Surgery vs Systemic Therapy in Diffuse TGCT

Alexander B. Christ, MD, of UCLA Health, and Dale R. Shepard, MD, PhD, of Cleveland Clinic, explain how they choose between surgery and systemic therapy for diffuse tenosynovial giant cell tumor (TGCT) in a discussion moderated by R. Lor Randall, MD, FACS, of UC Davis Health. Dr Christ weighs symptom severity, mechanical symptoms, and resectability, and raises drug therapy up front with patients who have diffuse disease. Surgery first can still help when mechanical symptoms dominate or there is no tissue diagnosis. Dr Randall notes that recurrence remains a risk even after a good operation. Dr Shepard stresses that the drugs carry side effects, were tested in unresectable disease, and are not “one and done,” so patients without a surgical consult first see an experienced orthopedic surgeon. Dr Christ views treatment before surgery through the lens of joint replacement. Dr Shepard adds that family planning may favor one more surgery in younger patients.