Long‑term outcomes of ultrasonic scalpel treatment in giant cell tumor of long bones

Sun,Sheng; Zhang,Qiang; Zhao,Chang‑Song; Cai,Juan

doi:10.3892/ol.2014.2092

Long‑term outcomes of ultrasonic scalpel treatment in giant cell tumor of long bones

Authors:
- Sheng Sun
- Qiang Zhang
- Chang‑Song Zhao
- Juan Cai
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Affiliations: Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China
Published online on: April 25, 2014 https://doi.org/10.3892/ol.2014.2092
Pages: 145-150

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Abstract

Giant cell tumors (GCTs) are generally benign, locally aggressive lesions with the potential to metastasize and a tendency of local recurrence. The present study aimed to investigate the advantages and long‑term outcomes of application of ultrasonic scalpel in the treatment of GCT of long bones. This study retrospectively analyzed 32 cases of GCT of long bones, including 24 males and eight females. The age range was from 8 to 34 years old (mean age, 23.5 years old). The 32 cases were randomly divided into an observation group (n=10) and a control group (n=22). Patients in the observation group received curettage by ultrasonic scalpel combined with local methotrexate gelfoam adjuvant treatment, and then the cavity was filled with allograft and/or homograft bone. Patients in the control group eceived curettage by local methotrexate gelfoam adjuvant treatment and bone grafting. No local recurrence or pulmonary metastases were observed among patients in the observation group, however, six patients in the control group exhibited recurrence following surgery, although none of the patients demonstrated distant metastasis (P<0.05). Additionally, all 10 patients showed good bone knitting and rehabilitation without deformity and functional issues. The segmental bone graft was perfectly incorporated without obvious immune rejection, collapse and fracture. Curettage by ultrasonic scalpel with local methotrexate gelfoam adjuvant treatment and filling the site by allograft and/or homograft bone showed satisfactory results.

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1	Chakarun CJ, Forrester DM, Gottesgen CJ, et al: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 33:197–211. 2013.
2	Thomas DM and Skubitz KM: Giant cell tumour of bone. Curr Opin Oncol. 21:338–344. 2009.
3	Sung HW, Kuo DP, Shu WP, et al: Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg Am. 64:755–761. 1982.
4	Shi W, Indelicato DJ, Reith J, Smith KB, Morris CG, Scarborough MT, Gibbs CP Jr, Mendenhall WM and Zlotecki RA: Radiotherapy in the management of giant cell tumor of bone. Am J Clin Oncol. 36:505–508. 2013.
5	Nishisho T, Hanaoka N, Endo K, Takahashi M and Yasui N: Locally administered zoledronic Acid therapy for giant cell tumor of bone. Orthopedics. 34:e312–e315. 2011.
6	Kafchitsas K, Habermann B, Proschek D, Kurth A and Eberhardt C: Functional results after giant cell tumor operation near knee joint and the cement radiolucent zone as indicator of recurrence. Anticancer Res. 30:3795–3799. 2010.
7	Klenke FM, Wenger DE, Inwards CY, Rose PS and Sim FH: Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res. 469:1181–1187. 2011.
8	Amaral JF: Laparoscopic cholecystectomy in 200 consecutive patients using an ultrasonically activated scalpel. Surg Laparosc Endosc. 5:255–262. 1995.
9	Zhang Q, Zou DW, Ma HS and Hai Y: Application of ultrasonic scalpel in treatment of giant cell tumor of the long bones. Zhongguo Jiao Xing Wai Ke Za Zhi. 15:1181–1183. 2007.
10	Arbeitsgemeinschaft Knochentumoren. Becker WT, Dohle J, et al: Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 90:1060–1067. 2008.
11	Liu HS and Wang JW: Treatment of giant cell tumor of bone: a comparison of local curettage and wide resection. Changgeng Yi Xue Za Zhi. 1:37–43. 1998.
12	Zhen W, Yaotian H, Songjian L, Ge L and Qingliang W: Giant cell tumour of bone: The long term results of treatment by curettage and bone graft. J Bone Joint Surg Br. 86:212–216. 2004.
13	Hoch B, Inwards C, Sundaram M and Rosenberg AE: Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases. J Bone Joint Surg Am. 88:1998–2008. 2006.
14	Vult von Steyern F, Bauer HC, Trovik C, et al: Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. J Bone Joint Surg Br. 88:531–535. 2006.
15	Turcotte RE: Giant cell tumor of bone. Orthop Clin North Am. 37:35–51. 2006.
16	Fraquet N, Faizon G, Rosset P, Phillipeau JM, Waast D and Gouin F: Long bones giant cells tumors: treatment by curretage and cavity filling cementation. Orthop Traumatol Surg Res. 95:402–406. 2009.
17	Campanacci DA, Scoccianti G, Beltrami G, Mugnaini M and Capanna R: Ankle arthrodesis with bone graft after distal tibia resection for bone tumors. Foot Ankle Int. 29:1031–1037. 2008.
18	Sakayama K, Sugawara Y, Kidani T, et al: Diagnostic and therapeutic problems of giant cell tumor in the proximal femur. Arch Orthop Trauma Surg. 127:867–872. 2007.
19	Al-Mahfoudh R, Qattan E, Ellenbogen JR, et al: Applications of the ultrasonic bone cutter in spinal surgery - our preliminary experience. Br J Neurosurg. 28:56–60. 2014.
20	Ying C, Zhaoying Z and Ganghua Z: Effects of different tissue loads on high power ultrasonic surgery scalpel. Ultrasound Med Biol. 32:415–420. 2006.
21	Chen Y, Luo XN, Shi WY and Zhou ZY: The application and development of ultrasonic scalpel. J Biomed Eng. 22:377–380. 2005.
22	Yilmaz KB, Dogan L, Nalbant H, et al: Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients. J Breast Cancer. 14:58–63. 2011.
23	Hodgson WJ: The ultrasonic scalpel. Bull N Y Acad Med. 55:908–915. 1979.
24	Abbasoglu O and Sayek I: Parenchymal transection with ultrasonic scalpel in liver resection. HPB (Oxford). 5:167–169. 2003.
25	Kanzaki J, Inoue Y, Kurashima K and Shiobara R: Use of the ultrasonically activated scalpel in acoustic neuroma surgery: preliminary report. Skull Base Surg. 10:71–74. 2000.
26	Homayounfar K, Meis J, Jung K, et al: Ultrasonic scalpel causes greater depth of soft tissue necrosis compared to monopolar electrocautery at standard power level settings in a pig model. BMC Surg. 12:32012.
27	Yuan CH, Xiu DR, Jia YM, Xiong JW and Zhang TL: Laparoscopic liver tumor resection of clinical experience in 126 patients. Zhonghua Wai Ke Za Zhi. 51:776–779. 2013.(In Chinese).
28	Fette A, Schleef J, Haberlik A and Seebacher U: Circumcision in paediatric surgery using an ultrasound dissection scalpel. Technol Health Care. 8:75–79. 2000.
29	Bensaha T: A new approach for the surgical exposure of impacted canines by ultrasonic surgery through soft tissue. Int J Oral Maxillofac Surg. 42:1557–1561. 2013.
30	Higami T: Ultrasonic scalpel. Kyobu Geka. 62:612–616. 2009.(In Japanese).