, Volume 471, Issue 8, pp 2675-2683

Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report

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Topic
Tumor

Abstract

Background

Aneurysmal bone cyst (ABC) has a recurrence rate of between 12% and 71% without en bloc resection or amputation. There is no percutaneous ABC treatment drug regimen demonstrating consistent evidence of bone healing with recurrence of < 12%. Doxycyline has properties that may make it appropriate for percutaneous treatment.

Questions/purposes

We therefore asked: (1) Is there reduction in ABC lytic cyst volume with injectable doxycycline? (2) Is it associated with thickening of involved bony cortex? (3) Is the recurrence rate after percutaneous treatment < 12%?

Methods

We retrospectively reviewed 20 patients who underwent percutaneous treatment of ABCs with doxycycline from 2006 to 2010. The mean age was 10 years (range, 3–18 years). There were 21 treatment locations: humerus (six), spine (five), clavicle (two), fibula (one), femur (two), ulna (two), tibia (two), and scapula (one). Twenty patients completed treatment involving 118 treatment sessions (two to 14 sessions per patient). Treatment response was evaluated radiographically by measuring the lytic component and thickness of involved cortex. Recurrence was indicated by new areas of lytic destruction after completion of treatment. The minimum followup was 24 months (mean, 38 months).

Results

Twenty of 20 patients demonstrated reduction in lytic destruction and bony healing. All patients demonstrated cortical thickening. One patient demonstrated recurrent minimal lytic destruction after 20 months of observation.

Conclusions

In this series, patients undergoing percutaneous doxycycline treatment of ABCs demonstrated a healing response and a recurrence rate of 5% at more than 24 months.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Nationwide Children’s Hospital, Columbus, OH, USA.