Giant cell tumor is still one of the most controversial and discussed bone tumors. Surgical treatment options include intralesional excision or segmental resection. Curettage has a higher recurrence rate but does preserve adjacent joint function. After curettage, the use of adjuvant therapies is still controversial. Three hundred forty-nine patients with giant cell tumors of the extremity, treated in a single institution, were analyzed in a retrospective study. Two hundred patients underwent curettage of the lesion and in 64 of these cases, three local adjuvants, such as phenol, alcohol and cement, were employed. The hypothesis is that an "aggressive curettage" with phenol, alcohol and cement provides better local control and functional results. The correlation between tumor in the proximal femur and higher recurrence rate has not been recorded before. The results of the present study suggest that an "aggressive curettage" reduces the recurrence rate in a disease whose aggressiveness is not easy to predict. Special attention must be given to giant cell tumors not only in the distal radius, but also in the proximal femur, where the treatment is more difficult and associated with a higher rate of local recurrence. 2009. Published by Elsevier Ltd. All rights reserved.