TGCT requires a multi-disciplinary treatment strategy that includes a team of healthcare providers, such as, an orthopedic oncologist, a medical oncologist, radiologist, orthopedic surgeon, and physical therapist.
Treating TGCT
There is no official treatment guidelines for TGCT. However, surgical resection remains the most common treatment strategy (1,2). There is no current consensus on the type of surgery or the technique that is best suited for TGCT patients. Each patient should be evaluated on an individual basis with their healthcare provider. It is important to note that while there is no guideline on the treatment of TGCT, surgery can be curative. Especially for localized patients, complete tumor resection is possible. However, complete removal of tumor(s) in diffuse TGCT remains difficult and other options or techniques may have to be considered. This is because diffuse TGCT is known for being more locally aggressive and infiltrating surrounding tissue inside and outside the affected joint (3,4).
For patients with recurrent or inoperable tumors, common in diffuse disease, a team based approach is critical. Due to the high recurrence rates for diffuse TGCT patients, many treatment options may be explored. Academic institutions, such as research centers, and large cancer centers may be a source of expertise in these situations(5). These institutions often specialize in rare tumors, as they have specialized oncologists and are capable of providing long-term support. Collaborative care from radiologists, medical oncologists, orthopedic oncologists, orthopedic surgeon, physical therapists, and other sarcoma experts may improve outcome (6).
The NCCN guidelines are widely recognized, comprehensive, and standardized guidelines for clinical policy in oncology. These guidelines detail management decisions based on many different diseases. The NCCN guidelines for Soft Tissue Sarcoma recommend that the care and management of TGCT be done by multi-disciplinary teams that can help patients due to their experience and expertise with other soft tissue tumors(5). Since TGCT location can be as diverse as the patients with the disease, several other specialists may be involved based on the location.
References
1. Mastboom MJL, Verspoor FGM, Verschoor AJ, et al. Higher incidence rates than previously known in tenosynovial giant cell tumors. Acta Orthop. 2017 2. Bernthal NM, Ishmael CR, Burke ZDC. Management of Pigmented Villonodular Synovitis (PVNS): an Orthopedic Surgeon’s Perspective. Curr Oncol Rep. 2020. doi:10.1007/s11912-020-00926-7 3. Ravi V, Wang WL, Lewis VO. Treatment of tenosynovial giant cell tumor and pigmented villonodular synovitis. Curr Opin Oncol. 2011. doi:10.1097/CCO.0b013e328347e1e3 4. Gelhorn HL, Tong S, McQuarrie K, et al. Patient-reported Symptoms of Tenosynovial Giant Cell Tumors. Clin Ther. 2016. doi:10.1016/j.clinthera.2016.03.008 5. Soft Tissue Sarcoma. NCCN Guidelines for Patients. https://www.nccn.org/patients/guidelines/content/PDF/sarcoma-patient.pdf. Published 2020. 6. Hao Y, Krohe M, Yaworsky A, et al. Clinical Trial Patient-reported Outcomes Data: Going beyond the Label in Oncology. Clin Ther. 2016. doi:10.1016/j.clinthera.2016.03.010
