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

Abstract

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.

Risk factors of fracture following curettage for bone giant cell tumors of the extremities

“…Compared to liquid nitrogen, phenol has less penetration into the bone (10–20 mm vs. 0.2 mm), and therefore, has a lower fracture rate [ 34 , 35 ]. Bombardier et al provided various local adjuvant therapies and subsequently performed histological evaluations of bone defect models of porcine humeri and femora [ 36 ]. They reported that the average depth of necrosis was 0.3 mm in the phenol group and 2.54 mm in the liquid nitrogen spray group [ 36 ].…”

“…Bombardier et al provided various local adjuvant therapies and subsequently performed histological evaluations of bone defect models of porcine humeri and femora [ 36 ]. They reported that the average depth of necrosis was 0.3 mm in the phenol group and 2.54 mm in the liquid nitrogen spray group [ 36 ]. Van der Heijden et al reported that the use of liquid nitrogen significantly increased the risk of non-oncological complications, including osteoarthritis, infection, postoperative fracture or femoral condyle collapse, nonunion, nerve palsy, and PMMA leakage [ 4 ].…”

Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review

“…Polymethyl methacrylate (PMMA) can also be employed in tumor management, as it was assumed that its heat of polymerization and direct toxic effect of monomers could be a mechanism of adjacent cellular toxicity [13,59,83]. However, it is not considered an adjuvant for local tumor control, but rather a mechanical reinforcement of the tumoral cavity.…”

“…Argon Beam Coagulation (ABC) can also help in bone tumor treatment [7,83]. For decades, this technique has been known as a method for surface controls during major open surgical sites, using the same principles as a standard electrosurgical generator, but without the need for direct contact [84].…”

Corrigendum

“…In the article by Bombardier et al, 1 the order of authorship has been changed. The correct order should read as follows:…”