br Benign bone tumors br Giant cell tumor
Benign bone tumors
Giant cell tumor of jaws [GCT] GCTs arising in the head and neck region constitute approximately 2% of all GCTs. They are locally aggressive, recurrent and non-metastasing. Neoplastic giant cell are very rare in jaws. GCT usually occurs in children and young adults, predominantly females. GCTs are usually mono-ostotic, although they may occasionally present in a polyostotic form, when they are usually of a high grade . Radiographic features are of an expansile radiolucent mass crossing the midline that tends to destroy and remodel the adjacent bone. A blurred border of the radiolucent area goes in favor of giant cell tumor. The giant adenosine receptor agonist represent osteoclast precursors. Numerous uniformly dispersed large giant cells with nuclei are seen (Fig. 7). Hemorrhagic elements are rare. Osteoid is not produced [21,40]. Due to the similarity of the biological behavior of central giant cell granulomas [CGCG] of the jaw with that of GCT of long bones, CGCG of the jaw may be considered as a low grade tumor and the differences between both may be due to the variations in the anatomical sites, since the presence of the teeth in addition to the histological structure of the jaw bone and bone marrow activity, could influence the biological behavior of CGCG comparatively. p53 activity can be used to chart its aggressiveness. The recurrence rate of CGCG and GCT was 40–45% . Sarcomatous areas may also develop in giant cell tumor .
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Introduction Bone metastases are a common event in metastatic cancer and are a significant cause of morbidity that can lead to pain, hypercalcaemia, pathologic fracture, spinal cord compression, and reduction in quality of life (QOL) . The prevalence in metastatic breast and prostate cancer patients is as high as 70–90% at autopsy [1,2]. In patients with bone metastases, goals of care often surround pain management and maintenance or improvement of QOL . A variety of treatment modalities are utilized in a multidisciplinary fashion in order to achieve this goal. This includes analgesia, bone modifying agents such as bisphosphonates, and radiation therapy (RT) [3,4]. Where analgesic medications frequently result in side effects like constipation and dry mouth, radiation therapy is well tolerated with fewer side effects and provides significant pain relief in approximately 70% of patients . Furthermore, RT has been shown to help prevent subsequent skeletal related events associated with bone metastases and improve overall QOL . Many dose fractionation options exist in the palliation of symptomatic bone metastases, with the most common fractionation schedules being a single 8Gy in one fraction, 20Gy in five fractions, and 30Gy in ten fractions . Numerous randomized control trials (RCTs) have concluded that both single fraction radiation therapy (SFRT) and multiple fraction radiation therapy (MFRT) are efficacious in providing pain relief caused by uncomplicated bone metastases [4,7]. MFRT may be indicated in the treatment of complicated bone metastases, such as those causing neuropathic pain, pathologic fractures, or spinal cord compression [8,9]. As such, guidelines from the American Society for Radiation Oncology (ASTRO) and the American College of Radiology (ACR) recommend SFRT as the preferred treatment for uncomplicated bone metastases [10,11]. Despite these evidence based guidelines, studies have shown that there is a reluctance to implement them into current practice [7,12]. Many of these studies are survey-based asking physicians about fractionation schedules of choice regarding hypothetical scenarios [12,13]. Conclusions from these studies may overestimate the prevalence of SFRT due to their survey based methodologies. Our review focussed on studies that have investigated actual patient databases with the goal being to present a more accurate assessment of international patterns of practice over the past twenty years, particularly with respect to the use of SFRT.