http://elynsgroup.com Copyright: © 2016 Franco IL, et al. http://dx.doi.org/10.19104/jorm.2016.114 Open Access Case Report J Orth Rhe Sp Med Journal of Orthopedics, Rheumatology and Sports Medicine Page 1 of 5 ISSN: 2470-9824 Percutaneous Radiofrequency Thermal Ablation Treatment of Recurrent Bone Giant Cell Tumor Ignacio L. Franco 1 *, Angel B. Horcajadas 2 , Jose Martel 1 and Eduardo Ortiz 3 1 Department of Radiology, Hospital Universitario Fundacion de Alcorcon, Madrid, Spain 2 Department of Musculoskeletal Radiology, Hospital Universitario Fundacion de Alcorcon, Madrid, Spain 3 Department of Traumatology and Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain Abstract Percutaneous Radiofrequency Thermal Ablation (PRFTA) is the method of choice to treat most of the cases of osteoid osteoma. The Good results on other benign bone tumors as osteoblastoma and chondroblastoma have been reported. The treatment for bone Giant Cell Tumor (GCT) is surgical resection. The PRFTA has not been previously described for recurrent GCT in the literature. We reported four recurrent GCTs from our institution, successfully treated with PRFTA (from 2009 to 2014), located in the lateral cuneiform bone, the distal epiphysis of tibia, the greater tuberosity of femur and the coxal bone involving the hip joint. The previous percutaneous CT guided 11G biopsy confirmed the diagnosis in all of the cases. The patients were under general anesthesia or deep sedation in the CT room. The radiofrequency electrode was inserted through a bone introducer needle and heated at 90°C for three to five minutes. There were no complications, with rapid recovery of the patients. Introduction Surgery remains as the primary treatment for the bone GCT. The GCT recurrence occurs in 2–25% of cases [1,2]. When surgery is not possible or could be associated with excessive morbidity, denosumab (a fully human monoclonal antibody to RANKL (Receptor activator of nuclear factor kappa-B ligand), a key mediator of osteoclast activity) is a good treatment option. The optimal length of treatment and schedule of denosumab is unknown, but recurrences after apparent complete responses have been observed after stopping denosumab, and long-term follow-up of denosumab treatment may reveal unrecognized effects [3]. On the other hand, recent advance in minimally invasive therapies are adding further tools for tumor management. For instance, percutaneous radiofrequency thermal ablation (PRFTA) has been reported in the literature as a successful treatment for hepatic tumor as well as for the treatment of benign bone tumors [4–6]. However, we have not found any reference in the literature to this treatment modality for recurrent GCT, and there are only a small number of case reports on GCT [6,7]. The Radiofrequency ablation is based on heating tumor cells to temperatures higher than 60°C until they are killed. It uses an electromagnetic 300 to 500 KHz frequency alternating current, carried by an image guided electrode which is introduced into the tumor. The current phase changes induce local ionic agitation, which triggers molecular friction movements responsible for a rise in temperature. The temperature increases around the electrode and the heat is distributed by diffusion. The primary purpose of this study is to describe our experience of PRFTA treatment in bone GCT recurrences, where further surgery would have been too aggressive. Received Date: July 25, 2016, Accepted Date: October 28, 2016, Published Date: November 07, 2016. *Corresponding author: Ignacio Lopez-Vidaur Franco, Department of Radiology, Hospital Universitario Fundacion de Alcorcon, Madrid, Spain, E-mail: ilopezvidaur@gmail.com Materials and Methods We reported the cases of four patients from our institution with GCTs recurrences, who where successfully treated with PRFTA (from 2009 to 2014). The study was approved by the Institutional Medical Ethical Review Board. All patients were provided with the relevant information and signed the relevant consent forms before the procedure took place. The recurrent GCTs were located in: Case 1: The lateral cuneiform bone of the right tarsus Case 2: The distal epiphysis of the left tibia involving the subchondral cortical bone Case 3: The greater tuberosity of the right femur Case 4: The iliac bone which included a fracture with of the subchondral cortical of acetabulum and tumor growth into the hip joint. All four patients had been diagnosed with bone giant cell tumor diagnosed by percutaneous CT guided biopsy and subsequent surgery. Prior surgical treatment had been performed in all patients with intra-lesion extended resection and curettage, in addition to high speed burr, pulsatile lavage, phenol, and reconstruction with bone allograft or cementplasty. Case 1 was treated surgically twice before PRFTA and case 2 was treated three times. Case 3 and 4 underwent surgery once. Recurrence of bone GCT was confirmed by percutaneous biopsy in all cases. The Percutaneous CT guided by radiofrequency thermal ablation (RFTA) was performed in all four patients. Before undergoing RF ablation, signed consent forms were obtained from each patient. All candidates were informed with regards to alternative treatments. The procedures were carried out under general anesthesia or deep sedation in the CT room. The technique used was the same as has been described in the literature for osteoid osteoma [4,5]. We reached the bone lesion under CT guidance with an 11−13 gauge (G) introducer bone biopsy needle. The stylet of the needle was removed and exchanged for a 17 G monopolar RF electrode (Cool-tip Covidien RAF System). The CT image ensured the right placement of the electrode active tip (7–10 mm) inside the lesion. Radiofrequency-activation time was three to five minutes providing that the core temperature reached 90°C (Figure 1). Cooling activation was not necessary due to the small size of the recurrence. The monitoring and follow up with CT and MRI was performed for 18 months to five years after treatment.