Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases

Kumar, Sumedh; Nandan, Brajesh; Chauhan, Ravi; Dhawan, Manish; Agrawal, Siddharth; Rivi, Sijal

doi:10.1055/s-0042-1742600

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Original Article • Rev. bras. ortop. 58 (2) • Mar-Apr 2023 • https://doi.org/10.1055/s-0042-1742600 copy

Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage.

Methods

We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint.

Results

Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18–30).

Conclusion

Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb.

Keywords
argon plasma coagulation; giant cell tumor of bone; bone neoplasms; chemoradiotherapy, adjuvant; orthopedics

MSTS Common Domains

Lower extremity specific domains

Upper extremity specific domains

Pain

Function

Emotional

Acceptance

Use of support

Walking ability

Gait

Hand position

Dexterity

Lifting ability

Depending on the extremity affected a score of 0–5 is given by the patient for each domain

Complication	Frequency
Graft site	6
Superficial infection	4
Neurological symptoms	4
No complications	36

S. no.	Study	Year	Follow up	Patients	Surgical treatment	Recurrences
1.	McDonald et. al.⁸8 McDonald DJ, Sim FH, McLeod RA, Dahlin DC. Giant-cell tumor of bone. J Bone Joint Surg Am 1986;68(02):235–242	1986	84 months	146	Wide resection curettage + burr	7% 34%
2.	Campanacci et al.⁹9 Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69(01):106–114	1987	2-44 years	280	Wide resection	0%
					Marginal excision	8%
					Intralesional excision	27%
3.	O’Donnel et al.¹⁰10 O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am 1994;76 (12):1827–1833	1994	4 Years	60	Curettage + PMMA	42%
3.		1994	4 Years	60	Curettage + PMMA + burr	17%
4.	Blackley et al.¹¹11 Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am 1999;81(06):811–820	1999	80 months	59	Curettage + burr	12%
5.	Trieb et al.⁶6 Trieb K, Bitzan P, Lang S, Dominkus M, Kotz R. Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy. Eur J Surg Oncol 2001;27(02): 200–202	2001	11 years	47	Curettage + burr	21%
5.		2001	11 years	47	Curettage + burr + phenol	25%
6.	Turcotte et. al.¹²12 Turcotte RE, Wunder JS, Isler MH, et al; Canadian Sarcoma Group. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res 2002;(397):248–258	2002	60 months	156	Wide resection	16%
6.		2002	60 months	156	Curettage +/− burr +/− Phenol	18%
7.	Saiz et al.¹1 Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016;4(01):2–9,³3 Campanacci M. Giant-cell tumor and chondrosarcomas: grading, treatment and results (studies of 209 and 131 cases). Recent Results Cancer Res 1976;(54):257–261	2004	76 months	40	Curettage + burr + phenol + PMMA	13%
8.	Su et al.¹1 Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016;4(01):2–9,⁴4 Cohen J, Abedi M, Haber G, et al. Argon plasma coagulation: a new effective techniqueofnon-contact thermal coagulation. Experience in 44 cases of GI angiomata. Gastrointest Endosc 1996;43:293	2004	62 months	87	Wide resection	3%
8.		2004	62 months	87	Curettage + phenol + burr	18%
9.	Prosser et al.¹1 Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016;4(01):2–9,⁵5 Schajowicz F. Giant-Cell Tumor (Osteoclastoma). In: Tumors and Tumorlike Lesions of Bone and Joints. New York: Springer; 1981: 301–367	2005	70 months	137	Curettage + burr	19%
10.	Malek et al.¹1 Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016;4(01):2–9,⁶6 Trieb K, Bitzan P, Lang S, Dominkus M, Kotz R. Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy. Eur J Surg Oncol 2001;27(02): 200–202	2006	48 months	40	Curettage + burr	33%
11.	Lewis et al.¹⁷17 Lewis VO, Wei A, Mendoza T, Primus F, Peabody T, Simon MA. Argon beam coagulation as an adjuvant for local control of giant cell tumor. Clin Orthop Relat Res 2007;454(454):192–197	2007	73 months	37	Curettage + argon beam + PMMA	8.3%
13.	Balke et al.¹⁸18 Balke M, Schremper L, Gebert C, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 2008;134(09):969–978	2008	60 Months	214	Wide resection	0%
					Curettage	65%
					Curettage + burr	22%
					Curettage + PMMA + burr	18%
					Curettage + PMMA + burr + H2O2	12%
14.	Kivioja et al.¹1 Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016;4(01):2–9,⁹9 Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69(01):106–114	2008	5 years	294	Wide\marginal Excision	12%
					Curettage	51%
					CurettageþPMMA	23%
15.	Errani et al.²⁰20 Errani C, Ruggieri P, Asenzio MA, et al. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev 2010;36(01):1–7	2010	91 months	349	Wide resection	12%
					Curettage + burr + phenol	51%
					Curettage + burr + phenol + PMMA	22%
16.	Klenke et al.²¹21 Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res 2011;469(02):591–599	2011	108 months	118	Wide resection	5%
					Curettage + burr	32%
					Curettage + phenol + burr	34%
					Curettage + PMMA + burr + phenol	15%
17.	Benevenia et al.²²22 Benevenia J, Patterson FR, Beebe KS, Abdelshahed MM, Uglialoro AD. Comparison of phenol and argon beam coagulation as adjuvant therapies in the treatment of stage 2 and 3benign-aggressive bone tumors. Orthopedics 2012;35(03):e371–e378	2012	10 months	93	Curettage + phenol	17.1%
17.		2012	10 months	93	Curettage + argon beam	14.8%

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E-mail: rbo@sbot.org.br

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[1] Endereço para correspondência Sumedh Kumar, MBBS, DNB (Orthopaedics), MNAMS, Senior Resident, Room 1218a, Second Floor, Sir Ganga Ram Hospital, New Delhi 110060, India (e-mail: Sumedh.4.kumar@gmail.com).