Verspoor F G M, Scholte A, van der Geest I C M, Hannink G, Schreuder H W B
Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands.
Sarcoma. 2016;2016:3072135. doi: 10.1155/2016/3072135. Epub 2016 Dec 26.
. Tenosynovial giant cell tumors (TGCT) emerge from the synovium and can behave aggressively. Surgical resection is the standard treatment. However, up to half of the patients with diffuse type show recurrences. Several additional treatments have been applied to reduce recurrences; none of these treatments was proven to be superior to surgical resection solely. This article describes the results of additional cryosurgery to surgical resection. . We retrospectively evaluated 141 TGCT patients, between 1999 and 2007. Twelve patients had additional cryosurgery. The knee ( = 8), hip ( = 2), ankle ( = 1), and elbow ( = 1) were affected. Primary outcome variables were treatment indications, recurrences, and complications. . Indications for additional cryosurgery were extended disease, bone involvement, and locations that are difficult to surgically get disease-free such as cruciate ligaments. Five patients had recurrent disease, all of which had prior treatments. None of the primary treated patients had recurrent disease. One patient had a deep infection. . Cryosurgery may serve as an additional treatment for diffuse TCGT in selected cases. However, because of the small number of patients and the heterogeneous group we could not prove an advantage of additional cryosurgery over surgical resection only. Cryosurgery should be considered for further evaluation in a prospective study. If there is any effect it would be helpful, especially in patients with multiple TGCT recurrences.
腱鞘巨细胞瘤(TGCT)起源于滑膜,可呈侵袭性生长。手术切除是标准治疗方法。然而,高达一半的弥漫型患者会复发。已应用多种其他治疗方法来减少复发;但这些治疗方法均未被证明单独优于手术切除。本文描述了手术切除联合冷冻手术的结果。
我们回顾性评估了1999年至2007年间的141例TGCT患者。其中12例患者接受了额外的冷冻手术。受累部位包括膝关节(8例)、髋关节(2例)、踝关节(1例)和肘关节(1例)。主要结局变量为治疗指征、复发情况和并发症。
额外冷冻手术的指征包括病变范围扩大、骨质受累以及如交叉韧带等手术难以实现无瘤切除的部位。5例患者有复发病变,均曾接受过先前治疗。初次治疗的患者均无复发病例。1例患者发生深部感染。
冷冻手术可作为特定病例中弥漫性TCGT的一种辅助治疗方法。然而,由于患者数量较少且群体异质性,我们无法证明额外的冷冻手术比单纯手术切除更具优势。冷冻手术应在前瞻性研究中进一步评估。如果有任何效果,将很有帮助,尤其是对于多次复发的TGCT患者。