The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee

Abstract

Pigmented villonodular synovitis (PVNS) is a rare proliferative process of the synovium which most commonly affects the knee and occurs in either a localised (LPVNS) or a diffuse form (DPVNS). The effect of different methods of surgical synovectomy and adjuvant radiotherapy on the rate of recurrence is unclear. We conducted a systematic review and identified 35 observational studies in English which reported the use of surgical synovectomy to treat PVNS of the knee. A meta-analysis included 630 patients, 137 (21.8%) of whom had a recurrence after synovectomy. For patients with DPVNS, low-quality evidence found that the rate of recurrence was reduced by both open synovectomy (odds ration (OR) = 0.47; 95% CI 0.25 to 0.90; p = 0.024) and combined open and arthroscopic synovectomy (OR = 0.19, 95% CI = 0.06 to 0.58; p = 0.003) compared with arthroscopic surgery. Very low-quality evidence found that the rate of recurrence of DPVNS was reduced by peri-operative radiotherapy (OR = 0.31, 95% CI 0.14 to 0.70; p = 0.01). Very low-quality evidence suggested that the rate of recurrence of LPVNS was not related to the surgical approach. This meta-analysis suggests that open synovectomy or synovectomy combined with peri-operative radiotherapy for DPVNS is associated with a reduced rate of recurrence. Large long-term prospective multicentre observational studies, with a focus on both rate of recurrence and function, are required to confirm these findings.

Diffuse-type tenosynovial giant cell tumour: Current treatment concepts and future perspectives

“…Furthermore, repetitive surgical treatment can lead to substantial morbidity to the impacted joints and impaired quality of life. Various forms of radiation therapy have been applied in an attempt to reduce the risk of local recurrence and as an alternative to surgery, although these strategies have not been rigorously tested in large, prospective clinical studies [10,11]. Historically, conventional chemotherapeutic agents have not been proven effective in TGCT, but new drugs are under investigation for this indication, with promising preliminary results [12e15].…”

Multifocal pigmented villonodular synovitis coexisting in both the knee joint and the patella: a case report and literature review

“…The diffuse type of PVNS recurrence is always a challenge, which was reported to be as high as 50% when complete resection of affected synovium is not achieved [16, 34]. Arthroscopic resection has grown to be a valuable option for PVNS arising in the knee joint [35–37].…”

“…Many studies have shown that peri-operative radiotherapy for PVNS is associated with a low rate of recurrence, and that external beam radiation is a safe and effective adjuvant therapy for PVNS [15, 16]. The risk of radiation-induced cancer due to radiotherapy for PVNS was estimated very small [38].…”

“…Suture removal was done on day 12. Adjuvant external beam radiation [15, 16] was used from day 15. A total of 20 Gy delivered in 10 sessions every 2 days, with a duration of 20 days.…”

Extra-articular diffuse-type tenosynovial giant cell tumor with benign histological features resulting in fatal pulmonary metastases

“…11 For recurrent or unresectable lesions, moderate-dose adjuvant radiotherapy might be able to provide good local control while maintaining good limb function. 12 Recently, new agents for the treatment of relapsed TS-GCT have been proposed. TS-GCT commonly overexpresses colony-stimulating factor 1 (CSF1) resulting from a t(1;2) translocation.…”