Comparison of Phenol and Argon Beam Coagulation as Adjuvant Therapies in the Treatment of Stage 2 and 3 Benign–Aggressive Bone Tumors

Abstract

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.

A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee

“…Van et al [ 15 ] believed that the exothermic reaction of PMMA is a risk factor for the development of osteoarthritis. Similar results were reported by Chen et al [ 23 ] and Joseph et al [ 24 ] Currently, PMMA is widely used for cavity filling and structural reconstruction in GCTB and some low-grade malignant bone tumors and is believed to be associated with a high rate of osteoarthritis. [ 1 , 3 , 21 ] However, some remedies might be available to prevent heat necrosis and problems related to the mechanical properties of PMMA.…”

“…Similarly, Van et al [ 15 ] found that the function and quality of life of patients with KL3-4 were comparable with those of patients with KL0-2, suggesting that radiographic findings of osteoarthritis identified at a mid-term follow-up persisted. Joseph et al [ 24 ] found that compared with PMMA alone, the use of periarticular bone graft constructions reduces postoperative osteoarthritis without increasing the likelihood of tumor recurrence. However, there remains a lack of consensus concerning the need for fixation when intralesional curettage is performed.…”

Giant cell tumor of bone revisited

“…Curettage with PMMA has been associated with local recurrence rates of 0–29% [ 46 , 61 , 63 – 65 , 68 – 75 , 90 , 91 ]; when combined with local phenol application the local recurrence rates are 3–33% [ 46 , 61 , 63 – 65 , 69 , 71 – 74 ]. Local recurrences can be treated with repeat curettage, phenol, and PMMA, with re-recurrence rates of 9–34% (mean: 19%) [ 61 , 64 – 67 , 72 , 73 , 76 – 80 ]. Cryoablation with liquid nitrogen is associated with local recurrence rates of 8–42% (mean: 21%) and 0–20% (mean: 6%) when combined with bone grafts and PMMA [ 60 , 65 , 70 , 72 , 81 – 99 ].…”

Local Adjuvants in Surgical Management of Bone Lesions

“…Tissue desiccation causes tissue carbonization, thus the cavity tends to assume a characteristic dark colouring. As data in medical literature confirm, this technique is easier to manage than others [25]; In fact argon beam coagulation has been considered a safe and reasonable adjuvant treatment with low recurrence rates.…”