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Levanon E, Merose O, Segal O, Dadia S, Sternheim A, Levin D, Sher O, Gortzak Y. Does cryotherapy decrease the local recurrence rate in the treatment of an aneurysmal bone cyst? A comparative assessment. J Orthop Res 2024; 42:1369-1375. [PMID: 38146068 DOI: 10.1002/jor.25775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
Curettage with or without the use of adjuvants is the standard of care in the treatment of an aneurysmal bone cyst (ABC). Historically, our approach combined curettage, high-speed burr drilling, and cryoablation. However, treatments varied based on age, tumor location, and surgeon preference. We asked: (1) Does cryoablation in addition to curettage and burr drilling decrease the local recurrence rates? (2) Are there any risk factors for the local recurrence rate? (3) Does cryoablation improve postsurgical functional outcomes in these patients? Patients treated for an ABC, between January 2006 and December 2019 were included in this retrospective analysis. Patient and surgical characteristics, such as age, gender, tumor location, type of treatment, time of follow-up, recurrence rate, and functional outcome measured by the Musculoskeletal Tumor Society Score 1993 (MSTS93) score were compared between those treated with and without cryoablation. Both groups, without cryoablation (n = 88) and with cryoablation (n = 42), showed no significant difference in local recurrence rates (9.1% vs. 7.1%, p = 0.553) and functional outcomes as measured by the MSTS93 score (28.9 vs. 27.8, p = 0.262). Risk factors analyzed did not significantly affect local recurrence risk, except for secondary ABC diagnosis (p = 0.017). The cryoablation group had a more extended follow-up (45.6 vs. 73.2 months, p < 0.001), reflecting a shift in practice over time. We found no significant difference in local recurrence rate or functional outcome in patients treated with or without cryoablation. Formal curettage with additional high-speed burr drilling provides effective tumor control and favorable functional outcomes, negating the need for adjuvant cryoablation.
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Affiliation(s)
- Eran Levanon
- Faculty of Health Sciences, Goldman School of Medicine, Ben Gurion University, Beer Sheva, Israel
| | - Omri Merose
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Sternheim
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Levin
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Osnat Sher
- Bone and Soft Tissue Pathology, Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Gortzak
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Pediatric Orthopedic Oncology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Marchenko ES, Dubovikov KM, Kuzhelivskiy II, Pleshkov MO, Koroluk ES, Brazovskii KS, Volinsky AA. In vivo study of porous NiTi cryotweezers for bone tissue cryotherapy. Cryobiology 2024; 115:104894. [PMID: 38614237 DOI: 10.1016/j.cryobiol.2024.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
This study examined the effects of liquid nitrogen vapor on osteogenesis in the rabbit femur. Cryotweezers made of porous nickel titanium alloy (nitinol or NiTi) obtained by self-propagating high temperature synthesis were used in this experiment. The porous structure of the cryotweezers allows them to hold up to 10 g of liquid nitrogen after being immersed for 2 min, which completely evaporates after 160 s. To study the effects of liquid nitrogen evaporation on osteogenesis, a rabbit femur was perforated. The formed holes were subjected to cryotherapy with varying exposure times. It was found that a 3 s exposure time stimulates osteogenesis, which was manifested in a greater number of osteoblasts in the regenerate compared to the control sample without liquid nitrogen. It was observed that increasing the exposure to 6, 9 or 12 s had a destructive effect, to varying degrees. The most severe damage was exerted by a 12 s exposure, which resulted in the formation of osteonecrosis areas. In the samples exposed to 6 and 9 s of cryotherapy, destruction of the cytoplasm of osteocytes and osteoclasts was observed.
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Affiliation(s)
- Ekaterina S Marchenko
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 36 Lenin Ave., 634045, Tomsk, Russia
| | - Kirill M Dubovikov
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 36 Lenin Ave., 634045, Tomsk, Russia
| | - Ivan I Kuzhelivskiy
- Department of Pediatric Surgical Diseases, Siberian State Medical University, 72 Olega Koshevogo Str., 634050, Tomsk, Russia
| | - Maksim O Pleshkov
- Laboratory "Bionic Digital Platforms", Siberian State Medical University, 2c7 Moskovsky Trakt, 634050, Tomsk, Russia
| | - Evgeniy S Koroluk
- Laboratory "Bionic Digital Platforms", Siberian State Medical University, 2c7 Moskovsky Trakt, 634050, Tomsk, Russia
| | - Konstantin S Brazovskii
- Division of Medical and Biological Cybernetics, Department of Biomedicine, Siberian State Medical University, 2 Moskovsky Trakt, 634050, Tomsk, Russia; Research School of Chemistry & Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia
| | - Alex A Volinsky
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 36 Lenin Ave., 634045, Tomsk, Russia; Department of Mechanical Engineering, University of South Florida, 4202 E. Fowler Ave. ENG030, Tampa, FL, 33620, USA.
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Rowland AN, Raji OR, Nelles DB, Jang ES, Kondrashov DG. Thermal Damage in Orthopaedics. J Am Acad Orthop Surg 2024; 32:e368-e377. [PMID: 38335498 DOI: 10.5435/jaaos-d-23-00838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
There are numerous potential sources of thermal damage encountered in orthopaedic surgery. An understanding of the preclinical mechanisms of thermal damage in tissues is necessary to minimize iatrogenic injuries and use these mechanisms therapeutically. Heat generation is a phenomenon that can be used to a surgeon's benefit, most commonly for hemostasis and local control of tumors. It is simultaneously one of the most dangerous by-products of orthopaedic techniques as a result of burring, drilling, cementation, and electrocautery and can severely damage tissues if used improperly. Similarly, cooling can be used to a surgeon's advantage in some orthopaedic subspecialties, but the potential for harm to tissues is also great. Understanding the potential of a given technique to rapidly alter local temperature-and the range of temperatures tolerated by a given tissue-is imperative to harness the power of heat and cold. In all subspecialties of orthopaedic surgery, thermal damage is a relevant topic that represents a direct connection between preclinical and clinical practice.
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Affiliation(s)
- Andrea N Rowland
- From the Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program (Rowland, and Kondrashov), the Biomechanical Lab, The Taylor Collaboration (Raji), the Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA (Nelles, and Kondrashov), and the Department of Orthopaedic Surgery, Kaiser Permanente, Oakland, CA (Jang)
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Miao Z, Xu M, Zheng K, Gong H, Yan N, Chen Q, Yu X. Denosumab combined with precision radiotherapy for recurrent giant cell tumor of the thoracic spine: a case report and literature review. Front Neurol 2024; 14:1308600. [PMID: 38239323 PMCID: PMC10794628 DOI: 10.3389/fneur.2023.1308600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Giant cell tumors of the spine have a high recurrence rate owing to their special anatomical site; hence, further treatment after recurrence is very challenging. Achieving effective tumor control and improving the long-term quality of life of the patients are the main treatment purposes to consider for recurrent giant cell tumors of the spine. A patient showing giant cell tumor recurrence of the thoracic spine after curettage received denosumab combined with precision radiotherapy, through which the tumor gained good control and the patient could regain normal functioning. A review of the relevant literature suggested that denosumab combined with radiotherapy is an effective new approach for the treatment of recurrent giant cell tumors of the spine.
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Affiliation(s)
- Zukang Miao
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming Xu
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Kai Zheng
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Hai Gong
- Department of Radiotherapy, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Ning Yan
- Department of Radiotherapy, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Qian Chen
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Xiuchun Yu
- Department of Orthopedics, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
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Feasibility of Percutaneous Image-Guided Combined Treatment of Symptomatic Bone Cyst Using Cryoablation and Bone Graft Substitute. Cardiovasc Intervent Radiol 2023; 46:512-518. [PMID: 36826492 DOI: 10.1007/s00270-023-03390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To describe the feasibility and technique of percutaneous image-guided combined treatment of bone cyst (BC) using cryoablation and bone graft substitute injection. MATERIALS AND METHODS Between July 2019 and January 2022, six consecutive patients (ages between 16 and 33 years) with symptomatic BC in pelvic and lower extremity bones underwent percutaneous image-guided combined treatment using cryoablation and bone graft substitute. To induce bone mineralization as early as possible, the cyst cavity was filled with bone graft substitute. Technical success of the procedure was evaluated, and clinical success was defined as satisfactory clinical symptom relief using visual analogue scale (VAS). Radiologic success was defined as early BC remineralization on radiographic studies. Detailed demographic data with lesion location, size, time to and degree of BC mineralization, complications, clinical outcomes, and radiological follow-up were retrospectively assessed. RESULTS Technical success was 100% achieved in all patients. BC mineralization was observed in all patients, with a median time to reach 80% mineralization at 6 months, with one patient reaching 80% at 5 months and another reaching 100% at 3 months. A significant drop in VAS was observed in all patients, reflecting significant pain relief. There were no major complications. The median follow-up period was 31.5 months, with a minimum follow-up of 5 months and a maximum follow-up of 3 years. CONCLUSION Percutaneous image-guided combined treatment with cryoablation and bone graft substitute for symptomatic BC is technically feasible and was safe in this limited series.
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Tse DT, Benedetto PW, Tse BC, Feuer WJ. Neoadjuvant Intra-Arterial Cytoreductive Chemotherapy for Lacrimal Gland Adenoid Cystic Carcinoma: A Long-Term Follow-up Study of a Trimodal Strategy. Am J Ophthalmol 2022; 240:239-251. [PMID: 35381201 PMCID: PMC9396917 DOI: 10.1016/j.ajo.2022.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the therapeutic efficacy of integrating neoadjuvant chemotherapy with conventional bimodal therapies for lacrimal gland adenoid cystic carcinoma by providing an additional 8 years of follow-up data on the same cohort of patients whose cumulative 10-year disease-free survival outcomes were reported in 2013. DESIGN Non-randomized, retrospective, interventional case series. METHODS Nineteen consecutive patients treated with neoadjuvant intra-arterial cytoreductive chemotherapy (IACC), orbital exenteration, chemoradiotherapy, and adjuvant intravenous chemotherapy at a single institution were included. Analyses were undertaken of locoregional recurrences and distant metastases, disease-free survival time, TNM tumor stage at presentation, response to IACC, and prognostic impact of positive resection margins. The main outcome measures were overall survival, disease-free survival, disease relapse, positive tumor resection margins, and tumor stage at presentation. RESULTS Eight patients with an intact lacrimal artery (group 1), 7 with AJCC stage T4a-c, had significantly better overall survival (87.5% versus 14.3% at 15 years), disease-specific mortality, and recurrences (all < .001, log-rank test) than prior conventionally treated patients from the Bascom Palmer Eye Institute. Group 1 was superior to group 2, patients lacking an intact lacrimal artery, concerning overall survival (P = .042) and recurrence (P = .017), but with no significant difference in disease-specific mortality (P = .23). Group 2 was associated with a significantly lower cause-specific mortality than the institutional comparator group (P = .039). Prior tumor resection with lateral wall osteotomy and failure to adhere to all protocol elements were adverse prognostic factors for suboptimal outcomes. Positive tumor margins increased the risk of all-cause mortality 4.1 times (P = .036, stratified Cox proportional hazards regression) and disease-specific mortality 8.0 times (P = .043, stratified Cox proportional hazards regression) than a patient with negative margins. CONCLUSIONS Extended follow-up supplemented with AJCC staging data supports neoadjuvant IACC as an integral component of a trimodal treatment strategy in patients with an intact lacrimal artery. Protocol elements implemented as designed appear to have improved overall survival and decreased disease relapse in this cohort. This extended long-term IACC dataset suggests that a critical bar of at least 15 years of follow-up is appropriate for assessing the efficacy of current conventional and future globe-sparing bimodal therapies.
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Surgical Management of Benign Tumors of the Proximal Fibula. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202109000-00009. [PMID: 34515668 PMCID: PMC8439992 DOI: 10.5435/jaaosglobal-d-21-00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
Benign tumors of the proximal fibula are clinically notable, often resulting in pain, cosmetic defects, and potential neurovascular compromise. These symptomatic lesions warrant surgical consultation, but specific procedure selection remains a topic of ongoing discussion. The fibula is widely considered an expendable bone, which permits a greater variety of surgical options relative to other skeletal locations. As a result, some authors suggested en bloc resections without reconstruction as a viable first-line option to decrease tumor recurrence risk. However, wide resections may still result in diminished postoperative functionality compared with the standard intralesional and marginal approaches. Thus, surgical management remains a multifactorial decision, and often orthopaedic surgeons rely on past clinical experience or surgical preference within this unique tumor location. This detailed review will summarize the published literature and discuss the outcomes and indications of various surgical approaches for benign tumors of the proximal fibula. Emphasis will be placed on balancing tumor recurrence risk and postoperative functionality within the context of histologic diagnoses and surgical approaches.
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Scandiffio R, Bozzi E, Ezeldin M, Capanna R, Ceccoli M, Colangeli S, Donati DM, Colangeli M. Image-guided Cryotherapy for Musculoskeletal Tumors. Curr Med Imaging 2021; 17:166-178. [PMID: 32842945 DOI: 10.2174/1573405616666200825162712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This article represents a review of the use of image-guided cryotherapy in the treatment of musculoskeletal tumor lesions. Cryotherapy is able to induce a lethal effect on cancer cells through direct and indirect mechanisms. In this manuscript, we combined our experience with that of other authors who have published on this topic in order to provide indications on when to use cryotherapy in musculoskeletal oncology. DISCUSSION Image-Guided percutaneous cryotherapy is a therapeutic method now widely accepted in the treatment of patients with musculoskeletal tumors. It can be used both for palliative treatments of metastatic bone lesions and for the curative treatment of benign bone tumors, such as osteoid osteoma or osteoblastoma. In the treatment of bone metastases, cryotherapy plays a major role in alleviating or resolving disease-related pain, but it has also been demonstrated that it can have a role in local disease control. In recent years, the use of cryotherapy has also expanded for the treatment of both benign and malignant soft tissue tumors. CONCLUSION Percutaneous cryotherapy can be considered a safe and effective technique in the treatment of benign and malignant musculoskeletal tumors. Cryotherapy can be considered the first option in benign tumor lesions, such as osteoid osteoma, and a valid alternative to radiofrequency ablation. In the treatment of painful bone metastases, it must be considered secondarily to other standard treatments (radiotherapy, bisphosphonate therapy, and chemotherapy) when they are no longer effective in controlling the disease or when they cannot be repeated (for example, radiotherapy).
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Affiliation(s)
- Rossella Scandiffio
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Elena Bozzi
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Mohamed Ezeldin
- Department of Diagnostic and Interventional Radiology, Sohag University Hospital, Sohag, Egypt
| | - Rodolfo Capanna
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ceccoli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Davide M Donati
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Colangeli
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
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Chen CF, Chu HC, Chen CM, Cheng YC, Tsai SW, Chang MC, Chen WM, Wu PK. A safety comparative study between freezing nitrogen ethanol composite and liquid nitrogen for cryotherapy of musculoskeletal tumors. Cryobiology 2018; 83:34-39. [PMID: 29953845 DOI: 10.1016/j.cryobiol.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/19/2018] [Indexed: 12/24/2022]
Abstract
Freezing nitrogen ethanol composite (FNEC) showed effective cryoablative ability for bone tumor ex vivo and in vivo comparable to liquid nitrogen (LN). We therefore wished to compare the radiant cooling damage of the surrounding tissue between FNEC and LN. The evaluation of the radiant cooling damage was demonstrated human bone xenograft transplantation (HXT) in a mouse model. Characterizations and quantifications of the damaging effects on morphologic features and apoptosis of the cryoablative surrounding bone tissue, muscle and epidermal layer of skin were compared. The radiant cooled damaging effects including epidermal rupture, hair follicle atrophy, dermis and subcutaneous crystal vacuolation of skin were significantly greater in LN than FNEC. Muscular apoptosis, structural shrinkage and bone cellular apoptosis were supposedly 15%-33% destroying degrees of LN more than FNEC. We concluded that FNEC is an innovative cryogenic material, and it could cause less cryoablative damage to surrounding normal tissue than LN. The findings might support the safety of FNEC being applied in clinical cryoablation therapy.
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Affiliation(s)
- Cheng-Fong Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan; Orthopaedic Department School of Medicine, National Yang-Ming University, Taiwan
| | - Hui-Chun Chu
- Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Ming Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Orthopaedic Department School of Medicine, National Yang-Ming University, Taiwan
| | - Yu-Chi Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Orthopaedic Department School of Medicine, National Yang-Ming University, Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan; Orthopaedic Department School of Medicine, National Yang-Ming University, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan; Orthopaedic Department School of Medicine, National Yang-Ming University, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taiwan; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taiwan; Orthopaedic Department School of Medicine, National Yang-Ming University, Taiwan.
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Yang Y, Han L, He Z, Li X, Yang S, Yang J, Zhang Y, Li D, Yang Y, Yang Z. Advances in limb salvage treatment of osteosarcoma. J Bone Oncol 2017; 10:36-40. [PMID: 29296558 PMCID: PMC5739147 DOI: 10.1016/j.jbo.2017.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/23/2017] [Indexed: 12/15/2022] Open
Abstract
Osteosarcoma is the most common primary malignant bone tumor; its standard treatment includes neoadjuvant chemotherapy combined with surgery. Neoadjuvant chemotherapy has significantly improved the 5-year survival and limb salvage rates in osteosarcoma since the 1870s. The survival rate of patients with limb salvage was not inferior to that of amputees, and therefore, limb salvage has become the main surgical option for patients with osteosarcoma. The 5-year survival rate for osteosarcoma has plateaued. However, new advances in limb salvage therapy in osteosarcoma, including adjuvant chemotherapy, ablation techniques, bone transport techniques, and computer navigation techniques, are now available. This report summarizes the recent advances in limb salvage therapy for osteosarcoma over the past decade.
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Affiliation(s)
- Yichun Yang
- Department of Medical, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No 16, Jichang Road, Baiyun District, Guangzhou, Guangdong 510405, People's Republic of China
| | - Lei Han
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Zewei He
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Xiaojuan Li
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Suping Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Jifei Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Ya Zhang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Dongqi Li
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Yihaho Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
| | - Zuozhang Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Orthopaedics, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, People's Republic of China
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What are the Oncologic and Functional Outcomes After Joint Salvage Resections for Juxtaarticular Osteosarcoma About the Knee? Clin Orthop Relat Res 2017; 475:2095-2104. [PMID: 28425055 PMCID: PMC5498384 DOI: 10.1007/s11999-017-5356-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Joint salvage surgery for patients with juxtaarticular osteosarcoma remains challenging, especially when the tumor invades the epiphysis. Because patients are surviving longer with current chemotherapy regimens, it is advantageous to retain native joints if possible, especially in young patients. However, the results using joint-preserving tumor resections in this context have not been well characterized. QUESTIONS/PURPOSES (1) What are the functional outcomes after limb salvage surgery at a minimum of 3 years? (2) What are the oncologic outcomes? (3) Is joint salvage surgery for epiphyseal tumors associated with an increased risk of local recurrence compared with metaphyseal tumors not invading the epiphysis? (4) What are the complications associated with joint salvage surgery? METHODS Between 2004 and 2013, we treated 117 patients with juxtaarticular osteosarcoma; of those, 43 (38%) were treated with joint salvage surgery, and 41 (95%) of the 43 patients are included in our study. The other two (5%) were lost to followup before 3 years (mean, 4.4 years; range, 3-11 years,). During the period in question, we generally performed joint salvage surgery in these patients when they had a favorable response to chemotherapy, did not have a pathologic fracture or extrusion of the tumor into the joint, and did not have a whole-epiphyseal osteolytic lesion, a large mass, or obvious neurovascular involvement. This report is a followup of an earlier study; the current study includes an additional nine patients, and additional followup of a mean of 19 months for the patients included in the earlier report. We ascertained overall survival and survival free from local recurrence which was estimated using the Kaplan-Meier method, functional status of the limb which was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 scoring system, and recorded reconstructive complications including infection, fracture, skin necrosis, and nonunion. We compared oncologic and functional outcomes between patients with (n = 28) and without tumor extension to epiphysis (n =13). We also compared oncologic and functional outcomes among patients with different adjuvant treatments including microwave ablation (n = 11), cryoablation (n = 12), and navigation-assisted osteotomy (n = 5). Complications were tallied using records from our institutional database. RESULTS The overall Kaplan-Mayer survival rate was 82% (95% CI, 104-128 months) at 5 years. The overall Kaplan-Meier survivorship from local recurrence was 91% at 5 years (95% CI, 115-133 months). Three patients had a local recurrence, but none had local recurrence in or close to the remaining epiphysis. The MSTS scores ranged from 22 to 30 points, with a median of 28. There were no differences in survival rate, local recurrence, or MSTS scores between patients with a tumor that did not invade the epiphysis and those in whom the tumor did invade the epiphysis. There were differences in MSTS scores among patients with epiphyseal tumor extension in which different adjuvant techniques, including microwave ablation, cryoablation, and navigation-assisted osteotomy, were used. Additional surgical procedures were recorded for 10 patients (24%). Osteonecrosis of the residual epiphysis was detected 13 patients (31%). CONCLUSIONS Our findings suggest it is possible to salvage joints in selected patients with juxtaarticular osteosarcoma around the knee. The patients who have a favorable response to chemotherapy are the best candidates for this approach. Future studies might explore the role of adjuvant techniques of microwave ablation and cryoablation, particularly when the tumor invades the epiphysis, and whether resections can be facilitated with navigation. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Wu PK, Chen CF, Wang JY, Chen PCH, Chang MC, Hung SC, Chen WM. Freezing Nitrogen Ethanol Composite May be a Viable Approach for Cryotherapy of Human Giant Cell Tumor of Bone. Clin Orthop Relat Res 2017; 475:1650-1663. [PMID: 28197783 PMCID: PMC5406334 DOI: 10.1007/s11999-017-5239-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liquid nitrogen has been used as adjuvant cryotherapy for treating giant cell tumor (GCT) of bone. However, the liquid phase and ultrafreezing (-196° C) properties increase the risk of damage to the adjacent tissues and may lead to perioperative complications. A novel semisolid cryogen, freezing nitrogen ethanol composite, might mitigate these shortcomings because of less-extreme freezing. We therefore wished to evaluate freezing nitrogen ethanol composite as a coolant to determine its properties in tumor cryoablation. QUESTIONS/PURPOSES (1) Is freezing nitrogen ethanol composite-mediated freezing effective for tumor cryoablation in an ex vivo model, and if yes, is apoptosis involved in the tumor-killing mechanism? (2) Does freezing nitrogen ethanol composite treatment block neovascularization and neoplastic progression of the grafted GCTs and is it comparable to that of liquid nitrogen in an in vivo chicken model? (3) Can use of freezing nitrogen ethanol composite as an adjuvant to curettage result in successful short-term treatment, defined as absence of GCT recurrence at a minimum of 1 year in a small proof-of-concept clinical series? METHODS The cryogenic effect on bone tissue mediated by freezing nitrogen ethanol composite and liquid nitrogen was verified by thermal measurement in a time-course manner. Cryoablation on human GCT tissue was examined ex vivo for effect on morphologic features (cell shrinkage) and DNA fragmentation (apoptosis). The presumed mechanism was investigated by molecular analysis of apoptosis regulatory proteins including caspases 3, 8, and 9 and Bax/Bcl-2. Chicken chorioallantoic membrane was used as an in vivo model to evaluate the effects of freezing nitrogen ethanol composite and liquid nitrogen treatment on GCT-derived neovascularization and tumor neoplasm. A small group of patients with GCT of bone was treated by curettage and adjuvant freezing nitrogen ethanol composite cryotherapy in a proof-of-concept study. Tumor recurrence and perioperative complications were evaluated at a minimum of 19 months followup (mean, 24 months; range, 19-30 months). RESULTS Freshly prepared freezing nitrogen ethanol composite froze to -136° C and achieved -122° C isotherm across a piece of 10 ± 0.50-mm-thick bone with a freezing rate of -34° C per minute, a temperature expected to meet clinical tumor-killing requirements. Human GCT tissues revealed histologic changes including shrinkage in morphologic features of multinucleated giant cells in the liquid nitrogen (202 ± 45 μm; p = 0.006) and freezing nitrogen ethanol composite groups (169 ± 27.4 μm; p < 0.001), and a decreased nucleated area of neoplastic stromal cells for the 30-second treatment. Enhanced counts of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells verified the involvement of DNA fragmentation in cryoablated GCT tissues. Western blotting analysis on the expression of apoptosis regulatory proteins showed enhancement of proteocleavage-activated caspases 3, 8, and 9 and higher ratios of Bax/Bcl2 in the liquid nitrogen- and freezing nitrogen ethanol composite-treated samples. Numbers of blood vessels and human origin tumor cells also were decreased by freezing nitrogen ethanol composite and liquid nitrogen treatment in the GCT-grafted chicken chorioallantoic membrane model. Seven patients with GCT treated by curettage and adjuvant cryotherapy by use of freezing nitrogen ethanol composite preparation had no intra- or postoperative complications related to the freezing, and no recurrences during the study surveillance period. CONCLUSIONS These preliminary in vitro and clinical findings suggest that freezing nitrogen ethanol composite may be an effective cryogen showing ex vivo and in vivo tumor cryoablation comparable to liquid nitrogen. The semisolid phase and proper thermal conduction might avoid some of the disadvantages of liquid nitrogen in cryotherapy, but a larger clinical study is needed to confirm these findings. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Po-Kuei Wu
- 0000 0001 0425 5914grid.260770.4Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ,0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan ,0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, 112 Taiwan ,0000 0001 0425 5914grid.260770.4Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Fong Chen
- 0000 0001 0425 5914grid.260770.4Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ,0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan ,0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, 112 Taiwan ,0000 0001 0425 5914grid.260770.4Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jir-You Wang
- 0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan ,0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, 112 Taiwan ,0000 0001 0425 5914grid.260770.4Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Paul Chih-Hsueh Chen
- 0000 0004 0604 5314grid.278247.cDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chau Chang
- 0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, 112 Taiwan ,0000 0001 0425 5914grid.260770.4Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Chieh Hung
- 0000 0001 0083 6092grid.254145.3Integrative Stem Cell Center, China Medical University Hospital, Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Ming Chen
- 0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan ,0000 0004 0604 5314grid.278247.cDepartment of Orthopaedics & Traumatology, Taipei Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Taipei, 112 Taiwan ,0000 0001 0425 5914grid.260770.4Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Steffey MA, Garcia TC, Daniel L, Zwingenberger AL, Stover SM. Mechanical properties of canine osteosarcoma-affected antebrachia. Vet Surg 2017; 46:539-548. [PMID: 28152185 DOI: 10.1111/vsu.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/08/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the influence of neoplasia on the biomechanical properties of canine antebrachia. STUDY DESIGN Ex vivo biomechanical study. SAMPLE POPULATION Osteosarcoma (OSA)-affected canine antebrachia (n = 12) and unaffected canine antebrachia (n = 9). METHODS Antebrachia were compressed in axial loading until failure. A load-deformation curve was used to acquire the structural mechanical properties of neoplastic and unaffected specimens. Structural properties and properties normalized by body weight (BW) and radius length were compared using analysis of variance (ANOVA). Modes of failure were compared descriptively. RESULTS Neoplastic antebrachia fractured at, or adjacent to, the OSA in the distal radial diaphysis. Unaffected antebrachia failed via mid-diaphyseal radial fractures with a transverse cranial component and an oblique caudal component. Structural mechanical properties were more variable in neoplastic antebrachia than unaffected antebrachia, which was partially attributable to differences in bone geometry related to dog size. When normalized by dog BW and radial length, strength, stiffness, and energy to yield and failure, were lower in neoplastic antebrachia than in unaffected antebrachia. CONCLUSIONS OSA of the distal radial metaphysis in dogs presented for limb amputation markedly compromises the structural integrity of affected antebrachia. However, biomechanical properties of affected bones was sufficient for weight-bearing, as none of the neoplastic antebrachia fractured before amputation. The behavior of tumor invaded bone under cyclic loading warrants further investigations to evaluate the viability of in situ therapies for bone tumors in dogs.
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Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Tanya C Garcia
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Leticia Daniel
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Susan M Stover
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
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Minimally invasive techniques for pain palliation in extraspinal bone metastases: a review of conventional methods and cryoablation. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Enchondroma is the most common primary bone tumor of the hand. This benign, cartilaginous tumor often presents as a pathologic fracture. When hand enchondroma is suspected, less common conditions, such as multiple enchondromatosis syndromes and benign and malignant lesions, should be ruled out. Surgical management with curettage is the standard of care for symptomatic lesions. However, controversy surrounds the timing of surgery for pathologic fractures and the use of surgical adjuncts and postcurettage void management. Microscopically distinguishing hand enchondroma from low-grade hand chondrosarcoma is a diagnostic challenge for pathologists, but the primary surgical treatment for both conditions is curettage because the latter has a low metastatic potential. Postoperative complications are typically joint stiffness and soft-tissue[FIGURE DASH]related deformities, whereas recurrence and malignant degeneration of solitary lesions are much less common. Most patients return to full function after surgery.
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Abstract
The field of cryosurgery began nearly 40 years ago with the open application of liquid nitrogen to ablate tumors. Recent developments in imaging and cryoprobe technology allow for percutaneous ablation of tumors. Computed tomography (CT)-guided cryoablation has particular use in treating musculoskeletal neoplasms because of the ability to image the lethal ice zone around both bone and soft tissue structures. This manuscript will review the development, indications, and results of cryoablation as applied to musculoskeletal neoplasms. This technique holds promise for the treatment of benign conditions as well as the palliation and durable treatment of musculoskeletal metastases; it is not commonly indicated in the curative treatment of primary malignant bone or soft tissue sarcomas.
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Li J, Guo Z, Yang Q, Ji C, Wang Z. Adjuvant argon-based cryoablation for joint-preserving tumor resection in patients with juxta-articular osteosarcoma around the knee. Cryobiology 2015. [DOI: 10.1016/j.cryobiol.2015.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zairi F, Vieillard MH, Assaker R. Spine metastases: are minimally invasive surgical techniques living up to the hype? CNS Oncol 2015; 4:257-64. [PMID: 26095003 DOI: 10.2217/cns.15.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Surgery is still considered the mainstay treatment of spine metastases. However, conventional surgery is associated with a high complication rate that may delay the initiation of adjuvant therapies and make some patients not eligible. Minimally invasive surgical techniques have been developed to overcome these drawbacks while providing the same benefits than standard open surgery. In recent years, there has been a flourishing enthusiasm demonstrating the advantages of these various techniques. Although, it is clear that these techniques have greatly improved the treatment of spine metastases, each has its own limitations. In this report, we list the main minimally invasive surgical techniques emphasizing their advantages and drawbacks.
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Affiliation(s)
- Fahed Zairi
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | | | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Abstract
Cryoablation is increasingly being used as a primary treatment for localized cancers and as a salvage therapy for metastatic cancers. Anecdotal clinical reports and animal experiments have confirmed an induction of systemic antitumor immune response by tumor cryoablation. To capitalize on the stimulatory effects of cryoablation for cancer immunotherapy, this response must be intensified using other immunomodulatory agents. This article reviews the preclinical and clinical evidence and discusses the mechanism of the antitumor immune response generated by cryoablation. The rationale and evidence behind several immunotherapy approaches that can be combined with cryoablation to devise a cryoimmunotherapeutic strategy with a potential to impact the progression of metastatic disease are described.
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Affiliation(s)
- Abhinav Sidana
- Division of Urology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Suite 2513, Cincinnati, OH 45229, USA.
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Gouin F, Rochwerger AR, Di Marco A, Rosset P, Bonnevialle P, Fiorenza F, Anract P. Adjuvant treatment with zoledronic acid after extensive curettage for giant cell tumours of bone. Eur J Cancer 2014; 50:2425-31. [PMID: 25088085 DOI: 10.1016/j.ejca.2014.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/09/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Giant cell tumours (GCT) of bone are benign neoplasms associated with a high rate of local recurrence after extensive intra-lesional curettage. Recently, understanding of the biological molecular availability of strong anti-osteoclastic drugs has suggested their potential value in reducing local recurrences after curettage. Through a phase II clinical trial, we investigated the effect of a short treatment with zoledronic acid (ZOL) after intra-lesional curettage of GCT, as well as local recurrence and tolerance of the treatment. METHODS AND PATIENTS Twenty-four patients were enrolled in a multicentre, phase 2 study. The patients were treated with extensive intra-lesional curettage followed by five courses of ZOL (4 mg IV every 3 weeks). The clinical and biological tolerance of each patient was assessed. Patients were reviewed clinically and by X-ray every 6 months until the end of the study (36 months). RESULTS Eighteen out of 20 patients reported side-effects with ZOL, mainly grade 1 and 2 effects. The local recurrence rate was 15%; three patients had a recurrence, one at 4 months (huge GCT of the sacrum), one at 24 months (patient who discontinued the treatment after the first course of ZOL), and one after the observational period, at 58 months. Finally, local relapse-free survival was 82 ± 9% at 60 months. CONCLUSION Short adjuvant treatments with ZOL after extensive intra-lesional curettage of GCT were associated with a low rate of recurrence but did not prevent local recurrence in this study. No serious general adverse effects were observed. More studies are needed to evaluate the potential benefit of medical bisphosphonate injections combined with intra-lesional curettage in the treatment of GCTB.
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Affiliation(s)
- Francois Gouin
- Orthopaedics and Traumatology Department, University Hospital of Nantes CHU, Hôtel-Dieu, 44 093 Nantes Cedex, France; LPRO, Inserm U957, UFR Médecine, Université de Nantes, 1 Rue Gaston Veil, 44000 Nantes, France.
| | | | - Antonio Di Marco
- University Hospital de Hautepierre, Av. Molière, 67 000 Strasbourg, France.
| | - Philippe Rosset
- University Hospital Trousseau, Rue des Loches, 37 004 Tours, France.
| | - Paul Bonnevialle
- University Hospital of Purpan, Place du Dr. Baylac, 31 059 Toulouse, France.
| | - Fabrice Fiorenza
- University Hospital Dupuytren, Av. Martin Luther King, 87 042 Limoges, France.
| | - Philippe Anract
- University Hospital of Cochin-Port Royal, Av. Du Fb Saint Jacques, 75 014 Paris, France.
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He ZZ, Xue X, Xiao J, Liu J. Anatomical model-based finite element analysis of the combined cryosurgical and hyperthermic ablation for knee bone tumor. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 112:356-366. [PMID: 24070544 DOI: 10.1016/j.cmpb.2013.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/25/2013] [Accepted: 07/25/2013] [Indexed: 06/02/2023]
Abstract
This paper is aimed at investigating the capacity of using combined cryosurgical and hyperthermic modality for treating knee bone tumor with complex shape. An anatomical model for human knee was constructed and a three-dimensional (3D) finite element analysis was developed to determine temperature distribution of the tissues subject to single freezing (SF), single heating (SH) and alternate freezing-heating (AFH), respectively. The heat fluxes of the probes wall and the ablation volume are particularly tracked to comparatively evaluate the ablation ability of different probe configurations with varied diameter, number and active working length. As example, an effective conformal treatment strategy via one time's insertion while cyclic freezing-heating using multiple probes is designed for a predefined knee bone tumor ablation. Both SF and SH could create large enough ablation volume, while it is hard for them to perform a conformal treatment on irregular and slender knee tumor. As an alternative, AFH could form a flexible and controlled shape and volume of the ablation by changing the size and number of the probes and adjusting their insertion depth. In addition, a thermal protection method is considered to reduce cryoinjury of the health tissue.
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Affiliation(s)
- Zhi Zhu He
- Beijing Key Laboratory of Cryo-Biomedical Engineering & Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
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Gouin F, Dumaine V. Local recurrence after curettage treatment of giant cell tumors in peripheral bones: retrospective study by the GSF-GETO (French Sarcoma and Bone Tumor Study Groups). Orthop Traumatol Surg Res 2013; 99:S313-8. [PMID: 23978709 DOI: 10.1016/j.otsr.2013.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Curettage is a well-established treatment modality for giant cell tumors of bone. The purpose of this retrospective study by the French Sarcoma and Bone Tumor Study Groups (GSF-GETO) was to analyze various tumor-specific and surgery-specific factors that could influence the rate of local recurrence. PATIENTS AND METHOD Data was collected from patients with giant cells tumors of the appendicular skeletal who were treated by intralesional curettage. The hazard ratio for tumor recurrence was calculated for the different variables collected and a multifactorial analysis carried out. RESULTS One hundred and ninety-three surgical procedures were included from nine centers. One hundred and seventy-one (89%) were primary tumors and 22 had been referred after one or more recurrences. The mean follow-up was 6 years and 11 months. The distal femur and proximal tibia were the most common locations: 42.5 and 34.2% of cases, respectively. The bone defect after curettage was filled in 176 cases (91.2%) and left empty in 16 cases. Local adjuvant treatment (phenol, alcohol, cryotherapy or combination treatment) was used in 39 cases (20.2%) and systemic adjuvant treatment used in 24 cases (calcitonin 11 and zoledronic acid 13). Local recurrence occurred in 71 cases (36.8%). Risk factors for local recurrence were an empty defect, a defect filled with autograft, and patients treated before 2005. Multivariate analysis showed that the only risk factors for local recurrence were a surgical procedure before 2005 (odds ratio 3.6 (95% CI: 1.2, 7.9) P=0.017) and a bone defect filled with autograft (odds ratio 3.9 [95% CI: 1.3, 11.6] P=0.013) CONCLUSION: Neither tumor-specific nor surgery-specific factors such as adjuvant treatment were found to be as risk factors for local recurrence after curettage of giant cell tumors in the appendicular skeleton. As recently reported, high-quality local curettage is probably the most effective technique to prevent local recurrence. The current study suggests that two factors associated with more recent management of these tumors in France, high-speed burring and centralization to skilled surgical teams, can improve the quality of curettage. LEVEL OF EVIDENCE 4, retrospective cohort study.
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Affiliation(s)
- F Gouin
- Clinique chirurgicale orthopédique et traumatologique, CHU Hôtel-Dieu, Nantes, France; Inserm UI 957, laboratoire de la résorption osseuse et des tumeurs osseuses primitives (LROP), faculté de médecine de Nantes, Nantes, France.
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Lim CT, Tan LBK, Nathan SS. Prospective Evaluation of Argon Gas Probe Delivery for Cryotherapy of Bone Tumours. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n8p347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Cryosurgery for tumoural ablation traditionally involves instilling liquid nitrogen into a tumoural bed. The inability to control precise delivery can result in potentially disastrous consequences of skin necrosis and nitrogen gas embolism. In this study, we evaluated a probe-based closed cryosurgical system, which eliminates these risks. Materials and Methods: We performed a prospective evaluation of 36 cases of bone tumours treated with a probe-based cryosurgical system at the National University Hospital, Singapore. Cases consisted of patients with benign aggressive tumours (42%), primary malignant bone tumours (25%) and bone metastases (33%). In primary bone tumours, the aim of therapy was cure. In bone metastasis, the aim of therapy was palliation defi ned as the relief of symptoms for the patients’ remaining lifetime. Results: In the primary bone tumour group, no recurrences were reported. In the metastases group, where the intention was palliation, there were 3 cases of radiological relapses (P = 0.02) and 2 clinical relapses. Kaplan-Meier evaluation showed a statistically significant tendency for radiological relapse in metastatic disease versus primary disease (P = 0.02). Median time for relapse free survival in the metastatic group was 17 months (P = 0.01). There were 4 deaths in the metastatic group due to progression of disease unrelated to the index region of cryosurgical treatment. There were no deaths in the primary bone tumor group. We had 2 complications from this therapy involving fractures through the cryoablated segments. One case healed spontaneously and the other was most expediently managed with a shoulder hemiarthoplasty. There were no skin burns or embolic complications. Conclusion: Good clinical efficacy with probe delivered cryotherapy has been shown in this group of 32 patients with cure in all primary disease. Relapse occurred in only a small proportion of patients with bone metastasis.
Key words: Cryoprobe, Cryosurgery, Liquid nitrogen, Musculoskeletal tumours
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Affiliation(s)
| | - Liza BK Tan
- National University Health System, Singapore
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Abstract
Bone tumors are uncommon clinical entities that are often a source of diagnostic and therapeutic uncertainty. Evaluating these lesions starts with a patient history and physical examination Imaging then begins with radiographs, followed by advanced imaging modalities, such as magnetic resonance imaging, computed tomography, or bone scan. Biopsy can be performed to establish histologic diagnosis by either closed or open means. Treatment options range from observation to wide resection with reconstruction or amputation. Surveillance schedules vary depending on the type of tumor that is being treated. An algorithm for the evaluation, work-up, and diagnosis of bone tumors is presented.
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Affiliation(s)
- Tessa Balach
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-5456, USA
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Souna BS, Belot N, Duval H, Langlais F, Thomazeau H. No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res 2010; 468:1956-62. [PMID: 20054673 PMCID: PMC2881994 DOI: 10.1007/s11999-009-1211-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 12/15/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND The low aggressiveness of Grade I chondrosarcomas is compatible with conservative surgical treatment. QUESTIONS/PURPOSE We asked whether combined curettage and cryotherapy would yield low rates of recurrence and whether supplemental internal fixation would retain function with low rates of complications in patients with Grade I central chondrosarcomas of the proximal humerus or distal femur. METHODS We retrospectively reviewed 15 patients: nine women and six men with a mean age of 45 years (range, 26-70 years). All patients underwent curettage and cryosurgery through a cortical window; we replaced the window and plated the region with at least three screws beyond the curetted area. None of the patients was lost to followup, and 14 patients (93%) were reexamined by us after a minimum of 5 years (mean, 8 years; range, 5-11 years). RESULTS There were no perioperative anesthetic, neurologic, hardware, or healing complications. None of the patients had local recurrence or metastases develop. At last followup, the Musculoskeletal Tumor Society score was 27.9 (range, 22-30) and all patients had resumed their previous activities. No complications were associated with this simplified cryotherapy technique. CONCLUSIONS The data confirm the appropriateness of conservative surgery for central low-grade chondrosarcomas of the proximal humerus and distal femur based on a combination of intralesional curettage and cryogenic parietal sterilization. Candidates for this approach should be chosen on the basis of the affected bone site, local extension staging, and clinicopathologic grading. We recommend supplementary internal fixation. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Badio S. Souna
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Nicolas Belot
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Hélène Duval
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Frantz Langlais
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Hervé Thomazeau
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
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Gage AA, Baust JM, Baust JG. Experimental cryosurgery investigations in vivo. Cryobiology 2009; 59:229-43. [PMID: 19833119 DOI: 10.1016/j.cryobiol.2009.10.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/30/2009] [Accepted: 10/01/2009] [Indexed: 12/16/2022]
Abstract
Cryosurgery is the use of freezing temperatures to elicit an ablative response in a targeted tissue. This review provides a global overview of experimentation in vivo which has been the basis of advancement of this widely applied therapeutic option. The cellular and tissue-related events that underlie the mechanisms of destruction, including direct cell injury (cryolysis), vascular stasis, apoptosis and necrosis, are described and are related to the optimal methods of technique of freezing to achieve efficacious therapy. In vivo experiments with major organs, including wound healing, the putative immunological response following thawing, and the use of cryoadjunctive strategies to enhance cancer cell sensitivity to freezing, are described.
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Affiliation(s)
- A A Gage
- Department of Surgery, SUNY Buffalo, Buffalo, NY, USA
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