Argon Beam Coagulation as an Adjuvant for Local Control of Giant Cell Tumor

Abstract

The argon beam coagulator is gaining popularity as an adjuvant therapy for treatment of giant cell tumors of bone. However, the effectiveness and functional implications of this treatment have not been assessed. To determine whether the argon beam coagulator could be a viable adjuvant treatment option, we examined the recurrence rate and functional outcome of patients with giant cell tumors who were treated with the argon beam coagulator, as an adjuvant to curettage and cementation. Thirty-seven patients who received argon beam coagulation as an adjuvant treatment for giant cell tumors diagnosed between 1993 and 2000 were identified. The median age of the patients was 32 years (range, 16-64 years). The mean followup was 73.7 months (range, 0.5-108 months). Three patients had osseous recurrences (8.3%) and one had a soft tissue recurrence. The 5-year Kaplan-Meier disease-free survival estimate was 87.2% (95% confidence interval, range, 76.3-99.8). No patient had radiographic evidence of arthritis. The average Musculoskeletal Tumor Society score was 28. Short form-36 evaluation showed no change in functional or mental perception in these patients compared with US norms. These data suggest argon beam coagulation as an adjuvant therapy is associated with in a low rate of local recurrence and is a reasonable adjuvant treatment option.

Similar local recurrence but better function with curettage versus resection for bone giant cell tumor and pathological fracture at presentation

“…Previous studies reported a higher local recurrence rate in patients with GCTB and a pathological fracture treated with curettage . Other studies did not confirm the previous reports .…”

“…The cavity was then curetted with a high‐speed burr and washed with saline to remove all pathological tissue . Then, in 11 patients, phenol was applied to the tumor cavity with cotton‐tipped swabs followed by washing with alcohol for neutralization while in two patients argon beam coagulator was used as a paintbrush throughout the entire cavity . The tumor cavity was then filled with bone allografts (five patients), cement (five patients), cement and bone allografts (one patient), or hydroxyapatite graft (two patients).…”

“…Giant cell tumor of bone (GCTB) accounts for approximately 5% of all primary bone tumors . The rate of pathological fracture at presentation in these patients is 4% to 50% . In the presence of a pathological fracture, treatment with curettage may be difficult and may lead to a higher local recurrence rate because of tumor contamination of adjacent soft tissues and joint by the hematoma .…”

Cement is recommended in intralesional surgery of giant cell tumors: A Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years

“…phenol, alcohol, sterile water, heat, freezing, zinc, and hydrogen peroxide (Nicholson et al 1998, Malawer et al 1999, Trieb et al 2001, Ghert et al 2002, Ward and Li 2002, Haskell et al 2003, Zhen et al 2004. Recently, argon laser therapy has been added to the list (Lewis et al 2007). None of these methods were used extensively in the present series and their indications remain unclear.…”

Clinical characteristics and prognoses of six patients with multicentric giant cell tumor of the bone

“…On MRI, 3 lesions showed soft tissue masses with extensive edema, which proved to be a prognostic marker of local recurrence [28]. Further, pathological fractures were considered not only a potential marker of aggression [29], but also a prognostic factor for local recurrence [30]. Although the prognostic value of cortical discontinuity and soft tissue mass is still debated, there is broad agreement that soft tissue mass extension definitely influences ideal surgical treatment selection.…”