Phenol levels during intralesional curettage and local adjuvant treatment of benign and low-grade malignant bone tumours

1. What is the initial local concentration of phenol in the tissue of the cavity wall after the application of phenol? 2. How quickly is phenol 85% diluted by washing the bone cavity with ethanol 96% solution? 3. Is the degree and speed of dilution influenced by the size of the cavity? 4. How many times should the cavity be rinsed to obtain sufficient elimination of phenol?A basic science study was performed at respectively 16 and 10 patients, treated by intralesional curettage and adjuvant therapy for low-grade central chondrosarcoma of bone. Test 1:in 16 patients ten samples were collected of the mixture of phenol and ethanol from the bone cavity. Test 2:in ten patients, two biopsy samples were taken from the cavity wall in the bone during surgery.Phenol concentrations had wide variety in different patients, but all decreased by rinsing with ethanol.Ethanol 96% is effective to wash out local applicated phenol, by rinsing the bone cavity six times. The local concentration of phenol diminishes to an acceptable concentration of 0.2%. This study provides new insights to safely further improve the surgical technique of intralesional treatment of bone tumours.In the surgical treatment of benign bone tumours, intralesional curettage has been performed throughout the past century. Over the recent years, its use has been extended to low-grade intramedullary malignant tumours in some instances. Unfortunately, this surgical technique has the risk of local recurrence from tumour cells that may be left behind. For this reason curettage was supplemented by the use of a local adjuvant, such as phenol, liquid nitrogen or bone cement (poly methyl methacrylate, PMMA). Various studies have demonstrated that by using adjuvant, the results of local therapy have been greatly improved [1-4].With regard to liquefied phenol, only a few documented studies have been published, despite of its routine use over a long period in orthopaedic practice. Previously, we were able to show that in cas