title: Use of warm Ringer's lactate solution in the management of locally advanced giant cell tumor of bone.
abstract: BACKGROUND
  This study was conducted to discover the effectiveness and safety of using warm Ringer's lactate solution (RLS) as a local treatment in the management of locally advanced giant cell tumor of bone with marked soft tissue invasion, including nearby neurovascular bundles.
  
  
  METHODS
  This was a longitudinal cohort study with an average follow-up period of 4.6 ± 0.3 years, ranging from 4.2 to 5.9 years. There were 21 patients (9 male and 12 female), with the ages of subjects ranging from 12 to 64 years. Eight patients (38 %) were tumor recurrence cases. Pathological fracture was found in 15 patients (71 %). After extended curettage, warm RLS (50 °C) was locally applied for 20 min. Bone stabilization and reconstruction were then performed.
  
  
  RESULTS
  All patients survived the operation. No additional neurovascular injury resulting from the use of warm RLS was found. Patients who had neurological deficit before the operation experienced significant improvement in motor and sensory function during the follow-up period. Complication was found in one patient (5 %). Two patients (9.5 %), had tumor recurrence and 19 patients (90.5 %) were tumor-free with good to acceptable function.
  
  
  CONCLUSIONS
  Use of warm Ringer's lactate solution as an adjunctive local treatment during intra-lesional curettage of giant cell tumor with locally soft tissue extension was found to be safe with relatively low recurrence rate. However, additional studies to identify the optimum thermoablation dose at each part of the body should be undertaken before this technique can be used as a standard treatment.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. saranatra.wai@mahidol.ac.th.|, 59/2 Soi Chareonjai Ekamai Road, Bangkok, 10110, Thailand. saranatra.wai@mahidol.ac.th.
authors.forename: Saranatra
authors.initials: S
authors.lastname: Waikakul
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Apichat
authors.initials: A
authors.lastname: Asavamongkolkul
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Rapin
authors.initials: R
authors.lastname: Phimolsarnti
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D002648:Child; D003475:Curettage; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology*; D018212:Giant Cell Tumor of Bone / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D000077325:Ringer's Lactate; D055815:Young Adult
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate
keywords: Benign bone tumor; Giant cell tumor; Heat shock proteins; Thermoablation