Adjuvant treatment of non-malignant active and aggressive bone tumors

Aggressive but nonmalignant bone tumors often pose a difficult therapeutic dilemma for orthopaedic oncologists. Intralesional surgery usually is the modality of choice to lessen the morbidity associated with a marginal or wide excision. With more aggressive tumors, such as giant cell tumor of bone, chondroblastoma or aneurysmal bone cysts, high recurrence rates after curettage alone present a challenge to the surgeon. Adjuvant therapies provide an additional means of clearing the cavity of tumor cells after aggressive intralesional resection. The addition of adjuvants then is able to extend the margins beyond that which is visible to a marginal excision, removing microscopic disease. Clinically, this yields lower recurrence rates, with different methods having better efficacy. With the less aggressive yet still active lesions, injections and percutaneous methods may be preferred. This article discusses some of the more common as well as emerging trends in adjuvant therapy for active and aggressive nonmalignant bone tumors. Broad categories included are mechanical (burring), hypothermic or hyperthermic (cryotherapy, argon beam, cementation), chemical (phenol, hydrogen peroxide), and biologic modalities (bisphosphonates). Injectable materials also are discussed. Current literature regarding these adjuvants (focusing on the past 2 years) is presented, with an eye on clinical recommendations.