In giant cell tumor (GCT) of bone, a Campanacci grade III lesion (extra-compartmental extension with soft tissue mass) at the distal radius is best managed by:
- A Curettage with cementation alone
- B En-bloc wide resection of the distal radius with wrist reconstruction (vascularised fibula transfer or osteoarticular allograft) ✓
- C Curettage + bone grafting + denosumab
- D Radiation therapy alone — GCT is radiosensitive
Explanation
Campanacci grade III GCTs have extra-compartmental soft tissue extension and cortical destruction, making intralesional curettage (even with adjuvants — burring, phenol, liquid nitrogen, cementation) oncologically insufficient with high local recurrence rates (up to 60%). At the distal radius specifically, wide en-bloc resection is preferred for grade III lesions because the distal radius has thin cortices, and GCT at this site is particularly aggressive with high recurrence after curettage. Reconstruction using vascularised fibula autograft (ipsilateral or contralateral) restores adequate wrist function while achieving oncologically clear margins. Radiation therapy is reserved for surgically inaccessible GCTs (sacral/spinal) due to risk of malignant transformation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.