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CAS guided RFA can be a safe and effective treatment in OFD like adamantinoma in a child.

4 pagesPublished: September 7, 2017

Abstract

Background
Osteo Fibrous Dysplasia (OFD) like adamantinoma is considered a benign condition that is usually located in the tibia. The condition is mainly found in children and has an association with classical adamantinoma, a malignancy of bone. The preferred treatment is surgical.
The lesion often requires a segment resection to eradicate the tumor as the margins of healthy bone are often too small to save continuity of bone and the lesion is located in the cortical area. Segmental resection in a young child is associated with a high complication rate.
To avoid these complications it would be ideal to spare the continuity of tibial bone by treating the tumor in situ. Radiofrequency Ablation (RFA) may be a safe and reliable option for treatment of OFD like adamantinoma, without vital tumor spill.
To ensure accurate ablation, the guidance and monitoring of antenna placement, planning and execution are performed with computer assisted surgery (CAS).

Results
Two young patients with OFD like adamantinoma of the tibia were treated with CAS guided open intra-operative RFA in our institution. Because of the heat generation and the proximity of the skin we performed the procedures half open. In both patients successful local tumor ablation was achieved without complications. At baseline MRI there was no sign of residual tumor activity in either patient.

Discussion
Follow-up is short and number of treated patients too low to draw definitive conclusions yet.
What we can say is that there is considerable less damage done to the patient if compared to classical open surgery like segmental resection or hemicortical resection.
Another great advantage is that it allows accurate local tumor ablation without tumor spill and it does not prohibit a local resection as a plan b if there still is viable local tumor tissue visible on MRI. It allows classical treatment in case of insufficient ablation.

Conclusion
Local tumor ablation with RFA has the potential to become a safe and effective treatment alternative in OFD like adamantinoma in a child.

Keyphrases: CAS, Local Tumor Ablation, Radiofrequency Ablation RFA, bone tumor

In: Klaus Radermacher and Ferdinando Rodriguez Y Baena (editors). CAOS 2017. 17th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 1, pages 417--420

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