ADJUVANT CRYOTHERAPY IN THE SURGICAL TREATMENT OF GIANT CELL BONE TUMOR

Abstract

Recurrence of a giant cell tumor or a malignization of the bone (osteoclastoma) is a common complication after surgical treatment. Increased surgical radicality in such pathology is an acute issue. Ablastic procedure can be performed by exposure to ultralow temperatures.Purpose — to improve the surgical treatment efficiency of osteoclastoma by uncontrolled cryodestruction of the visual cells and tissue elements in the resection of the tumor-affected bone.Material and methods. Experimental studies on tumor fragments in vitro. Pathological tumor tissue was three times treated with liquid nitrogen (boiling point −195.8°C). The time of each freeze-defrost cycle was up to three minutes. In the clinical practice, the same cooling agent instillation of the bone defect after resection and mechanical removal of the tumor was used in 67 patients (52 cryosurgical interventions and 15 traditional resections).Results. In the study the authors used the methods of evidence-based medicine. After instillation of liquid nitrogen on giant cell tumor the temperature of −154°C was noted. In the area of cryotreatment 80% of necrotic tumor tissue was identified morphometrically. The study of 67 operated patients demonstrated that positive results were obtained in 40 cases among patients exposed to cryogenic treatment and recurrent was observed in 8 cases. Good outcomes after conventional surgery were observed in 7 patients and recurrence of tumor was reported in 5 cases.Conclusion. Positive experience of cryosurgical procedures allows to restrict indications for articular and extensive segmental resections in favor of intrafocal and marginal resections with cryodestruction and bone defect grafting. The method allows to expand a preservation trend in orthopedic oncology.