Adjuvan tedavilerin anevrizmal kemik kistinde nüks üzerindeki etkileri

Öz

Bu çalışmadaki amacımız anevrizmal kemik kistinin tedavisinde uygulanan cerrahi tedavi yöntemi, yaş ve boşluk doldurma materyali gibi faktörlerin lokal nüks üzerine etkilerinin saptanması idi.

Çalışma planı: Çalışmamıza primer anevrizmal kemik kisti tanısı almış ve cerrahi olarak tedavi edilmiş, yaş ortalaması 17.9 olan 85 hasta dahil edildi. Hastaların 9’una eksizyon, 76’sına intralezyonel küretaj uygulandı. İntralezyonel küretaj grubundaki hastalar uygulanan adjuvan tedaviye göre 3 alt gruba ayrıldı. İlk gruba ek bir adjuvan tedavi görmezken; 2. gruba, ek olarak, yüksek devirli burr; 3. gruba, ek olarak, yüksek devirli burr ve alkol/fenol adjuvan tedavileri uygulandı. Kavitenin doldurulmasında kemik grefti ve kemik çimentosu kullanıldı. Hastaların ortalama takip süresi 107.5 ay idi. Gruplar lokal nüks oluşumu açısından incelenmiştir. On ve 20 yaş sınırlarının altında kist oluşumu negatif prognostik faktör kabul edildi ve istatistiksel analizi yapıldı.

Bulgular: Hastalarımızın 10’unda (%11.8) lokal nüks saptandı. Lokal nüksün ilk girişim sonrası ortaya çıkma süresi ortalama 10 ay idi. Uygulanan cerrahi tipleri, adjuvan tedavi grupları, yaş ve dolgu materyallerinin prognoz üzerine etkileri istatistiksel olarak anlamsız bulundu.

Çıkarımlar: Anevrizmal kemik kistinin intralezyonel tedavisinde en önemli aşama hala tüm kist duvarının özenli bir şekilde kürete edilmesi olarak gözükmektedir.

Anahtar Kelimeler

• Biyopsi; kemik kisti; kemik tümörleri; küretaj.

Effect of adjuvant therapies on recurrence in aneurysmal bone cysts

Abstract

Objective: The aim of this study was to define the effective factors such as surgical method, age and cavity filling materials on local recurrence in the treatment of aneurysmal bone cysts.

Methods: The study included 85 patients (mean age: 17.9 years) that received surgical treatment for primary aneurysmal bone cyst. Nine were treated with cyst excision and 76 with intralesional curettage. The intralesional curettage group was divided into 3 subgroups according to adjuvant therapies applied; the first group received no additional adjuvant therapy, the second group received additional high-speed burr and the third group received additional high-speed burr and alcohol/phenol adjuvant treatments. Bone graft or bone cement was used to fill in the cavity. Mean follow-up period was 107.5 months. Groups were analyzed statistically in terms of local recurrence. Onset of cyst in ages under 10 and 20 years were considered a negative prognostic factor and analyzed statistically.

Results: Local recurrence occurred in 10 (11.8%) patients. Mean duration between the initial operation and recurrence was 10 months. There was no significant difference in terms of local recurrence among the surgical treatment groups, adjuvant therapy groups, age groups and bone graft and bone cement groups.

Conclusion: Careful curettage of the entire cyst wall remains the most important step in the intralesional treatment of aneurysmal bone cyst.

Keywords

• Biopsy
• bone cyst
• bone neoplasms
• curettage

References

1. Leithner A, Windhager R, Lang S, Haas OA, Kainberger F, Kotz R. Aneurysmal bone cyst. A population based epi- demiologic study and literature review. Clin Orthop Relat Res 1999;363:176-9.
2. Mirra JM. Aneurysmal bone cyst. In: Mirra JM, Picci P, Gold RH, editors. Bone Tumors: Clinical, Radiological, and Pathologic Correlations. Philadelphia, PA: Lea and Febiger; 1989. p.1267-311.
3. Capanna R, Campanacci DA, Manfrini M. Unicam- eral and aneurysmal bone cysts. Orthop Clin North Am 1996;27:605-14.
4. Yücetürk G, Sabah D, Keçeci B, Kara AD, Yalçinkaya S. Prevalence of bone and soft tissue tumors. Acta Orthop Traumatol Turc 2011;45:135-43. CrossRef
5. Leithner A, Machacek F, Haas OA, Lang S, Ritschl P, Radl R, et al. Aneurysmal bone cyst: a hereditary disease? J Pediatr Orthop B 2004;13:214-17. CrossRef
6. Lichtenstein L. Aneurysmal bone cyst. A pathological entity commonly mistaken for giant-cell tumor and occa- sionally for hemangioma and osteogenic sarcoma. Cancer 1950;3:279-89. CrossRef
7. Dabezies EJ, D’Ambrosia RD, Chuinard RG, Ferguson AB Jr. Aneurysmal bone cysts after fracture. A report of three cases. J Bone Joint Surg Am 1982;64:617-21.
8. Ginsburg LD. Congenital aneurysmal bone cyst. Case re- port with comments on the role of trauma in the patho- genesis. Radiology 1974;110:175-6. CrossRef

9. Ratcliffe PJ, Grimer RJ. Aneurysmal bone cyst arising after tibial fracture. A case report. J Bone Joint Surg Am 1993;75:1225-7.
10. Althof PA, Ohmori K, Zhou M, Bailey JM, Bridge RS, Nelson M, et al. Cytogenetic and molecular cytogenetic findings in 43 aneurysmal bone cysts: aberrations of 17p mapped to 17p13.2 by fluorescence in situ hybridization. Mod Pathol 2004;17:518-25. CrossRef
11. Leithner A, Windhager R, Kainberger F, Lang S. A case of aneurysmal bone cyst in father and son. Eur J Radiol 1998;29:28-30. CrossRef
12. Oliveira AM, Perez-Atayde AR, Inwards CY, Medeiros F, Derr V, Hsi BL, et al. USP6 and CDH11 oncogenes iden- tify the neoplastic cell in primary aneurysmal bone cysts and are absent in so-called secondary aneurysmal bone cysts. Am J Pathol 2004;165:1773-80. CrossRef
13. Martinez V, Sissons HA. Aneurysmal bone cyst. A review of 123 cases including primary lesions and those second- ary to other bone pathology. Cancer 1988;61:2291-304.
14. Cottalorda J, Kohler R, Chotel F, De Gauzy JS, Lefort G, Louahem D, et al. Recurrence of aneurysmal bone cysts in young children: a multicentre study. J Pediatr Orthop B 2005;14:212-8. CrossRef
15. Cottalorda J, Bourelle S. Current treatments of primary an- eurysmal bone cysts. J Pediatr Orthop B 2006;15:155-67.
16. Biesecker JL, Marcove RC, Huvos AG, Miké V. Aneu- rysmal bone cysts. A clinicopathologic study of 66 cases. Cancer 1970;26:615-25. CrossRef
17. Campanacci M, Capanna R, Picci P. Unicameral and an- eurysmal bone cysts. Clin Orthop Relat Res 1986;204:25- 36.
18. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 pa- tients. J Clin Oncol 2005;23:6756-62. CrossRef
19. Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clin Orthop Relat Res 1995;311:157-63.
20. Ozaki T, Hillmann A, Lindner N, Winkelmann W. Ce- mentation of primary aneurysmal bone cysts. Clin Orthop Relat Res 1997;337:240-8. CrossRef
21. Ruiter DJ, van Rijssel TG, van der Velde EA. Aneurysmal bone cysts: a clinicopathological study of 105 cases. Can- cer 1977;39:2231-9. CrossRef
22. Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, Koops HS, Molenaar WM. Aneurysmal bone cysts treat- ed by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br 1997;79:20-5. CrossRef
23. Vergel De Dios AM, Bond JR, Schives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer 1992;69:2921-31. CrossRef
24. Gibbs CP Jr, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA. Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am 1999;81:1671-8.
25. Freiberg AA, Loder RT, Heidelberger KP, Hensinger RN. Aneurysmal bone cysts in young children. J Pediatr Or- thop 1994;14:86-91. CrossRef
26. Dormans JP, Hanna BG, Johnston DR, Khurana JS. Surgi- cal treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop Relat Res 2004;421:205-11. CrossRef
27. Dabak N, Tomak Y, Piskin A, Gulman B, Ozcan H. Early results of a modified technique of cryosurgery. Int Orthop 2003;27:249-53. CrossRef