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Similar Local Control between Phenol- and Ethanol-treated Giant Cell Tumors of Bone

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Giant cell tumors (GCTs) of bone often are treated with curettage, adjuvant therapy, and cementation. Phenol is a commonly used adjuvant associated with local control rates ranging from 9% to 25%. However, it is corrosive to the eyes, skin, and respiratory tract. Ethanol is readily available and does not cause chemical burns on contact, but it is unclear whether ethanol can achieve similar local control rates as phenol for treating GCTs.

Questions/purposes

We evaluated (1) the recurrence rate and recurrence-free Kaplan-Meier survival function, (2) Musculoskeletal Tumor Society (MSTS) functional score (1993 version), and (3) complications of two groups of patients with GCTs treated with extensive curettage, local adjuvant therapy with phenol or ethanol, and cement reconstruction, to determine if ethanol was a reasonable alternative to phenol.

Patients and Methods

We retrospectively reviewed all 26 patients with GCTs in the long bones of extremities treated with curettage, high-speed burring, phenolization, and cementation between May 1995 and November 2001, and 35 patients treated with the same protocol, except phenol was replaced with 95% ethanol, between November 2001 and November 2007. The recurrence rates, Kaplan-Meier recurrence-free survival curves, and MSTS functional scores of these two treatment groups were compared with Fisher’s exact test, Tarone-Ware test, and Mann-Whitney U test, respectively. The minimum followup was 36 months (mean, 58 months; range, 36–156 months).

Results

Local recurrence rates were similar in the two groups: 11% in the ethanol group and 12% in the phenol group. The survival curves (using local recurrence as an endpoint) of the two groups were similar. The mean MSTS functional score was 27.3 (91%) for the ethanol group and 26.9 (90%) for the phenol group.

Conclusions

Ethanol is a reasonable alternative to phenol when adjuvant therapy is considered in the treatment of GCTs of long bones.

Level of Evidence

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

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References

  1. Ahlback S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh). 1968:Suppl 277:7–72.

    Google Scholar 

  2. Algawahmed H, Turcotte R, Farrokhyar F, Ghert M. High-speed burring with and without the use of surgical adjuvants in the intralesional management of giant cell tumor of bone: a systematic review and meta-analysis. Sarcoma. 2010;2010. pii: 586090. Epub 2010 Jul 27.

  3. Arbeitsgemeinschaft Knochentumoren, Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU. Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 2008;90:1060–1067.

    Article  Google Scholar 

  4. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 2008;134:969–978.

    Article  PubMed  CAS  Google Scholar 

  5. Bas T, Aparisi F, Bas JL. Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years. Spine(Phila Pa 1976). 2001;26:1577–1582.

    Article  CAS  Google Scholar 

  6. 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;81:811–820.

    Article  PubMed  CAS  Google Scholar 

  7. Campanacci M. Giant-cell tumor and chondrosarcomas: grading, treatment and results (studies of 209 and 131 cases). Recent Results Cancer Res. 1976;54:257–261.

    PubMed  Google Scholar 

  8. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69:106–114.

    PubMed  CAS  Google Scholar 

  9. Cotten A, Demondion X, Boutry N, Cortet B, Chastanet P, Duquesnoy B, Leblond D. Therapeutic percutaneous injections in the treatment of malignant acetabular osteolyses. Radiographics. 1999;19:647–653.

    PubMed  CAS  Google Scholar 

  10. Crawford EA, Slotcavage RL, King JJ, Lackman RD, Ogilvie CM. Ethanol sclerotherapy reduces pain in symptomatic musculoskeletal hemangiomas. Clin Orthop Relat Res. 2009;467:2955–2961.

    Article  PubMed  Google Scholar 

  11. Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 1996;5:508–516.

    Article  PubMed  CAS  Google Scholar 

  12. Deheshi BM, Jaffer SN, Griffin AM, Ferguson PC, Bell RS, Wunder JS. Joint salvage for pathologic fracture of giant cell tumor of the lower extremity. Clin Orthop Relat Res. 2007;459:96–104.

    Article  PubMed  Google Scholar 

  13. Durr HR, Maier M, Jansson V, Baur A, Refior HJ. Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone. Eur J Surg Oncol. 1999;25:610–618.

    Article  PubMed  CAS  Google Scholar 

  14. el-Mowafi H, Refaat H, Kotb S. Percutaneous destruction and alcoholisation for the management of osteoid osteoma. Acta Orthop Belg. 2003;69:447–451.

    PubMed  Google Scholar 

  15. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.

    PubMed  Google Scholar 

  16. Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev. 2010;36:1–7.

    Article  PubMed  Google Scholar 

  17. Frassica FJ, Sim FH, Pritchard DJ, Chao EY. Subchondral replacement: a comparative analysis of reconstruction with methyl methacrylate or autogenous bone graft. Chir Organi Mov. 1990;75(1 suppl):189–190.

    PubMed  CAS  Google Scholar 

  18. Fujimoto T. The experimental and clinical studies of percutaneous ethanol injection therapy (PElT) under ultrasonography for small hepatocellular carcinoma. Acta Hepatol Jpn. 1988;29:52–59.

    Article  Google Scholar 

  19. Gangi A, Kastler B, Klinkert A, Dietemann JL. Injection of alcohol into bone metastases under CT guidance. J Comput Assist Tomogr. 1994;18:932–935.

    Article  PubMed  CAS  Google Scholar 

  20. Ghert MA, Rizzo M, Harrelson JM, Scully SP. Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res. 2002;400:201–210.

    Article  PubMed  Google Scholar 

  21. Gortzak Y, Kandel R, Deheshi B, Werier J, Turcotte RE, Ferguson PC, Wunder JS. The efficacy of chemical adjuvants on giant-cell tumour of bone: an in vitro study. J Bone Joint Surg Br. 2010;92:1475–1479.

    Article  PubMed  CAS  Google Scholar 

  22. Guglielmi R, Pacella CM, Bianchini A, Bizzarri G, Rinaldi R, Graziano FM, Petrucci L, Toscano V, Palma E, Poggi M, Papini E. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid. 2004;14:125–131.

    Article  PubMed  CAS  Google Scholar 

  23. Jones KB, DeYoung BR, Morcuende JA, Buckwalter JA. Ethanol as a local adjuvant for giant cell tumor of bone. Iowa Orthop J. 2006;26:69–76.

    Article  PubMed  Google Scholar 

  24. Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C, Walloe A, Bauer HC, Jorgensen PH, Bergh P, Folleras G. Cement is recommended in intralesional surgery of giant cell tumors: a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop. 2008;79:86–93.

    Article  PubMed  Google Scholar 

  25. Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res. 2011;469:591–599.

    Article  PubMed  Google Scholar 

  26. Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ. Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res. 2005;438:123–127.

    Article  PubMed  Google Scholar 

  27. Malawer MM, Bickels J, Meller I, Buch RG, Henshaw RM, Kollender Y. Cryosurgery in the treatment of giant cell tumor: a long-term followup study. Clin Orthop Relat Res. 1999;359:176–188.

    Article  PubMed  Google Scholar 

  28. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R. Cryosurgery in the treatment of giant cell tumors of bone: a report of 52 consecutive cases. Clin Orthop Relat Res. 1978;134:275–289.

    PubMed  Google Scholar 

  29. Mjoberg B, Pettersson H, Rosenqvist R, Rydholm A. Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand. 1984;55:597–600.

    Article  PubMed  CAS  Google Scholar 

  30. Muramatsu K, Ihara K, Taguchi T. Treatment of giant cell tumor of long bones: clinical outcome and reconstructive strategy for lower and upper limbs. Orthopedics. 2009;32:491.

    Article  PubMed  Google Scholar 

  31. Nelson DA, Barker ME, Hamlin BH. Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia. 1997;13:287–306.

    Article  PubMed  CAS  Google Scholar 

  32. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am. 1994;76:1827–1833.

    PubMed  Google Scholar 

  33. Oh JH, Yoon PW, Lee SH, Cho HS, Kim WS, Kim HS. Surgical treatment of giant cell tumour of long bone with anhydrous alcohol adjuvant. Int Orthop. 2006;30:490–494.

    Article  PubMed  Google Scholar 

  34. Pals SD, Wilkins RM. Giant cell tumor of bone treated by curettage, cementation, and bone grafting. Orthopedics. 1992;15:703–708.

    PubMed  CAS  Google Scholar 

  35. Piotrowski JK. Evaluation of exposure to phenol: absorption of phenol vapour in the lungs and through the skin and excretion of phenol in urine. Br J Ind Med. 1971;28:172–178.

    PubMed  CAS  Google Scholar 

  36. Remedios D, Saifuddin A, Pringle J. Radiological and clinical recurrence of giant-cell tumour of bone after the use of cement. J Bone Joint Surg Br. 1997;79:26–30.

    Article  PubMed  CAS  Google Scholar 

  37. Rock M, Capanna R. The treatment of giant cell tumor of bone. In: Stauffer RN, Ehrlich MG, Fu FH, Kostuik JP, Manske PR, Sim FH, eds. Advances in Operative Orthopaedics. Vol 1. St Louis, MO: Mosby-Year Book; 1993:367–390.

  38. Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S. Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res. 2004;424:221–226.

    Article  PubMed  Google Scholar 

  39. Shih HN, Hsu RW, Sim FH. Excision curettage and allografting of giant cell tumor. World J Surg. 1998;22:432–437.

    Article  PubMed  CAS  Google Scholar 

  40. Shiina S, Tagawa K, Niwa Y, Unuma T, Komatsu Y, Yoshiura K, Hamada E, Takahashi M, Shiratori Y, Terano A. Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol. 1993;160:1023–1028.

    PubMed  CAS  Google Scholar 

  41. Shiina S, Tagawa K, Unuma T, Takanashi R, Yoshiura K, Komatsu Y, Hata Y, Niwa Y, Shiratori Y, Terano A. Percutaneous ethanol injection therapy for hepatocellular carcinoma: a histopathologic study. Cancer. 1991;68:1524–1530.

    Article  PubMed  CAS  Google Scholar 

  42. Szendroi M. Giant-cell tumour of bone. J Bone Joint Surg Br. 2004;86:5–12.

    PubMed  CAS  Google Scholar 

  43. Trieb K, Bitzan P, Lang S, Dominkus M, Kotz R. Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy. Eur J Surg Oncol. 2001;27:200–202.

    Article  PubMed  CAS  Google Scholar 

  44. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am. 2006;37:35–51.

    Article  PubMed  Google Scholar 

  45. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM; Canadian Sarcoma Group. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002;397:248–258.

    Google Scholar 

  46. Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jorgensen P, Folleras G, Rydholm A, Scandinavian Sarcoma Group. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing: a Scandinavian Sarcoma Group study. J Bone Joint Surg Br. 2006;88:531–535.

    Article  PubMed  CAS  Google Scholar 

  47. Wang P, Zuo C, Qian Z, Tian J, Ren F, Zhou D. Computerized tomography guided percutaneous ethanol injection for the treatment of hyperfunctioning pheochromocytoma. J Urol. 2003;170:1132–1134.

    Article  PubMed  Google Scholar 

  48. Ward WG Sr, Li G 3rd. Customized treatment algorithm for giant cell tumor of bone: report of a series. Clin Orthop Relat Res. 2002;397:259–270.

    Article  PubMed  Google Scholar 

  49. Zhen W, Yaotian H, Songjian L, Ge L, Qingliang W. Giant-cell tumour of bone: the long-term results of treatment by curettage and bone graft. J Bone Joint Surg Br. 2004;86:212–216.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Dr. Tiffany Ting-Fang Shih and Dr. Chao-Yu Hsu for interpreting the imaging studies and producing the formal radiographic reports. We also thank Dr. Chen-Tu Wu for conducting the pathologic examinations of the surgical specimens.

Author information

Authors and Affiliations

  1. Department of Orthopedics, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan

    Wei-Hsin Lin MD

  2. Department of Orthopedics, Far-Eastern Memorial Hospital, Taipei, Taiwan

    Tsung-Yu Lan MD & Karl Wu MD

  3. Department of Orthopedic Surgery, Taipei Medical University Shuang-Ho Hospital, Taipei, Taiwan

    Chih-Yu Chen MD

  4. Department of Orthopedics, College of Medicine, National Taiwan University and Hospital, Number7, Chung-Shan South Road, Taipei, Taiwan

    Rong-Sen Yang MD

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  1. Wei-Hsin Lin MD
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  2. Tsung-Yu Lan MD
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Correspondence to Rong-Sen Yang MD.

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Each author certifies that he has no 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.

Each author certifies that his institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at National Taiwan University Hospital.

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Lin, WH., Lan, TY., Chen, CY. et al. Similar Local Control between Phenol- and Ethanol-treated Giant Cell Tumors of Bone. Clin Orthop Relat Res 469, 3200–3208 (2011). https://doi.org/10.1007/s11999-011-1962-3

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  • DOI: https://doi.org/10.1007/s11999-011-1962-3

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