Advantages of Pressurized-Spray Cryosurgery in Giant Cell Tumors of the Bone

Abstract

Background: Giant Cell Tumor is considered a benign, local and aggressive tumor. Although considered a benign bone tumor, it is still the subject of discussion and research because of the associated local bone destruction, as well as high rates of recurrence and distant metastases. Options are being developed for both surgical techniques and adjuvant therapies.

Aims: The present study evaluated the administration of cryotherapy via a pressurized-spray technique in giant cell tumors of the bone.

Study design: Cross-sectional study.

Methods: The study included 40 patients who were treated with extensive curettage and cryotherapy at various locations during the period from February 2006 to December 2013. Informed consent forms were obtained from the participants and ethics committee approval was taken from the local ethics committee of Ondokuz Mayıs University. The pressurized-spray technique was performed using liquid nitrogen. The patients were evaluated with respect to age, gender, radiological appearance, treatment modality, duration of follow-up, skin problems and recurrence.

Results: Twenty-one patients were female; 19 were male. The average age of the patients was 33 years (range: 16-72 years), and the average duration of follow-up was 43 months (range: 12-80 months). The average time from the onset of the complaints to the diagnosis was 6 months (range: 2-12 months). Based on the Campanacci classification: 9 patients were Grade I; 25 patients were Grade II; six patients were Grade III. The lesion was located in the femur in 14 patients, in the tibia in 11 patients, in the radius in 5 patients, in the pelvis in 4 patients, in the fibula in 3 patients, in the metatarsal in 2 patients and in the phalanges of the hand in one patient. One patient had postoperative early fracture. None of the patients had skin problems and infection. Three (7.5%) of the patients had recurrence.

Conclusion: It was found that cryotherapy was highly effective in the lesions, especially those located in the femur and tibia and remained insufficient in the lesions expanded outside the cortex. Wound healing problems, infection and fracture risk are lower with this technique.

Keywords: Giant cell tumor; bone; cryotherapy; pressurized-spray technique; surgical treatment.

FIG. 1.

X-ray, MRI and CT images of giant cell tumor(X-ray: direct radiography; MRI: magnetic resonance imaging; CT: computerized tomography)

FIG. 2.

Intraoperative appearance of pressurized-spray cryosurgery

FIG. 3.

Localizations of giant cell tumor on skeleton

FIG. 4.

Second surgical treatment of a patient with fracture established after cryotherapy

FIG. 5.

Preoperative and postoperative view of sacral GCT (GCT: giant cell tumor)

FIG. 6.

Preoperative and postoperative view of metatarsal giant cell tumor