented Villonodular synovitis. Curr Opin Oncol 2011;23:361-6.
13. Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jörgensen P, et al. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian sarcoma group study. J Bone Joint Surg Br 2006;88:531-5.
14. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin Oncol 2006;29:96-9.
15. Jacobs PA, Clemency RE Jr. The closed cryosurgical treatment of giant cell tumor. Clin Orthop Relat Res 1985;192:149-58.
16. Fu KP, Fan CP, Feng TH, Wei ST. Cryosurgery in giant cell tumor of bone. Chin Med J Engl 1979;92:125-28.
17. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res 1995;321:245-50.
18. Komiya S, Inoue A. Cementation in the treatment of giant cell tumor of bone. Arch Orthop Trauma Surg 1993;112:51-5.
19. Pals SD, Wilkins RM. Giant cell tumor of bone treated by curettage, cementation, and bone grafting. Orthopedics 1992;15:703-8.
20. Campanacci M, Gluntini A, Olim R. Giant cell tumour of bone: A study of 209 cases with long term follow up in 130 cases. Ital J Orthop Traumatol 1975;1:249-77.
21. Jaffe HL, Lichtenstein L, Partis RB. Giant cell tumour of bone: Its pathological appearance, grading, supposed variants and treatment. Arch Pathol 1940;30:993-1031.
22. McGrath PJ. Giant-cell tumour of bone: An analysis of fifty-two cases. J Bone Joint Surg Br 1972;54:216-29.
23. Schajowicz F. Giant cell tumour of bone [Osteoclastoma]. A pathological and histochemical study. J Bone Joint Surg Am 1961;43:1-29.
24. Vanel D, Contesso G, Rebibo G, Zafrani B, Masselot J. Benign giant-cell tumours of bone with pulmonary metastases and favorable prognosis. Report on two cases and review of the literature. Skeletal Radiol 1983;10:221-6.
25. Zhen W, Yaotian H, Songjian L, Ge L, Qingliang W. Giant-cell tumour of bone. The long-term results of treatment by curettage and bone graft. J Bone Joint Surg Br 2004;86:212-6.
26. Dahlin DC, Cupps RE, Johnson EW Jr. Giant cell tumour: A study of 195 cases. Cancer 1970;25:1061-70.
27. Rock MG, Sim FH, Unni KK, Witrak GA, Frassica FJ, Schray MF, et al. Secondary malignant giant-cell tumor of bone. Clinic pathological assessment of nineteen patients. J Bone Joint Surg Am 1986;68:1073-9.
28. Tuli SM, Gupta IM, Mishra RK. A clinic pathological appraisal of treatment, complications and recurrence in giant-cell tumour of bone. Indian J Cancer 1984;21:14-22.
29. Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am 1970;52:619-64.
30. Tuli SM, Srivastava TP, Verma BP. Giant cell tumour of bone – A study of natural course. Int Orthop 1978;2:207-14.
31. McDonald DJ, Sim FH, McLeod RA, Dahlin DC. Giant-cell tumor of bone. J Bone Joint Surg Am 1986;68:235-42.
32. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y, et al. Cryosurgery in the treatment of giant cell tumor. A long-term follow-up study. Clin Orthop Relat Res 1999;359:176-88.
33. Yip KM, Leung PC, Kumta SM. Giant cell tumor of bone. Clin Orthop Relat Res 1996;323:60-4.
34. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, et al. Giant cell tumor of long bone: A Canadian sarcoma group study. Clin Orthop Relat Res 2002;397:248-58.
35. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM, et al. Giant-cell tumor of bone: Analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am 1982;64:755-61.
36. Schajowicz F. Tumors and Tumor like Lesions of Bone: Pathology, Radiology and Treatment. 2nd ed. Germany: Springer-Verlag; 1994.
37. Dreinhöfer KE, Rydholm A, Bauer HC, Kreicbergs A. Giant-cell tumours with fracture at diagnosis. Curettage and acrylic cementing in ten cases. J Bone Joint Surg Br 1995;77:189-93.
38. Capanna R, Fabbri N, Bettelli G. Curettage of giant cell tumor of bone. The effect of surgical technique and adjuvants on local recurrence rate. Chir Organi Mov 1990;75:206.
39. Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ. Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res 2005:211-8.
40. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ, et al. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 1994;76:1827-33.
41. Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ. Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res 2005;438:123-7.
42. Su YP, Chen WM, Chen TH. Giant-cell tumors of bone: An analysis of 87 cases. Int Orthop 2004;28:239-43.
43. Ward WG Sr., Li G 3rd. Customized treatment algorithm for giant cell tumor of bone: Report of a series. Clin Orthop Relat Res 2002;397:259-70.

How to Cite this Article: Jain R, Kumar S, Gupta A, Swarup A, Shrimal R. Efficacy of Hydrogen Peroxide as Adjuvant in Preventing Recurrence of Giant Cell Tumor of Bone. Journal of Bone and Joint Diseases Oct – Dec 2017;32(3):17-21.

(Abstract) (Full Text HTML) (Download PDF)