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Ethanol rinsing lowers phenol levels after treatment of low-grade bone tumors
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The use of liquefied phenol during intralesional curettage of low-grade malignant bone tumors is safe when washed out with ethanol, according to study results.
Intralesional curettage is a surgical procedure typically performed on patients with low-grade bone tumors. The technique, however, carries the risk of tumor cell recurrence.
Supplementing intralesional curettage with a local adjuvant such as phenol for low-grade malignant bone tumors has improved therapy results, according to background information in the study. Still, only a few documented studies about the effects of liquefied phenol — which has toxic and potentially carcinogenic properties — have been published, despite its routine use, the researchers wrote.
The current study involved 16 patients (median age, 48 years) with grade-1 chondrosarcoma who received intralesional curettage and adjuvant therapy.
Suzan H.M. Verdegaal, MD, a researcher in the department of orthopedic surgery at Leiden University Medical Center in the Netherlands, and colleagues performed two tests during the study.
In the first test, 2 ml to 4 ml of liquefied phenol 85% were applied to the inner surface of the bone cavity after curettage of the tumor. The cavity then was filled with ethanol 96% solution. Surgeons repeated this procedure 10 times for each of the 16 patients.
In the second test — performed on 10 of the 16 study patients — researchers removed two biopsy samples from the bone cavity wall during surgery. The first biopsy was taken after the cavity was swabbed with 85% phenol solution. The second biopsy was taken after the cavity was rinsed 10 times with ethanol.
The researchers evaluated the two biopsies, plus all 10 flush solutions, from each patient to determine the concentration of phenol.
Although phenol concentrations varied widely among the patients, the concentrations decreased in all patients after ethanol rinsing.
Verdegaal and colleagues determined rinsing the bone cavity with ethanol 96% six times diminished the local concentration of liquefied phenol to an acceptable concentration of less than 0.2%.
“This study shows that the adverse effects on the whole body due to the use of liquefied phenol as adjuvant in the intralesional curettage of benign and low-grade malignant bone tumors are reduced to safe concentrations by washing phenol out by ethanol,” Verdegaal and colleagues wrote.
Perspective
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Ilya Iofin, MD
There are many possible adjuvants that are available for use after low rate malignant bone tumors. The first question becomes, which adjuvant do you use? There isn’t much agreement on that among orthopedic oncologists because each surgeon has his or her own preference, as does each institution. For the people who decide to use phenol, this is a useful study in that it shows you how much you have to wash out the tumor cavity in order to get rid of the phenol. But questions, which weren’t designed to be addressed by the study, remain as to which adjuvant is better to be used. That is still not resolved.
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