Percutaneous doxycycline treatment of aneurysmal bone cysts with low recurrence rate: a preliminary report

Abstract

Background: Aneurysmal bone cyst (ABC) has a recurrence rate of between 12% and 71% without en bloc resection or amputation. There is no percutaneous ABC treatment drug regimen demonstrating consistent evidence of bone healing with recurrence of < 12%. Doxycycline has properties that may make it appropriate for percutaneous treatment.

Questions/purposes: We therefore asked: (1) Is there reduction in ABC lytic cyst volume with injectable doxycycline? (2) Is it associated with thickening of involved bony cortex? (3) Is the recurrence rate after percutaneous treatment < 12%?

Methods: We retrospectively reviewed 20 patients who underwent percutaneous treatment of ABCs with doxycycline from 2006 to 2010. The mean age was 10 years (range, 3-18 years). There were 21 treatment locations: humerus (six), spine (five), clavicle (two), fibula (one), femur (two), ulna (two), tibia (two), and scapula (one). Twenty patients completed treatment involving 118 treatment sessions (two to 14 sessions per patient). Treatment response was evaluated radiographically by measuring the lytic component and thickness of involved cortex. Recurrence was indicated by new areas of lytic destruction after completion of treatment. The minimum followup was 24 months (mean, 38 months).

Results: Twenty of 20 patients demonstrated reduction in lytic destruction and bony healing. All patients demonstrated cortical thickening. One patient demonstrated recurrent minimal lytic destruction after 20 months of observation.

Conclusions: In this series, patients undergoing percutaneous doxycycline treatment of ABCs demonstrated a healing response and a recurrence rate of 5% at more than 24 months.

Figures

Fig. 1A–B

Recurrence of a 16-cm sacral and bilateral iliac ABC after surgical resection in a 17-year-old girl is shown. (A) This sagittal T2-weighted MR image demonstrates the 16-cm sacral ABC after surgical resection and before percutaneous treatment. (B) This 3-year followup CT scan reconstruction of a coronal demonstrates dense bony healing of the sacral ABC after 11 treatment sessions with doxycycline ablation targeting individual locules. The patient was asymptomatic after treatment without gait or nerve dysfunction.

Fig. 2A–E

Images from a 3-year-old girl with distal left ulna ABC and fibrous dysplasia are shown. (A) This frontal radiograph of the distal ulna shows the expansile ABC (straight arrow) and adjacent area of fibrous dysplasia (curved arrow). (B) A fluoroscopic spot view documents surgical curettage and bone graft placement. (C) A radiograph obtained 3 months after curettage and grafting demonstrates the recurrent ABC with graft resorption and tumor progression (arrow). (D) A spot radiograph during percutaneous ABC treatment demonstrates contrast definition of the cystic component of the ABC. (E) A 4-year followup radiograph of the wrist demonstrates healing and dimetaphyseal concavity of the treated ulna (straight arrow), including evidence of healing and reduction in the fibrous dysplastic component (curved arrow).

Fig. 3A–C

Images from an 11-year-old boy with left tibial ABC (metachronous ABCs [right scapula, left tibia] presenting 31 months apart) are shown with percutaneous treatment. (A) A frontal radiograph of the left knee demonstrates the proximal tibial metaphyseal juxtaphyseal ABC (arrows). (B) A fluoroscopic image treatment of the ABC demonstrates contrast material outlining the ABC cysts. (C) A 3-year followup radiograph of the left knee demonstrates healing of the ABC, proximal metaphyseal remodeling, and preservation of tibial physeal growth function with distal migration of the bone scar away from the original juxtaphyseal location (arrows).