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Curettage suggested as first treatment for tumorinduced osteomalacia lesions in long bone
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As researchers of this retrospective study of 17 patients with tumor-induced osteomalacia lesions in long bones found 82% of tumors were located in the epiphysis, they recommend curettage as the initial surgical treatment followed by segmental resection in cases of incomplete resection or recurrence.
“[Our] results suggest that multiple modalities of imaging may be needed to help localize the site of the phosphaturic mesenchymal tumor in a patient with tumor-induced osteomalacia,” the researchers wrote. “Curettage should be effective for most lesions near a joint, followed by segmental resection if needed.”
The study involved patients who underwent curettage or segmental resection for tumor-induced osteomalacia lesions in the long bones. Curettage patients who had a recurrent tumor or incomplete resection underwent a secondary segmental resection. The patients had a mean follow-up of 35 months. Clinical and laboratory data were collected from retrospective charts. Serum fibroblast growth factor-23 (FGF-23) was measured using the enzyme-linked immunosorbent assay and the FGF-23 ELISA kit. At 1 day, 3 days, 5 days, 7 days, 10 days and 14 days postoperative, researchers measured serum phosphorous levels.
CT and MRI scans were performed to identify and confirm suspicious areas, and the researchers recorded tumor locations. They also evaluated tumor characteristics and compared the effects of curettage and segmental resection.
Results showed 82% of tumors were grew eccentrically and the maximum mean tumor diameter was 2.4±2 cm. Overall, the cure rate was 71%. Complete resection rates were 67% for curettage and 80% for segmental resection, but recurrence rates were 50% for curettage and 0% for resection.
Secondary segmental resection and primary segmental resection were not significantly different in regards to the complete resection rate. One patient’s osteomalacia was not resolved with curettage; and needed a segmental resection of a left tibial plateau tumor.
According to researchers, phosphaturic mesenchymal tumors were the cause for all tumor-induced osteomalacia cases. Serum FGF-23 and serum phosphorous returned to normal levels at 24 hours and 6.5±3.5 days, respectively following tumor removal. ‒ by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
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