Inconclusive benefit of adjuvant 90Yttrium hydroxyapatite to radiosynovectomy for diffuse-type tenosynovial giant-cell tumour of the knee

Bone Joint J. 2018 Jul;100-B(7):984-988. doi: 10.1302/0301-620X.100B7.BJJ-2017-0867.R3.

Abstract

Aims: Intra-articular 90Yttrium (90Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with 90Yttrium.

Patients and methods: All patients with dtTGCT of the knee who underwent synovectomy between 1991 and 2014 were included in the study. Group A patients underwent synovectomy and an intra-articular injection of 90Yttrium between six and eight weeks after surgery. Group B patients underwent surgery alone.

Results: There were 34 patients in group A and 22 in group B. Recurrence of dtTGCT was identified by MRI, which was undertaken in patients with further symptoms. At a mean follow-up of 7.3 years (2.5 to 25.4), there was residual disease in 15 patients in group A and 11 in group B (p < 0.363). The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was 85% and 83%, respectively (p < 0.91).

Conclusion: There were no significant differences in outcome between patients treated surgically for dtTGCT of the knee with or without an adjuvant intra-articular injection of 90Yttrium. We were unable to provide conclusive evidence of any benefits derived from the adjuvant treatment. Cite this article: Bone Joint J 2018;100-B:984-8.

Keywords: 90Yttrium hydroxyapatite; Diffuse-type tenosynovial giant-cell tumour; Knee; Pigmented villonodular synovitis; Radiosynovectomy.

MeSH terms

  • Adult
  • Durapatite / administration & dosage*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intra-Articular
  • Knee Joint / pathology*
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Radiotherapy, Adjuvant / methods
  • Retrospective Studies
  • Synovectomy / methods*
  • Synovial Membrane / pathology
  • Synovitis, Pigmented Villonodular / pathology
  • Synovitis, Pigmented Villonodular / radiotherapy
  • Synovitis, Pigmented Villonodular / surgery*
  • Treatment Outcome
  • Yttrium Radioisotopes / administration & dosage*

Substances

  • Yttrium Radioisotopes
  • Yttrium-90
  • Durapatite