Cryosurgery as Additional Treatment in Tenosynovial Giant Cell Tumors

Abstract

Introduction. Tenosynovial giant cell tumors (TGCT) emerge from the synovium and can behave aggressively. Surgical resection is the standard treatment. However, up to half of the patients with diffuse type show recurrences. Several additional treatments have been applied to reduce recurrences; none of these treatments was proven to be superior to surgical resection solely. This article describes the results of additional cryosurgery to surgical resection. Materials and Methods. We retrospectively evaluated 141 TGCT patients, between 1999 and 2007. Twelve patients had additional cryosurgery. The knee (n = 8), hip (n = 2), ankle (n = 1), and elbow (n = 1) were affected. Primary outcome variables were treatment indications, recurrences, and complications. Results. Indications for additional cryosurgery were extended disease, bone involvement, and locations that are difficult to surgically get disease-free such as cruciate ligaments. Five patients had recurrent disease, all of which had prior treatments. None of the primary treated patients had recurrent disease. One patient had a deep infection. Discussion. Cryosurgery may serve as an additional treatment for diffuse TCGT in selected cases. However, because of the small number of patients and the heterogeneous group we could not prove an advantage of additional cryosurgery over surgical resection only. Cryosurgery should be considered for further evaluation in a prospective study. If there is any effect it would be helpful, especially in patients with multiple TGCT recurrences.

Long-term efficacy of imatinib mesylate in patients with advanced Tenosynovial Giant Cell Tumor

“…In the present study, age, localization and gender distribution were consistent with the literature 10,24,26 . The extent of disease in our patient group is emphasized by a disease specific survival of 90% including four metastatic patients and 49% of patients had three or more surgeries before start IM.…”

“…The extent of disease in our patient group is emphasized by a disease specific survival of 90% including four metastatic patients and 49% of patients had three or more surgeries before start IM. Similar to previous case-series, we calculated a 1- and 5-years PFS of 71% and 48%, metastatic patients excluded, respectively 10,24,26 . Because of heterogeneity of patients and a variety of treatments, it is debatable to compare these numbers.…”

“…However, diffuse TGCT is difficult to remove completely and often requires a total synovectomy, or at times a joint replacement, or rarely even amputation 1,2,7 . In patients with extensive and/or recurrent TGCT, other available treatment modalities include radiation synovectomy 8 , external beam radiation therapy 9 , and cryosurgery 10 . Their therapeutic value has only been assessed in retrospective, in most cases single center series and their long term side effects and complications are poorly described 11 .…”

CSF1 Receptor Inhibition of Tenosynovial Giant Cell Tumor Using Novel Disease-Specific MRI Measures of Tumor Burden

“…Surgical resection is the treatment of choice for localized TGCT [ 4 ], whereas total synovectomy, joint replacement or amputation may be needed in diffuse TGCT [ 5 ]. These surgical treatment strategies are not optimal and carry a high risk of recurrence [ 6 ].…”