One of the most common methods for surgical treatment of bone metastasis is curettage. Local adjuvants are used to improve the effect of curettage in local cancer surgery and they may exerted their effects either chemically either physically; in orthopaedic oncology the most common are phenol, liquid nitrogen, laser, cement and argon beam coagulation. The purpose of this article is to review the main characteristics of the most common chemical and physical agents used in bone oncology, emphasizing the toxic effects of some of them, especially phenol and liquid nitrogen.
Cooper, I.S. (1963) Cryogenic Surgery: A New Method of Destruction or Extirpation of Benign or Malignant Tissues. The New England Journal of Medicine, 268, 743-749. http://dx.doi.org/10.1056/NEJM196304042681401
Gage, A.A., Green Jr., G.W., Neiders, M.E. and Emmings, F.G. (1966) Freezing Bone without Excision. An Experimental Study of Bone Cell Destruction and Manner of Regrowth in Dogs. JAMA, 196, 770-774. http://dx.doi.org/10.1001/jama.1966.03100220062020
Marcove, R.C., Lyden, J.P., Huvos, A.G. and Bullough, P.B. (1973) Giant-Cell Tumors Treated by Cryosurgery. A Report of Twenty-Five Cases. Journal of Bone and Joint Surgery (America), 55, 1633-1644.
Ippolito, V. and Motta, C. (1989) Advantages of Surgical Treatment of Metastatic Bone Disease. Acta Oncologica, 10, 45-52.
Malawer, M.M., Bickels, J., Meller, I., et al. (1999) Cryosurgery in the Treatment of Giant Cell Tumor. A Long-Term Follow up Study. Clinical Orthopaedics and Related Research, 359, 176-188. http://dx.doi.org/10.1097/00003086-199902000-00019
Marcove, R.C., Weis, L.D., Vaghaiwalla, M.R., et al. (1978) Cryosurgery in the Treatment of Giant Cell Tumors of Bone. A Report of 52 Consecutive Cases. Cancer, 41, 957-969. http://dx.doi.org/10.1002/1097-0142(197803)41:3 3.0.CO;2-Y
Bickels, J., Meller, I., Shmookler, B.M. and Malawer, M.M. (1999) The Role and Biology of Cryosurgery in the Treatment of Bone Tumors. A Review. Acta Orthopaedica Scandinavica, 70, 308-315. http://dx.doi.org/10.3109/17453679908997814
Marcove, R.C. and Miller, T.R. (1969) Treatment of Primary and Metastatic Bone Tumors by Cryosurgery. JAMA, 207, 1890-1894. http://dx.doi.org/10.1001/jama.1969.03150230104014
Bickels, J., Kollender, Y., et al. (2004) Closed Argon-Based Cryoablation of Bone Tumors. Journal of Bone and Joint Surgery (British), 86, 714-718. http://dx.doi.org/10.1302/0301-620X.86B5.14416
Henshaw, R.M. (2007) Treatment of Bone Lesions with Cryoprobes. Techniques in Orthopaedics, 22, 134-142. http://dx.doi.org/10.1097/BTO.0b013e3181237d2a
Charnley, J. (1970) Acrylic Cement in Orthopaedic Surgery. British Medical Journal, 15, 73-74.
Persson, B.M. and Wouters, H.V. (1976) Curettage and Acrylic Fixation Cementation in Surgery of Giant Cell Tumor of Bone. Journal of Bone and Joint Surgery, 120B, 125.
Malawer, M.M. and Dunham, W. (1991) Cryosurgery and Acrylic Cementation as Surgical Adjuncts in the Treatment of Aggressive (Benign) Bone Tumors: Analysis of 25 Patients below the Age of 21. Clinical Orthopaedics and Related Research, 262, 42-57. http://dx.doi.org/10.1097/00003086-199101000-00007
Leeson, M.C. and Lippitt, S.B. (1993) Thermal Aspects of the Use of Polymethylmethacrylate in Large Metaphyseal Defects in Bone: A Clinical Review and Laboratory Study. Clinical Orthopaedics and Related Research, 295, 239-245. http://dx.doi.org/10.1097/00003086-199310000-00035
Malawer, N.M., Marks, M.R., Mcchesney, D., Piasio, M., Gunther, S.F. and Schmookler, B.M. (1988) The Effect of Cryosurgery and Polymethylmethacrylate in Dogs with Experimental Bone Defects Comparable to Tumor Defects. Clinical Orthopaedics and Related Research, 226, 299-310. http://dx.doi.org/10.1097/00003086-198801000-00038
Mjoberg, B., Pettersson, H., Rosenqvist, R. and Rydholm, A. (1984) Bone Cement, Thermal Injury and the Radiolucent Zone. Acta Orthopaedica, 55, 597-600. http://dx.doi.org/10.3109/17453678408992403
Capanna, R., et al. (2000) Indicazioni e strategia chirurgica nelle metastasi ossee da carcinoma delle estremità e dei cingoli pelvico e scapolare. Corso di Istruzione SIOT.
Gasparini, G., De Gori, M., Calonego, G., Della Bora, T., Caroleo, B. and Galasso, O. (2014) Drug Elution from High Dose Antibiotic Loaded Acrylic Cement: A Comparative, in Vitro Study. Orthopedics, 37, e999-e1005. http://dx.doi.org/10.3928/01477447-20141023-57
Hern1gou, P.H., Thiery, J.P., Benoit, J., Voisin, M.C., Leroux, P., Hagege, G., et al. (1989) Methotrexate Diffusion from Acrylic Cement: Local Chemotherapy for Bone Tumours. The Journal of Bone & Joint Surgery (British Volume), 71, 804-811.
Rosa, M.A., Maccauro, G., Sgambato, A., Ardito, R., Falcone, G., De Santis, V. and Muratori, F. (2003) Acrylic Cement Added with Antiblastics in the Treatment of Bone Metastases. The Journal of Bone & Joint Surgery (British Volume), 85-B, 712-716.
Maccauro, G., Cittadini, A., Casarci, M., Muratori, F., De Angelis, D., Piconi, C., Rosa, M.A., Spadoni, A., Braden, M. and Sgambato, A. (2007) Methotrexate-Added Acrylic Cement: Biological and Physical Properties. Journal of Materials Science: Materials in Medicine, 18, 839-844. http://dx.doi.org/10.1007/s10856-006-0036-7
Di Caprio, M.R., Boyle, J. and Gibbs, C.P. (2007) Use of the Argon Beam Coagulator as an Adjuvant for Treating Bone Tumors. Techniques in Orthopaedics, 22, 110-115. http://dx.doi.org/10.1097/BTO.0b013e31811f35b7
Lewis, V.O., Wei, A., Mendoza, T., Primus, F., Peabody, T. and Simon, M.A. (2007) Argon Beam Coagulation as an Adjuvant for Local Control of Giant Cell Tumor. Clinical Orthopaedics and Related Research, 454, 192-197. http://dx.doi.org/10.1097/01.blo.0000238784.98606.d4
Heck, R.K., Pope, W.D., Ahn, J.I., Smith, R.A. and Webber, B.L. (2009) Histologic Evaluation of the Depth of Necrosis Produced by Argon Beam Coagulation: Implications for Use as Adjuvant Treatment of Bone Tumors. Journal of Surgical Orthopaedic Advances, 18, 69-73.
Benevia, J., Patterson, F.R., Beebe, K.S., Abdelshahed, M.M. and Uglialoro, A.D. (2012) Coagulation as Adjuvant Therapies in the Treatment of Stage 2 and 3 Benign-Aggressive Bone Tumors. Orthopedics, 35, e371-e378.
Reynolds, J.E.F. (1993) The Extra Pharmacopoeia. 30th Edition, The Phamaceutical Press, London, 570-572.
Lackman, R.D., Hosalkar, H.S., Ogilvie, C.M., Torbert, J.T. and Fox, E.J. (2005) Intralesional Curettage for Grades II and III Giant Cell Tumors of Bone. Clinical Orthopaedics and Related Research, 438, 123-127. http://dx.doi.org/10.1097/01.blo.0000180051.27961.c3
Quint, U., Muller, R.T. and Muller, G. (1998) Characteristics of Phenol. Instillation in Intralesional Tumor Excision of Chondroblastoma, Osteoclastoma and Enchondroma. Archives of Orthopaedic and Trauma Surgery, 117, 43-46. http://dx.doi.org/10.1007/BF00703438
Trieb, K., Bitzan, P., Lang, S., Dominkus, M. and Kotz, R. (2001) Recurrence of Curetted and Bone-Grafted Giant Cell Tumours with and without Adjuvant Phenol Therapy. European Journal of Surgical Oncology, 27, 200-202. http://dx.doi.org/10.1053/ejso.2000.1086
Capanna, R., Sudanese, A., Baldini, N. and Campanacci, M. (1985) Phenol as an Adjuvant in the Control of Local Recurrence of Benign Neoplasms of Bone Treated by Curettage. Italian Journal of Orthopaedics and Traumatology, 11, 381-388.
Lin, W.-H., Lan, T.-Y., Chen, C.-Y., Wu, K. and Yang, R.-S. (2011) Similar Local Control between Phenol and Ethano Treated Giant Cell Tumors of Bone. Clinical Orthopaedics and Related Research, 469, 3200-3208. http://dx.doi.org/10.1007/s11999-011-1962-3
Shiina, S., Tagawa, K., Niwa, Y., Unuma, T., Komatsu, Y., Yoshiura, K., Hamada, E., Takahashi, M., Shiratori, Y. and Terano, A. (1993) Percutaneous Ethanol Injection Therapy for Hepatocellular Carcinoma: Results in 146 Patients. American Journal of Roentgenology, 160, 1023-1028. http://dx.doi.org/10.2214/ajr.160.5.7682378
Shiina, S., Tagawa, K., Unuma, T., Takanashi, R., Yoshiura, K., Komatsu, Y., Hata, Y., Niwa, Y., Shiratori, Y. and Terano, A. (1991) Percutaneous Ethanol Injection Therapy for Hepatocellular Carcinoma: A Histopathologic Study. Cancer, 68, 1524-1530. http://dx.doi.org/10.1002/1097-0142(19911001)68:7 3.0.CO;2-O
Guglielmi, R., Pacella, C.M., Bianchini, A., Bizzarri, G., Rinaldi, R., Graziano, F.M., Petrucci, L., Toscano, V., Palma, E., Poggi, M. and Papini, E. (2004) Percutaneous Ethanol Injection Treatment in Benign Thyroid Lesions: Role and Efficacy. Thyroid, 14, 125-131. http://dx.doi.org/10.1089/105072504322880364
Wang, P., Zuo, C., Qian, Z., Tian, J., Ren, F. and Zhou, D. (2003) Computerized Tomography Guided Percutaneous Ethanol Injection for the Treatment of Hyperfunctioning Pheochromocytoma. The Journal of Urology, 170, 1132-1134. http://dx.doi.org/10.1097/01.ju.0000081145.44969.b8
El-Mowafi, H., Refaat, H. and Kotb, S. (2003) Percutaneous Destruction and Alcoholisation for the Management of Osteoid Osteoma. Acta Orthopaedica Belgica, 69, 447-451.
Bas, T., Aparisi, F. and Bas, J.L. (2001) Efficacy and Safety of Ethanol Injections in 18 Cases of Vertebral Hemangioma: A Mean Follow-Up of 2 Years. Spine, 26, 1577-1582. http://dx.doi.org/10.1097/00007632-200107150-00015
Crawford, E.A., Slotcavage, R.L., King, J.J., Lackman, R.D. and Ogilvie, C.M. (2009) Ethanol Sclerotherapy Reduces Pain in Symptomatic Musculoskeletal Hemangiomas. Clinical Orthopaedics and Related Research, 467, 2955-2961. http://dx.doi.org/10.1007/s11999-009-0919-2
Cotton, A., Demondion, X., Boutry, N., Cortet, B., Chastanet, P., Duquesnoy, B. and Leblond, D. (1999) Therapeutic Percutaneous Injections in the Treatment of Malignant Acetabular Osteolyses. Radiographics, 19, 647-653. http://dx.doi.org/10.1148/radiographics.19.3.g99ma04647
Gangi, A., Kastler, B., Klinkert, A. and Dietemann, J.L. (1994) Injection of Alcohol into Bone Metastases under CT Guidance. Journal of Computer Assisted Tomography, 18, 932-935. http://dx.doi.org/10.1097/00004728-199411000-00016
Jones, K.B., De Young, B.R., Morcuende, J.A. and Buckwalter, J.A. (2006) Ethanol as a Local Adjuvant for Giant Cell Tumor of Bone. Iowa Orthopaedic Journal, 26, 69-76.
Oh, J.H., Yoon, P.W., Lee, S.H., Cho, H.S., Kim, W.S. and Kim, H.S. (2006) Surgical Treatment of Giant Cell Tumour of Long Bone with Anhydrous Alcohol Adjuvant. International Orthopaedics, 30, 490-494. http://dx.doi.org/10.1007/s00264-006-0154-3
Docherty, J.G., McGregor, J.R., Purdie, C.A., Galloway, D.J. and O’Dwyer, P.J. (1995) Efficacy of Tumoricidal Agents in Vitro and in Vivo. British Journal of Surgery, 82, 1050-1052. http://dx.doi.org/10.1002/bjs.1800820816
Wooldridge, A.N., Kolovich, G.P., Crist, M.K., Mayerson, J.L. and Scharschmidt, T.J. (2013) Predictors of Local Recurrence in High-Grade Soft Tissue Sarcomas; Hydrogen Peroxide as a Local Adjuvant. Orthopedics, 36, e207-e215. http://dx.doi.org/10.3928/01477447-20130122-24