苯酚和乙醇治疗骨巨细胞瘤的局部控制效果相似。
Similar local control between phenol- and ethanol-treated giant cell tumors of bone.
机构信息
Department of Orthopedics, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan.
出版信息
Clin Orthop Relat Res. 2011 Nov;469(11):3200-8. doi: 10.1007/s11999-011-1962-3. Epub 2011 Jul 6.
BACKGROUND
Giant cell tumors (GCTs) of bone often are treated with curettage, adjuvant therapy, and cementation. Phenol is a commonly used adjuvant associated with local control rates ranging from 9% to 25%. However, it is corrosive to the eyes, skin, and respiratory tract. Ethanol is readily available and does not cause chemical burns on contact, but it is unclear whether ethanol can achieve similar local control rates as phenol for treating GCTs.
QUESTIONS/PURPOSES: We evaluated (1) the recurrence rate and recurrence-free Kaplan-Meier survival function, (2) Musculoskeletal Tumor Society (MSTS) functional score (1993 version), and (3) complications of two groups of patients with GCTs treated with extensive curettage, local adjuvant therapy with phenol or ethanol, and cement reconstruction, to determine if ethanol was a reasonable alternative to phenol.
PATIENTS AND METHODS
We retrospectively reviewed all 26 patients with GCTs in the long bones of extremities treated with curettage, high-speed burring, phenolization, and cementation between May 1995 and November 2001, and 35 patients treated with the same protocol, except phenol was replaced with 95% ethanol, between November 2001 and November 2007. The recurrence rates, Kaplan-Meier recurrence-free survival curves, and MSTS functional scores of these two treatment groups were compared with Fisher's exact test, Tarone-Ware test, and Mann-Whitney U test, respectively. The minimum followup was 36 months (mean, 58 months; range, 36-156 months).
RESULTS
Local recurrence rates were similar in the two groups: 11% in the ethanol group and 12% in the phenol group. The survival curves (using local recurrence as an endpoint) of the two groups were similar. The mean MSTS functional score was 27.3 (91%) for the ethanol group and 26.9 (90%) for the phenol group.
CONCLUSIONS
Ethanol is a reasonable alternative to phenol when adjuvant therapy is considered in the treatment of GCTs of long bones.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
骨巨细胞瘤（GCT）常采用刮除术、辅助治疗和骨水泥填充治疗。苯酚是一种常用的辅助剂，其局部控制率为 9%至 25%。然而，它对眼睛、皮肤和呼吸道具有腐蚀性。乙醇容易获得，接触时不会引起化学灼伤，但尚不清楚乙醇是否能达到与苯酚相似的局部控制率，用于治疗 GCT。
问题/目的：我们评估了（1）复发率和无复发生存的 Kaplan-Meier 生存函数，（2）肌肉骨骼肿瘤学会（MSTS）功能评分（1993 年版），（3）两组接受广泛刮除术、局部辅助治疗苯酚或乙醇以及骨水泥重建的 GCT 患者的并发症，以确定乙醇是否是苯酚的合理替代品。
患者和方法
我们回顾性分析了 1995 年 5 月至 2001 年 11 月间接受刮除术、高速钻孔、苯酚化和骨水泥填充治疗的 26 例长骨 GCT 患者，以及 2001 年 11 月至 2007 年 11 月间接受相同方案治疗的 35 例患者，除苯酚用 95%乙醇替代外，其余均相同。采用 Fisher 确切检验、Tarone-Ware 检验和 Mann-Whitney U 检验比较两组的复发率、Kaplan-Meier 无复发生存曲线和 MSTS 功能评分。最小随访时间为 36 个月（平均 58 个月；范围 36-156 个月）。
结果
两组局部复发率相似：乙醇组为 11%，苯酚组为 12%。两组的生存曲线（以局部复发为终点）相似。乙醇组的平均 MSTS 功能评分为 27.3（91%），苯酚组为 26.9（90%）。
结论
在长骨 GCT 的治疗中，当考虑辅助治疗时，乙醇是苯酚的合理替代品。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
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