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Chondroblastoma treatment by radiofrequency thermal ablation: Initial experience and implementation

Published:September 17, 2021DOI:https://doi.org/10.1016/j.ejrad.2021.109950

      Highlights

      • Chondroblastoma can be successfully treated by radiofrequency thermal ablation.
      • Cementoplasty is recommended in chondroblastoma located at the weight bearing areas.
      • Resolution of bone marrow oedema is an MRI hallmark of clinical success.
      • Necrosis extending beyond the tumour edge is another MRI hallmark of clinical success.

      Abstract

      Purpose

      To present our experience on the implementation of radiofrequency thermal ablation (RFA) for the treatment of chondroblastoma.

      Materials and methods

      This case series includes 12 patients (10 males) with chondroblastoma using RFA under CT guidance. Tumours were located in the humeral head (3), femoral head (2), distal femoral epiphysis (4), tibial epiphysis (2) and calcaneus (1). Tumour size ranged from 12 to 60 mm (median: 33 mm).
      According to tumour size and location, monopolar electrode’s active tip ranged from 1 to 3 cm. Dry and perfused ablation mode was used to treat smaller (6) and larger (6) lesions, respectively. Cementation was also made in 5 cases.
      Technical success was considered if the tumour was treated according to the protocol and complete ablation was achieved. Clinical success was assessed according to a visual analogue scale.

      Results

      Technical success was achieved in 11 of 13 cases (83%) afters the first treatment. After a second treatment in the 2 failed cases, pain control was achieved in all cases eventually (100% of clinical success). Follow-up MRI demonstrated resolution of oedema in all cases, as well as a necrotic area extending beyond the outer edge of the lesion in all cases except one. Radiography or CT showed stability of the lesions, with increased sclerosis and no cortex collapse.
      In one case, a 4 cm shortening of the humerus was observed at the end of skeletal development (7 years after treatment). In another case, early hip osteoarthritis was developed (15 years after treatment). No other long-term complications were observed.

      Conclusion

      Successful treatment of chondroblastoma can be achieved by RFA. Cementoplasty adds strength to the ablated bone in weight bearing areas. MRI hallmarks associated with clinical success were resolution of bone marrow edema, and area of necrosis extending beyond the tumour edge. Radiography and CT proved to be useful in demonstrating cortex integrity.

      Keywords

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      References

        • Suneja R.
        • Grimer R.J.
        • Belthur M.
        • Jeys L.
        • Carter S.R.
        • Tillman R.M.
        • Davies A.M.
        Chondroblastoma of bone: long-term results and functional outcome after intralesional curettage.
        J. Bone Joint Surg. 2005; 87: 974-978
        • Laitinen M.K.
        • Stevenson J.D.
        • Evans S.
        • Abudu A.
        • Sumathi V.
        • Jeys L.M.
        • Parry M.C.
        Chondroblastoma in pelvis and extremities- a single centre study of 177 cases.
        J Bone Oncol. 2019; 27100248
        • Ramappa A.J.
        • Lee F.Y.
        • Tang P.
        • Carlson J.R.
        • Gebhardt M.C.
        • Mankin H.J.
        Chondroblastoma of bone.
        J. Bone Joint Surg. Am. 2000; 82: 1140-1145
        • Tins B.
        • Cassar-Pullicino V.
        • McCall I.
        • Cool P.
        • Williams D.
        • Mangham D.
        Radiofrequency ablation of chondroblastoma using a multi-tined expandable electrode system: initial results.
        Eur. Radiol. 2006; 16: 804-810
        • Xie C.
        • Jeys L.
        • James S.L.J.
        Radiofrequency ablation of chondroblastoma: longterm clinical and imaging outcomes.
        Eur. Radiol. 2015; 25: 1127-1134
        • Ruiz Santiago F.
        • del Mar Castellano García M.
        • Guzmán Álvarez L.
        • Martínez Montes J.L.
        • Ruiz García M.
        • Tristán Fernández J.M.
        Percutaneous treatment of bone tumors by radiofrequency thermal ablation.
        Eur. J. Radiol. 2011; 77: 156-163
        • Rybak L.D.
        • Rosenthal D.I.
        • Wittig J.C.
        Chondroblastoma: radiofrequency ablation–alternative to surgical resection in selected cases.
        Radiology. 2009; 251: 599-604
        • Enneking W.F.
        • Dunham W.
        • Gebhardt M.C.
        • Malawar M.
        • Pritchard D.J.
        A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.
        Clin. Orthop. Relat. Res. 1993; 286: 241-246
        • Goldberg S.N.
        • Grassi C.J.
        • Cardella J.F.
        • Charboneau J.W.
        • Dodd G.D.
        • Dupuy D.E.
        • Gervais D.
        • Gillams A.R.
        • Kane R.A.
        • Lee F.T.
        • Livraghi T.
        • McGahan J.
        • Phillips D.A.
        • Rhim H.
        • Silverman S.G.
        Image-guided tumor ablation: standardization of terminology and reporting criteria.
        Radiology. 2005; 235: 728-739
        • Goldberg S.N.
        • Grassi C.J.
        • Cardella J.F.
        • Charboneau J.W.
        • Dodd G.D.
        • Dupuy D.E.
        • Gervais D.
        • Gillams A.R.
        • Kane R.A.
        • Lee F.T.
        • Livraghi T.
        • McGahan J.
        • Phillips D.A.
        • Rhim H.
        • Silverman S.G.
        Image-guided tumor ablation: standardization of terminology and reporting criteria.
        J. Vasc. Interv. Radiol. 2005; 16: 765-778
        • Erickson J.K.
        • Rosenthal D.I.
        • Zaleske D.J.
        • Gebhardt M.C.
        • Cates J.M.
        Primary treatment of chondroblastoma with percutaneous radio-frequency heat ablation: report of three cases.
        Radiology. 2001; 221: 463-468
        • Oxtoby J.W.
        • Davies A.M.
        MRI characteristics of chondroblastoma.
        Clin. Radiol. 1996; 51: 22-26
        • Lalam R.K.
        • Cribb G.L.
        • Tins B.J.
        • Cool W.P.
        • Singh J.
        • Tyrrell P.N.M.
        • Cassar-Pullicino V.N.
        Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?.
        Skeletal Radiol. 2014; 43: 513-522
        • Laitinen M.K.
        • Stevenson J.D.
        • Evans S.
        • et al.
        Chondroblastoma in pelvis and extremities- a single centre study of 177 cases.
        J. Bone Oncol. 2019; 17100248
        • Santiago F.R.
        • del Mar Castellano García M.
        • Montes J.L.M.
        • García M.R.
        • Fernández J.M.T.
        Treatment of bone tumours by radiofrequency thermal ablation.
        Curr. Rev. Musculoskelet. Med. 2009; 2: 43-50
        • Cantwell C.P.
        • O'Byrne J.
        • Eustace S.
        Radiofrequency ablation of osteoid osteoma with cooled probes and impedance-control energy delivery.
        AJR Am. J. Roentgenol. 2006; 186: S244-S248
        • Voss J.R.
        • Lu Y.
        • Edwards R.B.
        • Bogdanske J.J.
        • Markel M.D.
        Effects of thermal energy on chondrocyte viability.
        Am. J. Vet. Res. 2006; 67: 1708-1712
        • Rathke H.
        • Hamm B.
        • Güttler F.
        • Rathke J.
        • Rump J.
        • Teichgraber U.
        • Bucourt M.d.
        Comparison of four radiofrequency ablation systems at two target volumes in an ex vivo bovine liver model.
        Diagn. Interv. Radiol. 2014; 20: 251-258
        • Christie-Large M.
        • Evans N.
        • Davies A.M.
        • James S.L.J.
        Radiofrequency ablation of chondroblastoma: procedure, technique, clinical and MR imaging follow up of four cases.
        Skeletal Radiol. 2008; 37: 1011-1017
        • Petsas T.
        • Megas P.
        • Papathanassiou Z.
        Radiofrequency ablation of two femoral head chondroblastomas.
        Eur. J. Radiol. 2007; 63: 63-67
        • Rajalakshmi P.
        • Srivastava D.N.
        • Rastogi S.
        • et al.
        Bipolar radiofrequency ablation of tibial chondroblastomas: a report of three cases.
        World J. Radiol. 2012; 4: 335-340
        • Thibaut A.
        • Bouhamama A.
        • Boespflug A.
        • Vaz G.
        • Cuinet M.
        • Kalenderian A.-C.
        • Menassel B.
        • Ricoeur A.
        • Mastier C.
        • Pilleul F.
        Percutaneous cryotherapy for treatment of chondroblastoma: early experience.
        Cardiovasc. Intervent. Radiol. 2019; 42: 304-307
        • Ebeid W.A.
        • Hasan B.Z.
        • Badr I.T.
        • Mesregah M.K.
        Functional and oncological outcome after treatment of chondroblastoma with intralesional curettage.
        J. Pediatr. Orthop. 2019; 39: e312-e317
        • Deventer N.
        • Deventer N.
        • Gosheger G.
        • de Vaal M.
        • Budny T.
        • Laufer A.
        • Heitkoetter B.
        • Luebben T.
        Chondroblastoma: is intralesional curettage with the use of adjuvants a sufficient way of therapy?.
        J. Bone Oncol. 2021; 26: 100342https://doi.org/10.1016/j.jbo.2020.100342