ABSTRACT
Fifty-two cases of giant cell tumor of bone have been treated by cryosurgery--an extensive freezing of residual tumor after curettage. Cryosurgery is performed by direct pouring of liquid nitrogen into the tumor cavity through a funnel. The cavity is filled with methylmethacrylate and corticocancellous onlay grafts until peripheral bone regeneration occurs to provide bone stability and prevent postoperative pathologic fracture. Patients with lesions in a weight bearing bone are placed in a long leg ischial weight bearing brace until sufficient healing has taken place. Rebiopsy (a second stage diagnostic procedure) is performed 3-6 months after the original cryosurgery. By comparison of pathology, results and complications between our first series of 25 cases and the additional 27, we have observed only one frank malignant giant cell tumor (1.9% incidence). This is much lower than the previously reported 16% fully malignant complication rate, and may be the result of the rapid elimination of the giant cell tumor by cryosurgery.
Subject(s)
Bone Neoplasms/surgery , Cryosurgery , Giant Cell Tumors/surgery , Adolescent , Adult , Aged , Ankle Joint/physiopathology , Ankle Joint/surgery , Child , Female , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Male , Middle Aged , Movement , Necrosis , Postoperative Complications , Skin/pathology , Surgical Wound Infection/etiologySubject(s)
Bone Neoplasms/surgery , Cryosurgery , Giant Cell Tumors/surgery , Adolescent , Adult , Aged , Bone Neoplasms/pathology , Child , Cryosurgery/adverse effects , Cryosurgery/methods , Female , Femoral Neoplasms/surgery , Fractures, Bone/etiology , Giant Cell Tumors/pathology , Humans , Knee Joint/surgery , Male , Middle Aged , Neoplasm Metastasis , Neoplasms, Multiple Primary , Paralysis/etiology , Skin Diseases/etiology , Surgical Wound Infection/etiology , Tibia/surgeryABSTRACT
Cryosurgery combined with routine "second look" biopsy has been previously reported in our initial series of 25 cases and has been demonstrated to be a promising modality in the treatment of giant cell tumors of bone. Further refinement of this surgical technique by more careful preliminary curettage has now significantly improved the rate of local tumor control and has markedly reduced the incidence of associated complications. While the problems of infection, fracture, delayed bone healing and local tumor recurrence have not been completely eliminated, our experience with 27 additional cases shows that it has been possible to develop a highly reliable procedure for the eradication of tumor while usually preserving joint motion and avoiding arthrodesis or amputation. The 1.9% malignancy rate is much lower than the previously reported papers by Hutter and Jaffe.
