Advantages of Pressurized-Spray Cryosurgery in Giant Cell Tumors of the Bone

Abstract

Background: Giant Cell Tumor is considered a benign, local and aggressive tumor. Although considered a benign bone tumor, it is still the subject of discussion and research because of the associated local bone destruction, as well as high rates of recurrence and distant metastases. Options are being developed for both surgical techniques and adjuvant therapies. Aims: The present study evaluated the administration of cryotherapy via a pressurized-spray technique in giant cell tumors of the bone. Study Design: Cross-sectional study. Methods: The study included 40 patients who were treated with extensive curettage and cryotherapy at various locations during the period from February 2006 to December 2013. Informed consent forms were obtained from the participants and ethics committee approval was taken from the local ethics committee of Ondokuz Mayıs University. The pressurized-spray technique was performed using liquid nitrogen. The patients were evaluated with respect to age, gender, radiological appearance, treatment modality, duration of follow-up, skin problems and recurrence. Results: Twenty-one patients were female; 19 were male. The average age of the patients was 33 years (range: 16–72 years), and the average duration of follow-up was 43 months (range: 12–80 months). The average time from the onset of the complaints to the diagnosis was 6 months (range: 2–12 months). Based on the Campanacci classification: 9 patients were Grade I; 25 patients were Grade II; six patients were Grade III. The lesion was located in the femur in 14 patients, in the tibia in 11 patients, in the radius in 5 patients, in the pelvis in 4 patients, in the fibula in 3 patients, in the metatarsal in 2 patients and in the phalanges of the hand in one patient. One patient had postoperative early fracture. None of the patients had skin problems and infection. Three (7.5%) of the patients had recurrence. Conclusion: It was found that cryotherapy was highly effective in the lesions, especially those located in the femur and tibia and remained insufficient in the lesions expanded outside the cortex. Wound healing problems, infection and fracture risk are lower with this technique.

Keywords

• Giant cell tumor, bone, surgical treatment, cryotherapy, pressurized-spray technique

Kaynakça

1. 1. Ghert MA, Rizzo M, Harrelson JM, Scully SP. Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res 2002;400:201-10. [CrossRef]
2. 2. Cooper A, Travers B. Surgical Essays. London: Cox&Son; 1818. 3. Virchow R. Die Krankhaften Geschwulste. Berlin: Hirschwald; 1846. 4. Campanacci M. Giant cell tumor. In: Gaggi A, editor. Bone and softtissue tumors. Bologna: Springer-Verlag; 1990:17-53. [CrossRef]
3. 5. Moon MS, Kim SS, Moon JL, Kim SS, Moon H. Treating giant cell tumours with curettage, electrocautery, burring, phenol irrigation and cementation. J Orthop Surg 2013;21:209-12.
4. 6. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, Huvos AG. Cryosurgery in the treatment of giant cell tumor of bone. A report of 52 consecutive cases. Cancer 1978;41:957-69. [CrossRef]
5. 7. Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, Koops HS, Molenaar MV. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br 1997;79:20-5. [CrossRef]
6. 8. Campanacci M. Giant-cell tumor and chondrosarcoma. Grading, treatment and results. Recent Results Cancer Res 1976;54:257-61.
7. 9. 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]
8. 10. Fletcher CDM, Unni KK, Mertens F. Pathology and genetics of tumors of soft tissue and bone. Lyon: IARC Press; 2002.

9. 11. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant cell tumor of bone: Analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am 1982;64:755-61.
10. 12. Saglik Y, Yildiz Y, Karakas A, Ogüt H, Erekul S. Giant cell tumor of bone. Bull Hosp Jt Dis 1999;58:98-104.
11. 13. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 2008;134:969- 78. [CrossRef]
12. 14. Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C, Walloe A, Bauer HC, et al. Cement is recommended in intralesional surgery of giant cell tumors: a Scandinaviansarcoma group study of 294 patients followed for a median time of 5 years. Acta Orthop 2008;79:86-93. [CrossRef]
13. 15. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.
14. 16. Knochentumoren A, Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, et al. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 2008;90:1060-7. [CrossRef]
15. 17. Gill W, Fraser J, Carter DC. Repeated freeze–thaw cyclesin cryosurgery. Nature 1968;219: 410-3. [CrossRef]
16. 18. Muramatsu K, Ihara K, Taquchi T. Treatment of giant cell tumor of long bones: Clinical outcome and reconstructive strategy for lower and upper limbs. Orthopedics 2009;32:491. [CrossRef]
17. 19. Kang L, Manoso MV, Boland PJ, Healey JH, Athanasian EA. Features of grade 3 Giant Cell Tumors of the distal radius associated with successful intralesional treatment. J Hand Surg Am 2010;35:1850-7. [CrossRef]
18. 20. Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant cell tumors of long bones with curettage and bone grafting. J Bone Joint Surg Am 1999;81:811-20.
19. 21. Veth R, Schreuder B, van Beem H, Pruszczynski M, de Rooy J. Cryosurgery in aggressive, benign and low-grade malignant bone tumours. Lancet Oncol 2005;6:25-34. [CrossRef]
20. 22. Abdelrahman M, Bassiony AA, Shalaby H, Assal MK. Cryosurgery and impaction subchondral bone graft for the treatment of giant cell tumor around the knee. HSS J 2009;5:123-8. [CrossRef]
21. 23. Lee RJ, Mayerson JL, Crist M. Fracture risk with pressurizedspray cryosurgery. Am J Orthop 2011;40:105-9.
22. 24. Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA. Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol 1998;24:120-6. [CrossRef]
23. 25. Malawer MM, Dunham W. Cryosurgery and acrylic cementation as surgical adjuncts in the treatment of aggressive (benign) bone tumors. Analysis of 25 patients below the age of 21. Clin Orthop Realt Res 1991;262:42-57.
24. 26. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor. A long-term follow up study. Clin Orthop Relat Res 1999;359:176-88. [CrossRef]
25. 27. Liu YP, Li KH, Sun BH. Which treatment is the best for giant cell tumors of the distal radius? A meta-analysis. Clin Orthop Relat Res 2012;470:2886-94. [CrossRef]
26. 28. Taraz-Jamshidi MH, Gharadaghi M, Mazloumi SM, HallajMoghaddam M, Ebrahimzadeh MH. Clinical outcome of enblock resection and reconstruction with nonvascularized fibular autograft for the treatment of giant cell tumor of distal radius. J Res Med Sci 2014;19:117-21.
27. 29. Guo W, Sun X, Zang J, Qu H. Intralesional excision versus wide resection for giant cell tumor involving the acetabulum: which is better? Clin Orthop Relat Res 2012;470:1213-20. [CrossRef]
28. 30. Balke M, Streitbuerger A, Budny T, Henrichs M, Gosheger G, Hardes J. Treatment and outcome of giant cell tumors of the pelvis. Acta Orthop 2009;80:590-6. [CrossRef]
29. 31. Wilkins RM, Okada Y, Sim FH, Chao EYS, Gorgki J. Methyl methacrylate replacement of subchondral bone: A biochemical and morphologic analysis. In: Enneking WF, editor. Limbs paring surgery in musculoskeletal oncology. New York: ChurchillLivingstone; 1987.
30. 32. Gage AA, Greene GW Jr, Neiders ME, Emmings FG. Freezing bone without excision. An experimental study of bonecell destruction and manner of regrowth in dogs. JAMA 1966;196:770-4. [CrossRef]
31. 33. Shi W, Indelicato DJ, Reith J, Smith KB, Morris CG, Scarborough MT, et al. Radiotherapy in the management of giant cell tumor of bone. Am J Clin Oncol 2013:36:505-8. [CrossRef]
32. 34. Ruka W, Rutkowski P, Morysinski T, Nowecki Z, Zdzienicki M, Makula D, et al. The megavoltage radiation therapy in treatment of patients with advanced or difficult giant cell tumors of bone. Int J Radiat Oncol Biol Phys 2010;78:494-8. [CrossRef]
33. 35. Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, et al. Giant Cell Tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am 2012;94:461-7. [CrossRef]
34. 36. Demirsoy U, Karadogan M, Selek O, Anik Y, Aksu G, Müezzinoglu B, et al. Golden bullet-denosumab: early rapid response of metastatic giant cell tumor of the bone. J Pediatr Hematol Oncol 2014;36:156-8. [CrossRef]