Lower recurrence rate in chondroblastoma using extended curettage and cryosurgery

Abstract

Purpose Various methods for the treatment of chondroblastoma of bone have been used including simple curettage, or combined with bone grafting, in addition to the use of adjuvant therapy. However, local recurrence still represents a challenge in the management of this aggressive tumour. This study focuses on evaluating the role of intraregional extended curettage together with the use of adjuvant cryotherapy and autogenous bone grafting in the treatment of benign chondroblastoma of bone aiming to decrease the recurrence rate. Methods All patients with chondroblastoma included in this study underwent intralesional extended curettage, adjuvant cryotherapy using liquid nitrogen, and autogenous iliac crest bone grafting. Follow up for healing of chondroblastoma lesions and detection of any local recurrence was assessed on clinical and radiological bases. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. Results The mean follow-up period was 49 months. The average time for bone healing was 7.4 months. Our rate of local recurrence is 7.1 %. Two patients (14.3 %) developed physeal growth arrest. One patient had superficial skin sloughing (7.1 %). None of the cases had pathological fracture. The mean Musculoskeletal Tumour Society functional score was 92.7 %. Conclusion Chondroblastoma is an aggressive benign bone tumour with a high rate of recurrence. The use of high-speed burr combined with adjuvant intralesional cryotherapy and iliac crest autogenous bone grafting is a reliable method of treatment with a low rate of recurrence.

10 Years Follow up of Chondroblastoma Treated with Intralesional Curettage: A Retrospective Study

“…While, it seems that a completely extended lesions curettage is more important than protection of the epiphyseal plate to avoid local recurrence [17]. Mashhour and Abdel Rahman [18] preferred aggressive surgical treatment at the time of the rst surgery to prevent recurrence, because re-operation after recurrence might cause more damage on growth plate. In this group of patients, complications of upper limb shortening occurred on 2 patients, who both had persistent epiphysis with lesions extended through the epiphyseal plate.…”

Benign Pediatric Tumors and Tumor-Like Conditions of the Hip

“…Additional adjuvants, such as cryosurgery with liquid nitrogen, heat, and phenol can be used to decrease the risk of recurrence in cartilage tumors. [59][60][61][62] In their study, Mashhour and Abdel Rahman reported a recurrence rate of 7.1% in patients treated with curettage followed by cryosurgery, in their literature review they did note recurrence rates up to 35%. 60 Additionally, Meftah et al and Mohler et al both reported a lower recurrence rate in patients treated with curettage and cryosurgery for low-grade cartilage tumors.…”

“…[59][60][61][62] In their study, Mashhour and Abdel Rahman reported a recurrence rate of 7.1% in patients treated with curettage followed by cryosurgery, in their literature review they did note recurrence rates up to 35%. 60 Additionally, Meftah et al and Mohler et al both reported a lower recurrence rate in patients treated with curettage and cryosurgery for low-grade cartilage tumors. 61,62 Lesions that recur may be more aggressive and larger, resulting in more extensive bone destruction.…”

CORR Insights®: What Are the Results Using the Modified Trapdoor Procedure to Treat Chondroblastoma of the Femoral Head?

“…controversial. Though studies [3,6,7,9] report low prevalence of local recurrence with use of adjuvant treatments, such as cryotherapy or phenol, it is not proven that it is the adjuvant rather than the extent of curettage that impacted the risk of local recurrence. A similar controversy existed regarding the management of giant cell tumor of bone.…”

“…The risk of local recurrence has been reported between 10% to 40% [6]. Use of adjuvant treatment with cryotherapy [3] or phenol [9] has been associated with a less than 10% risk of local recurrence [3,9], while others have reported a low-risk of local recurrence (13%) with extended curettage alone [7]. Radiofrequency ablation has been proposed as a less invasive treatment with reported local recurrence in one of 17 patients [5] and zero out of 12 patients [2].…”