The widely used antiseptic chlorhexidine gluconate (CHG) appears to be the most effective irrigation solution for use as part of surgical treatment of bone tumors, suggests a trial in Journal of Bone & Joint Surgery.
Among the various solutions used to remove the remaining tumor cell After surgery, 0.05% CHG solution proved to be the most effective at killing cultured osteosarcoma cells, according to laboratory research by Matthew J. Thompson, MD, University of Washington, Seattle and colleagues.
CHG showed the highest cytotoxicity against chondrosarcoma and giant cell tumors
Some patients with bone tumors experience surgical procedure called organ curettage. During this procedure, the tumor is removed while preserving as much healthy bone as possible. A common adjuvant treatment is to irrigate the surgical area of the bone with some type of chemical solution. This irrigation is done to reduce the number of remaining cells that are likely to lead to tumor recurrence and relapse.
Several different solutions have been used to irrigate the tumor bed, including saline, ethanol, and various disinfectants. Thompson and colleagues performed a series of experiments to determine which of these solutions had the greatest cytotoxic (cell-killing) effects on bone tumor cells.
The experiments used cultures of two types of bone tumors: giant cell tumors, a benign but aggressive tumor; and chondrosarcoma, a type of bone cancer. Tumor cell cultures were treated with one of six different solutions – sterile water, 0.9% salt, 70% ethanol, 3% hydrogen peroxide, 0.05% CHG, and 0.3% povidone-iodine . The cytotoxicity was compared for different treatments.
Of the six treatments, only CHG had a cytotoxic effect comparable to that of the control solution with 100% cytotoxicity, and this was observed regardless of the duration of treatment (ie. 2 minutes or 5 minutes).
No other solution achieves the cell-killing effect of CHG. There are only two solutions (sterile water and hydrogen peroxide) outperforms control treatment with low cytotoxicity. The other three solutions tested — saline, ethanol, and povidone-iodine — showed little or no cytotoxicity.
Chlorhexidine is a familiar antiseptic with various medical purposes, including as a topical antiseptic prior to surgery. The researchers write, “[CHG] widely used and readily available, with proven in vivo safety in other surgical applications and lower predicted toxicity than some agents currently in use. “
New research shows that CHG is highly effective in destroying bone Tumor cells– at least under laboratory conditions. “Therefore, the use of 0.05% CHG solution may clinically act as a potential chemoadjuvant in chondrosarcoma and endothelial curettage. [giant cell tumors]”, Dr. Thompson and co-authors conclude.
The researchers stress that further studies will be needed to evaluate the outcome of CHG irrigation in patients undergoing surgery. Dr Thompson commented: “We believe it is important to continue to explore better ways to achieve long-term local control of aggressive benign tumors such as giant cells. tumor of the skeletalis associated with a high risk of local recurrence when treated with conventional prolonged endometrial curettage. ”
Cytotoxic effects of conventional irrigation solutions on chondrosarcoma and giant cell tumors of bone, DOI: 10.2106 / JBJS.22.00404 https://journals.lww.com/jbjsjournal/Fulltext/9900/Cytotoxic_Effects_of_Common_Irrigation_Solutions.625.aspx
Wolters Kluwer Health
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