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Giant cell tumor of bone: A series of 97 cases with a mean follow-up of 12 years
Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años
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Noventa y siete casos con seguimiento medio de 12 años" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "65" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Giant cell tumour of bone: A series of 97 cases with a mean follow-up of 12 years" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1134 "Ancho" => 1500 "Tamanyo" => 291752 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Composición de un TCGO de fémur distal. a) Obsérvense imágenes de radiografía simple anteroposterior y lateral mostrando una lesión lítica metafisoepifisaria de cóndilo femoral interno, excéntrica que adelgaza la cortical sin romperla, con márgenes mal definidos, sin reacción perióstica. b) Tratamiento mediante resección intralesional por legrado agresivo y fresado a alta velocidad. c) Aporte de injerto esponjoso homólogo fragmentado y estructural corticoesponjoso en marquetería, fijado con tornillos. d) Control evolutivo mediante radiografías simples donde se observa la correcta integración del injerto.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. 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Abat, M. Almenara, A. Peiró, L. Trullols, S. Bagué, I. Grácia" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Abat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Almenara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "A." "apellidos" => "Peiró" "email" => array:1 [ 0 => "apeiro@santpau.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Trullols" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Bagué" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "I." "apellidos" => "Grácia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1476 "Ancho" => 1502 "Tamanyo" => 363705 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Composition of a GCTB of the third metacarpal which recurred after curettage 6 months earlier. The image shows the treatment through block resection and reconstruction with interposed graft. (a) Simple radiograph showing an expansive lithic lesion in the third metacarpal, which inflates and thins out the cortical. The magnetic resonance scan clearly shows soft tissue involvement. (b) Identification under scopy of the area affected by the tumor and marking with Kirschner wires. The lower right corner shows the bone graft prior to its section, along with the resection piece. (c) Prior reconstruction of the metacarpal intermediate graft with an osteosynthesis plate and screws for subsequent placement in the resection bed. (d) Subsequent radiographic control.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Giant cell tumor of bone (GCTB) accounts for between 3% and 5% of primary bone tumors and 20% of benign bone tumors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was classified histologically by Jaffe et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and radiographically by Campanacci.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It mainly appears between the second and fourth decades of life, usually in the epiphysis of long bones, with a locally aggressive behavior, and its clinical evolution is difficult to predict.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Radiographic exploration shows an excentric metaphysoepiphyseal lithic lesion with a geographic pattern. The aspect of the edges of the tumor may vary from well-defined margins with a sclerous edge to poorly defined margins which reduce and destroy the cortical until the bone fractures.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Surgical treatment is necessary and controversial, as there are various different surgical options. Therefore, it is advisable to classify the tumors into Campanacci grades through a radiographic study.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus, grade i and ii cases may be treated by intralesional resection through curettage and high-speed drilling and graft and/or cement. In grade iii cases, with significant cortical destruction, it is advisable to carry out a block resection with reconstruction (megaprosthesis or osteoarticular graft) if the location requires it.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this review was to describe a series of GCTB with a long follow-up period, showing the results obtained with a specific treatment protocol.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective study of a series of cases treated between September 1982 and April 2009 from the records of University Hospital de la Santa Creu i Sant Pau, in Barcelona, Spain. We included all the patients with a diagnosis of GCTB confirmed by anatomopathological analysis and excluded those for whom the clinical records were not complete. An oncological orthopedic surgeon, together with a radiologist specializing in the musculoskeletal system, analyzed all the cases. These data focused on the clinical presentation, location, classification, extension, recurrences, complications and evolution.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We studied 97 patients with a mean follow-up period of 12 years (range: 2–27 years). The series was comprised of 53 females (54.6%) and 44 males (45.4%), with a mean age at the time of diagnosis of 34.16 years (range: 15–71 years). All the patients were studied by simple radiographs and stratified according to the Campanacci classification,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with 15 (15.5%) grade i cases, 70 (72.1%) grade ii cases and 12 (12.4%) grade iii cases (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The locations are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The initial clinical presentation was pain in 85 patients (87.6%), pathological fracture in 3 cases (3.1%), painless mass in 2 cases (2.1%) and an accidental finding in 7 cases (7.2%). The surgical treatment of primary GCTB was curettage in 71 cases (73.2%) in Campanacci stages i and ii and 26 block resections (26.8%) in stage iii or when it was considered that curettage was technically unfeasible.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The bone defect resulting from curettage was filled with homologous cancellous graft in 61 cases (85.9%) and autogenous in 10 cases (14.1%). The defect resulting from block resection was reconstructed with a structural graft in 3 cases (11.5%), with cancellous homograft in 5 cases (19.2%) and with autograft in 2 cases (7.8%). The remaining 16 cases (61.5%) did not require it. A total of 58 (59.8%) patients did not require additional osteosynthesis or prosthetic reconstruction, 28 (28.9%) required osteosynthesis with plates and screws and 11 (11.3%) required placement of a reconstruction prosthesis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The curettage (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and block resection (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) techniques followed the general oncological pathology guidelines. We obtained intra- and postoperative radiographs in all cases. In the postoperative period, patients followed an antibiotic protocol with 1<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h cefazolin for 3 days. Patients were clinically and radiographically reviewed at 3, 6 and 12 months from the intervention, and annually thereafter.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">We obtained the number and percentage of cases for categorical variables, as well as the mean and standard deviation for quantitative variables. Relationships between variables were described using contingency tables and inferences were studied using the Chi-squared test, t test or Fisher's exact test, as applicable. We conducted a multivariate analysis, selecting those variables which had previously shown a trend toward significance (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.20) applying logistic regression. The level of statistical significance was set at 5% (alpha<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.05). We used the statistics software package SPSS (V15.0).</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Oncological results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Out of the 97 patients with GCTB, 25 (25.8%) suffered local recurrence. Among the 71 patients who were treated by high-speed drilling and a cancellous graft, 20 (28.2%) suffered recurrence. Out of the 26 cases treated by block resection, 5 (19.2%) suffered recurrence. These first recurrences were treated by a new curettage (17 cases) or block resection (8 cases). Regarding recurrences in the block resection group, these appeared within 1 year in 92% of cases, decreasing to 70% after the third year. In the curettage group, 80% of recurrences appeared during the first year, decreasing to 58% after the third year.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The multivariate comparative study only found a statistically significant relationship (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.047) between the type of surgery employed and the rate of recurrence with a mean time of recurrence of 120 months (range: 107–201 months). That is, grade iii GCTB cases which suffered recurrence did so earlier than grade i and ii cases.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Six cases with multiple recurrences were treated by radiotherapy (mean value of 45<span class="elsevierStyleHsp" style=""></span>Gy) and chemotherapy (denosumab 120<span class="elsevierStyleHsp" style=""></span>mg per month during the follow-up period) pre- and postoperatively. The reconstructions of recurrences initially used homologous cancellous grafts, followed by structural grafts and, lastly, autogenous grafts.</p><p id="par0065" class="elsevierStylePara elsevierViewall">We observed 7 cases of malignization. These malignancies resulted in 1 case of intramedullary osteogenic sarcoma, 2 malignant fibrohistiocytomas, 1 low-grade fusocellular sarcoma, 2 osteosarcomas and 1 high-grade undifferentiated sarcoma. These 7 cases of malignization evolved with distant dissemination; 5 cases to the lungs, 1 to the dorsal rachis and 1 to the pleura. By the end of the follow-up period, 2 patients (2.1%) had died at 35 and 48 months, respectively. In addition, we observed 1 case of large tumoral expansion and found 1 massive giant cell tumor.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Radiographic results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Considering the classification of the osseointegration of the allografts of the International Society of Limb Salvage (ISOLS), the GCTB treated by high-speed drilling and cancellous graft (71 patients) presented excellent results in 88.7% (63 patients) of cases, good in 9.9% (7 patients) and acceptable in 1.4% (1 patient). Patients who underwent block resection with reconstruction by a graft (26 patients) showed an excellent osseointegration in 65.4% (17 patients) of cases, good in 19.2% (5 patients), acceptable in 3.9% (1 patient) and poor in 11.5% (3 patients). One case of osteoarticular graft in the distal radius in a patient with grade iii GCTB which did not integrate was fractured, as was another in the same location which presented radiocarpal arthrosis. Both cases required arthrodesis and extraction of the graft.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">General complications</span><p id="par0075" class="elsevierStylePara elsevierViewall">We observed 1 case of infection of the surgical wound in a grade iii GCTB in the femur which was treated by block resection and 1 case of septic loosening of a proximal tibial megaprosthesis. The patients were treated with antibiotic therapy alone or in combination with knee arthrodesis, respectively. None of the cases treated by drilling and grafting suffered a postoperative fracture, but 2 cases of grade ii GCTB in the femur which were treated by drilling recurred and presented pathological fracture. One case of block resection in the proximal fibula presented paralysis of the external popliteal sciatic nerve.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Although GCTB accounts for 20% of benign bone tumors, its treatment is still controversial. It has been suggested that these tumors should be classified according to their Campanacci grades,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in order to treat grade i and ii cases through intralesional resection by curettage with high-speed drilling plus a graft and/or cement, and grade iii cases with significant cortical destruction by block resection with reconstruction in cases requiring it.</p><p id="par0085" class="elsevierStylePara elsevierViewall">For cases with grade i and ii GCTB, the authors preferred high-speed drilling as the main option, taking into account that both liquid nitrogen and phenol have shown good results regarding local recurrences. Liquid nitrogen produces an osteonecrosis of the tumoral bed which is 1 or 2<span class="elsevierStyleHsp" style=""></span>mm deep, reducing the rate of recurrence to 2–4%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In spite of these positive results, the high risk of fracture due to difficult control of the depth of the induced osteonecrosis prevents this procedure from becoming the method of choice.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The osteonecrosis produced by phenol is limited to a depth of 1.5<span class="elsevierStyleHsp" style=""></span>mm, reducing the risk of fracture but presenting a rate of recurrence of 20–30%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> The effectiveness of phenol is increased when used together with cement after curettage, with a rate of recurrence which varies between 3% and 17%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Nevertheless, some studies have reported a high recurrence among grade iii GCTB.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Block resection and subsequent reconstruction of these cases near the joints has been described as the treatment of choice due its low rate of local recurrence compared to curettage,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,8</span></a> whilst other authors argue that this option is not adequate for the majority of cases.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9</span></a> We believe that this option is very aggressive, more so considering the young age of patients in the series, so we opted for block resection and reconstruction in cases of Campanacci grade iii GCTB<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with significant cortical destruction.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The literature contains reports from series with different treatments which obtained similar results and with a comparable rate of recurrences (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,7,8,10–22</span></a> GCTB presents an overall rate of recurrence of 20% in block resections, increasing to 50% with intralesional curettage.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,23</span></a> Our series presented a rate of first recurrence of 25.8%, a result comparable with that of the relevant series of Campannaci,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> who obtained a rate of recurrence of 27%. High-speed drilling and adjuvants such as cryotherapy with liquid nitrogen and radiotherapy have been used to decrease the rate of recurrence. Likewise, the use of substances such as phenols, corticoids, polymethylmethacrylate cement, zoledronic acid, aqueous zinc hydrochloride and hydroxyapatite has also been studied.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7–9,11</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Although GCTB is considered as a benign bone tumor, some publications have shown that about 10% of these tumors become malignant.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,23,24</span></a> Our series presented a rate of malignization of 8.2%.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The study presented certain limitations, such as being a single-center study, with a single therapeutic protocol. Despite being a limitation, the protocol used was similar to those in other works published in the literature. Another weakness of the study was being a retrospective study of a series of cases presenting different locations. The grade iii GCTB group was reduced, but comparable with the series consulted. In spite of this, we consider the size of the sample in our study and its long follow-up period as sufficient strengths to balance the limitations.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">We consider curettage with high-speed drilling and bone graft in Campanacci grade i and ii GCTB, as well as block resection and subsequent reconstruction in grade iii cases, or in grade ii when curettage is not technically feasible, as the treatment of choice.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Level of evidence</span><p id="par0110" class="elsevierStylePara elsevierViewall">Level of evidence iv.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical responsibilities</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of people and animals</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres407927" "titulo" => array:5 [ 0 => "Abstract" 1 => "Purpose" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec384144" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres407926" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y método" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec384143" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Oncological results" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Radiographic results" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "General complications" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Level of evidence" ] 10 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-13" "fechaAceptado" => "2014-06-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec384144" "palabras" => array:4 [ 0 => "Giant cell tumor of bone" 1 => "Recurrence" 2 => "Curettage" 3 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec384143" "palabras" => array:4 [ 0 => "Tumor de células gigantes óseo" 1 => "Recurrencia" 2 => "Legrado" 3 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe our series of patients with giant cell tumor of bone with a long-term follow-up to show the results obtained with our treatment protocol.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 97 histologically confirmed giant cell tumors of bone were treated in our center between 1982 and 2009. The mean follow-up period was 12 years (2–27 years). The treatment received was determined by the radiological grade based on the Campanacci classification. The series consisted of 53 women (54.6%) and 44 men (54.4%) with a median age of 34.16 years (15–71 years). The data collected was focused on the clinical presentation, location, phase, extension, recurrences, and complications.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The treatment most used in Campanacci grades i and ii was intralesional excision with high-velocity drilling and filling with a graft. In grades iii that could not be treated with the aforementioned method, it was decided to perform <span class="elsevierStyleItalic">en bloc</span> resection. An overall recurrence rate of around 25.8% was observed. Seven cases (7.2%) presented with a recurrence of the malignancy. The death rate at the end of follow-up was 2.1% (2 cases).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Curettage with a high-velocity drill and a bone graft in giant cell tumor of bone Campanacci grades i and ii obtains good results after long-term follow-up. Some grade iii giant cell tumors of bone that cannot be treated with this therapeutic option require <span class="elsevierStyleItalic">en bloc</span> resection and reconstruction.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir una serie de tumores óseos de células gigantes con largo seguimiento, mostrando los resultados obtenidos con nuestro protocolo terapéutico.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre 1982-2009, 97 pacientes con lesiones histológicamente confirmadas como tumores óseos de células gigantes fueron tratados en nuestro centro con un seguimiento medio de 12 años (2-27 años). El tratamiento recibido lo determinó la clasificación de Campanacci. La serie la formaron 53 mujeres (54,6%) y 44 hombres (54,4%) con una edad media de 34,16 años (15-71 años). Los datos recogidos se centraron en la presentación clínica, localización, estadio, extensión, recurrencias y complicaciones.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El tratamiento más utilizado en los estadios <span class="elsevierStyleSmallCaps">i</span> y <span class="elsevierStyleSmallCaps">ii</span> de Campanacci fue escisión intralesional con fresado a alta velocidad y rellenado con injerto homólogo, mientras que en los estadios <span class="elsevierStyleSmallCaps">iii</span> que no podían ser tratados con este método se abogó por la resección en bloque. Se halló una recurrencias global del 25,8%. Siete casos (7,2%) presentaron malignización. La tasa de exitus fue del 2,1% (2 casos).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La opción terapéutica presentada para los tumores óseos de células gigantes que consiste en legrado con fresado a alta velocidad y aporte de injerto óseo en los grados <span class="elsevierStyleSmallCaps">i</span> y <span class="elsevierStyleSmallCaps">ii</span> de Campanacci obtiene resultados comparables con literatura actual. Los tumores de grado <span class="elsevierStyleSmallCaps">iii</span>, que no pueden ser tratados con la opción terapéutica mencionada anteriormente, requieren resección en bloque y reconstrucción posterior.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abat F, Almenara M, Peiró A, Trullols L, Bagué S, Grácia I. Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años. Rev Esp Cir Ortop Traumatol. 2015;59:59–65.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2449 "Ancho" => 1629 "Tamanyo" => 308464 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Anatomical diagram of the location of GCTB in the series presented.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1134 "Ancho" => 1500 "Tamanyo" => 321024 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Composition of a distal femoral GCTB. (a) The anteroposterior and lateral simple radiograph images show an excentric, metaphysoepiphyseal lithic lesion in the internal femoral condyle, which thins out the cortical without breaking it, with poorly defined margins and no periosteal reaction. (b) Treatment through intralesional resection by aggressive curettage and high-speed drilling. (c) Fragmented homologous cancellous graft and structural corticocancellous in marquetry, fixed with screws. d) Evolution control through simple radiographs showing a correct integration of the graft.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1476 "Ancho" => 1502 "Tamanyo" => 363705 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Composition of a GCTB of the third metacarpal which recurred after curettage 6 months earlier. The image shows the treatment through block resection and reconstruction with interposed graft. (a) Simple radiograph showing an expansive lithic lesion in the third metacarpal, which inflates and thins out the cortical. The magnetic resonance scan clearly shows soft tissue involvement. (b) Identification under scopy of the area affected by the tumor and marking with Kirschner wires. The lower right corner shows the bone graft prior to its section, along with the resection piece. (c) Prior reconstruction of the metacarpal intermediate graft with an osteosynthesis plate and screws for subsequent placement in the resection bed. (d) Subsequent radiographic control.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The table shows the percentage of first recurrences classified by Campanacci groups and type of treatment applied.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Campanacci stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% First recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Survival (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Curettage (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (3 patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">II</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Curettage (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.4 (17 patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.2 (1 patient) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block resection (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 (2 patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block resection (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (3 patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.7 (1 patient) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab635661.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Description of the series of giant cell tumor of bone cases presented.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Author and reference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Adjuvant used \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Recurrence (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Goldenberg et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1970 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.9 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bone graft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dahlin et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1970 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cytotoxic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Larsson et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1975 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None or bone graft \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Marcove et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1978 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cryosurgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sung et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1982 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phenol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">McDonald et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phenol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Campanacci et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waldram et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1990 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O’Donnell et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1994 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blackley et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drilling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Boons et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polymethylmethacrylate<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>liquid nitrogen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zhen et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aqueous zinc hydrochloride \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kivioja et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">294 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bone, cement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Balke et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">214 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polymethylmethacrylate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nishisho et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zoledronic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fraquet et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Errani et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phenol, alcohol, cement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Our series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drilling<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>bone graft or block resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab635662.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Rate of recurrence reported in the literature following intralesional treatment for giant cell tumor of bone.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.W. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 0 | 11 |
| 2024 October | 44 | 2 | 46 |
| 2024 September | 45 | 8 | 53 |
| 2024 August | 46 | 3 | 49 |
| 2024 July | 49 | 7 | 56 |
| 2024 June | 40 | 2 | 42 |
| 2024 May | 45 | 6 | 51 |
| 2024 April | 52 | 1 | 53 |
| 2024 March | 59 | 12 | 71 |
| 2024 February | 75 | 5 | 80 |
| 2024 January | 80 | 7 | 87 |
| 2023 December | 54 | 11 | 65 |
| 2023 November | 92 | 21 | 113 |
| 2023 October | 111 | 13 | 124 |
| 2023 September | 88 | 13 | 101 |
| 2023 August | 68 | 3 | 71 |
| 2023 July | 90 | 8 | 98 |
| 2023 June | 88 | 4 | 92 |
| 2023 May | 105 | 6 | 111 |
| 2023 April | 108 | 2 | 110 |
| 2023 March | 45 | 2 | 47 |
| 2023 February | 35 | 5 | 40 |
| 2023 January | 42 | 2 | 44 |
| 2022 December | 40 | 8 | 48 |
| 2022 November | 25 | 7 | 32 |
| 2022 October | 46 | 6 | 52 |
| 2022 September | 41 | 7 | 48 |
| 2022 August | 34 | 6 | 40 |
| 2022 July | 16 | 5 | 21 |
| 2022 June | 15 | 11 | 26 |
| 2022 May | 18 | 8 | 26 |
| 2022 April | 32 | 10 | 42 |
| 2022 March | 39 | 9 | 48 |
| 2022 February | 30 | 8 | 38 |
| 2022 January | 13 | 4 | 17 |
| 2021 December | 24 | 10 | 34 |
| 2021 November | 28 | 5 | 33 |
| 2021 October | 29 | 8 | 37 |
| 2021 September | 12 | 11 | 23 |
| 2021 August | 13 | 5 | 18 |
| 2021 July | 14 | 11 | 25 |
| 2021 June | 18 | 7 | 25 |
| 2021 May | 25 | 7 | 32 |
| 2021 April | 31 | 18 | 49 |
| 2021 March | 17 | 5 | 22 |
| 2021 February | 13 | 10 | 23 |
| 2021 January | 8 | 7 | 15 |
| 2020 December | 1 | 0 | 1 |
| 2020 June | 0 | 1 | 1 |
| 2019 April | 0 | 7 | 7 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 6 | 3 | 9 |
| 2017 December | 8 | 2 | 10 |
| 2017 November | 6 | 4 | 10 |
| 2017 October | 14 | 1 | 15 |
| 2017 September | 9 | 8 | 17 |
| 2017 August | 14 | 4 | 18 |
| 2017 July | 4 | 4 | 8 |
| 2017 June | 7 | 1 | 8 |
| 2017 May | 2 | 1 | 3 |
| 2017 April | 7 | 9 | 16 |
| 2017 March | 4 | 10 | 14 |
| 2017 February | 8 | 4 | 12 |
| 2017 January | 7 | 2 | 9 |
| 2016 December | 0 | 1 | 1 |
| 2016 November | 0 | 2 | 2 |
| 2016 October | 1 | 3 | 4 |
| 2016 September | 0 | 1 | 1 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 0 | 1 | 1 |
| 2016 May | 0 | 4 | 4 |
| 2016 April | 0 | 3 | 3 |
| 2016 March | 0 | 11 | 11 |
| 2016 February | 0 | 9 | 9 |
| 2016 January | 0 | 7 | 7 |
| 2015 December | 0 | 5 | 5 |
| 2015 November | 0 | 1 | 1 |
| 2015 October | 0 | 1 | 1 |
| 2015 August | 0 | 1 | 1 |
| 2015 April | 0 | 1 | 1 |
| 2015 February | 1 | 2 | 3 |
| 2015 January | 0 | 3 | 3 |
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