Chondroblastoma treatment by radiofrequency thermal ablation: Initial experience and implementation

Santiago, Fernando Ruíz; Ramos‐Bossini, Antonio Jesús Láinez; Martínez, Alberto; Espinosa, Jade García

doi:10.1016/j.ejrad.2021.109950

Cited by 11 publications

(13 citation statements)

References 24 publications

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“…Although our experience didn’t include minimal invasive procedures, RFA is another attractive option for small lesions localized in challenging surgical sites as femoral head, posterior aspect of proximal tibia and tarsal bones, with an incidence of LR comparable to curettage [ 3 , 26 – 28 ]. Due to the learning curve, authors observed a higher incidence of recurrence in the early stage of application of this method, but they concluded RFA can be a successful treatment option of CBL in all anatomical sites [ 3 , 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Long term outcome of surgical treatment of chondroblastoma: analysis of local control and growth plate/articular cartilage related complications

Muratori

Scanferla

Roselli

et al. 2023

BMC Musculoskelet Disord

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Background Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage. Methods We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur’s head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient. Results Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed. Conclusion More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis. Trial Registration Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Long term outcome of surgical treatment of chondroblastoma: analysis of local control and growth plate/articular cartilage related complications

Muratori

Scanferla

Roselli

et al. 2023

BMC Musculoskelet Disord

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“…They also showed that pain control after a second surgery was 100% in the 2 cases of recurrence they had. 15 Radiofrequency ablation could be an acceptable treatment; however, the number of patients treated with radiofrequency ablation in our series was too limited to give any robust conclusions about this treatment strategy. Radiation therapy is advised against, since it can stimulate progression to malignancy (sarcomatous transformation).…”

Section: Discussionmentioning

confidence: 83%

“…New surgical approaches like percutaneous cryoablation and radiofrequency ablation are being developed and might contribute to treatment in selected cases as a primary treatment (ie chondroblastomas found in locations of difficult or challenging surgical access), or as a preferred treatment for local recurrences. 15…”

Section: Discussionmentioning

confidence: 99%

“…Chemical cauterization with phenol or liquid nitrogen cryoablation might be used as adjuvant therapies, as they have been suggested to decrease the recurrence rate 2,6 . In their study of 13 cases, Ruiz Santiago et al 15 suggest good results using radiofrequency thermal ablation, showing an 83% healing rate after the first surgery. They also showed that pain control after a second surgery was 100% in the 2 cases of recurrence they had 15 .…”

Section: Discussionmentioning

confidence: 99%

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Chondroblastomas in Children and Young Adults: Revision of 55 Cases

Brunet,

Torner,

Suñol

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Chondroblastomas are uncommon primary bone tumors localized in long bone epiphyses in children and young adults. The risk of metastasis is rare, but they have a high capacity for local recurrence. Surgical curettage with bone grafting or bone substitute is the preferred treatment. Methods: We performed an observational retrospective study of chondroblastomas treated in 2 hospitals in Barcelona from 1988 to 2018. We reviewed the location of the tumor, clinical presentation, imaging, histopathology, initial treatment, and cases of recurrence with a review of their treatment. We assessed the correlation between recurrence and index surgery, anatomic location, and certain histopathologic findings (presence of mitotic figures, necrosis, and positivity for protein S-100). Results: The series included 55 patients treated from 1988 to 2018, with ages ranging from 6 to 26, and a mean follow-up of 6.1 years (±3.7). The most common location was the distal femur metaphyseal/epiphyseal region. The most frequent clinical presentation was pain in the affected. Forty-five cases (81.8%) were treated with curettage of the tumor, and 4 cases (7.3%) with a wide resection. Forty-two cases (85.7%) received bone substitutes after curettage or resection. We found 5 cases of recurrence (9.1% recurrence rate); however, we could not find a statistically significant correlation between index surgery and recurrence (P=0.24), anatomic location and recurrence (P=0.49), or recurrence and histopathologic findings (mitotic figures, P=0.49; necrosis, P=0.60; positivity for protein S-100, P=0.52). In all the cases the treatment for the local recurrence was surgical, with a final healing rate of 100%. Conclusions: Chondroblastomas should be considered in children and adolescents when presenting with pain and an image suggestive of a tumoral lesion on plain x-ray, most frequently in epiphyses of long bones. Surgical treatment is preferred, obtaining good results after curettage and bone substitute. Chondroblastomas are tumors with a high capacity for recurrence, therefore an adequate surgical technique and surgeon experience are paramount to achieve good outcomes. Level of Evidence: Level IV (case series). Therapeutic studies—investigating results or treatment.

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“…[1] Further emphasis has been laid on patient selection by adopting multidisciplinary teams/ musculoskeletal tumour committees in planning intervention and individualising treatment. [2,3] Multiple studies have shown that radiofrequency ablation can result in subchondral fractures as a complication. [1,[3][4][5] We would like to emphasize that during initial arthroscopic examination in our patient, the roof of the lesion in question was noted to be hyperaemic and friable, indicating inadequate bony margins and increased susceptibility to subchondral fracture.…”

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confidence: 99%