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
In 2022, a group of TGCT experts came together and created a consensus document of the treatments for localized and diffuse disease (1). Surgical resection remains the most common treatment approach (2,3). Additionally, there is no current consensus on the type of surgery or the technique that is best suited for TGCT patients. Each patient’s disease should be evaluated on an individual basis with their healthcare provider. It is important to note that while there is no standard treatment pathway for TGCT, surgery can be curative. Particularly, localized/nodular TGCT can be cured when complete tumor resection is possible. However, complete removal of tumor(s) in diffuse TGCT remains difficult and other treatment options or surgical techniques may be considered. This is because diffuse TGCT can be aggressive and infiltrate the surrounding tissue inside and outside the affected joint, thus, it can be more difficult to treat (4,5). Treatment should be patient centric and determined based on consultation with your healthcare team.
For patients with recurrent or inoperable TGCT, 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 (6). Data suggests that initial surgery within an expert center has lower recurrence rates (44%) compared to recurrence rates outside these expert centers (92%) (7). These institutions often specialize in rare tumors, as they have specialized oncologists and orthopedic oncologists that 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 outcomes (8).
The NCCN guidelines are widely recognized, comprehensive, and standardized guidelines for clinical policy in oncology. These guidelines detail management decisions based on various diverse 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 (6). Since the location of TGCT can be as unique as the patients with the disease, several other specialists may be involved.
References
1. Stacchiotti S, Durr R, Schaefer I-M, Stern S, Van De Sande M, Bauer S, et al. Best clinical management of tenosynovial giant cell tumour (TGCT): a consensus paper from the community of experts. Cancer Treatment Review. 2022 2. Mastboom MJL, Verspoor FGM, Verschoor AJ, et al. Higher incidence rates than previously known in tenosynovial giant cell tumors. Acta Orthop. 2017 3. 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 4. 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 5. 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 6. Soft Tissue Sarcoma. NCCN Guidelines for Patients. https://www.nccn.org/patients/guidelines/content/PDF/sarcoma-patient.pdf. Published 2020. 7. Verspoor F, Zee A, Hannink G, van der Geest I, Veth R, Schreuder B. 2014. Long-term follow-up results of primary and recurrent pigmented villonodular synovitis. Oxford. 10.1093/rheumatology/keu230 8. 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
