Use of the Argon Beam Coagulator as an Adjuvant for Treating Bone Tumors

A comparison of depth of necrosis among adjuvant therapies used for the treatment of benign bone tumors

BACKGROUND AND OBJECTIVES

Benign bone tumors are often treated with extended curettage utilizing an adjuvant therapy to eliminate any remaining tumor cells. The purpose of this study was to explore and compare the histologic depth of necrosis created by various adjuvant therapies used in the treatment of benign bone tumors.

METHODS

A high-speed burr was utilized to create cortical defects within porcine humeri and femora. Phenol, polymethyl methacrylate (PMMA), argon beam coagulation (ABC), liquid nitrogen, and the Bipolar Hemostatic Sealer (BHS) were each applied to five defects, with an additional five defects left untreated as a control. The maximal depth of necrosis was determined under microscopic examination.

RESULTS

The phenol, PMMA, ABC, liquid nitrogen, and BHS demonstrated an average histologic depth of necrosis of 0.30, 0.78, 2.54, 2.54, and 0.92 mm, respectively, each of which was significantly increased compared to the control group (p = .001, .003, .003, .01, and  <.001). Their respective variances, a measure of reproducibility, were 0.01, 0.09, 0.96, 1.93, and 0.03 mm² .

CONCLUSION

This study confirms, through histologic analysis, adjuvant therapies create a rim of cellular necrosis beyond that of burring during extended curettage, supporting their use in the treatment of benign bone tumors. Furthermore, it provides a head-to-head comparison.

Excisional Curettage of Benign Cystic Lesions

There are many treatment modalities for benign cystic lesions of bone, but all methods, except for total resection, are plagued with varying rates of recurrence¹. Thorough curettage with the use of a high-speed burr, however, has demonstrated a low recurrence rate of 12% and has been suggested to be the best method for the treatment of benign cystic lesions. Approximately 90% of aneurysmal bone cysts can be controlled adequately with this treatment alone².

Description

Treatment of benign cystic lesions of bone with the use of excisional curettage requires careful preoperative planning and patient positioning before the initial incision is made. The initial incision must be carefully planned to expose the entire lesion without violating multiple compartments unnecessarily. A sizeable cortical window must then be made using a high-speed burr followed by evacuation of all cystic contents via curettage. The cavity is copiously irrigated before an adjuvant is used, and the lesion is stabilized, if necessary, before closing.

Alternatives

There are many types of alternatives to curettage, such as wide resection, radiation, and embolization of feeding vessels.

Rationale

In orthopaedics, as in all medical specialties, many interventions and techniques have been rendered obsolete and, ultimately, replaced by newer, safer, and more efficient ones. The appeal of curettage has remained because of its procedural simplicity and adaptability in the management of a plethora of diseases such as benign cystic lesions of bone. Additionally, curettage, unlike wide resection, radiation, and embolization of feeding vessels, is minimally invasive and often definitive in nature when used as a treatment modality². Lastly, curettage grants the performing surgeon the ability to maintain a contained cavity that can be treated with a variety of adjuvant therapies^3-17. These reasons listed above make curettage a viable option for the surgical treatment of benign cystic lesions such as giant cell tumors of bone, aneurysmal bone cysts, unicameral bone cysts, chondromyxoid fibromas, and symptomatic nonossifying fibromas.

Comparison of phenol and argon beam coagulation as adjuvant therapies in the treatment of stage 2 and 3 benign-aggressive bone tumors

Argon beam photocoagulation has gained popularity as an adjuvant therapy for the treatment of giant cell tumors of bone and other stage 2 or 3 benign-aggressive bone tumors. Although argon beam photocoagulation has been considered a safe and reasonable adjuvant treatment with acceptable recurrence rates, it has never been directly compared with the commonly described phenol as adjuvant. The purpose of this study was to determine whether argon beam photocoagulation is as effective as phenol in preventing recurrence without affecting functional outcome as an adjuvant to surgical curettage. We retrospectively reviewed 93 consecutive patients with a minimum 10-month follow-up between 1992 and 2007 who were treated with curettage and either phenol or argon beam photocoagulation. Functional outcomes and complications were recorded. Overall, 16 (17.2%) of 93 patients who were initially treated with 1 of the adjuvants had pathologically confirmed recurrences. No additional recurrences were noted after retreatment, leading to an overall recurrence rate of 17.1% with phenol and 14.8% with argon beam photocoagulation (P=.726). While avoiding the toxic effects of phenol, argon beam photocoagulation provides for statistically equivalent recurrence rates, functional outcomes, and complication rates in the treatment of benign-aggressive bone tumors.

Local adjuvants in surgical management of bone metastases

Curettage is one of the most common method for surgical treatment of bone metastasis. Local adjuvant improve most commonly used for improving the effect of curettage in local cancer surgery may exerted their effects either chemically either physically; in Orthopedic Oncology the most common are phenol, liquid nitrogen, laser, and cement. This article reviewed the main characteristics of the most common chemical and physical agents used in bone oncology, emphasizing the toxic effects of some of them, especially phenol and liquid nitrogen.