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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Surgery LOW DOSE RADIOTHERAPY
AND STAGED SURGICAL RESECTION FOR DIFFUSE PIGMENTED VILLONODULAR
SYNOVITIS OF THE KNEE PRESERVES NORMAL KNEE FUNCTION WITH MINIMAL
RISK OF RECURRENCE OBJECTIVE: Pigmented villonodular synovitis (PVNS) of the knee is a benign, proliferative synovial disorder characterized by knee pain and recurrent effusions. Recent karyotype chromosomal analysis suggest that it is a true neoplasm and not an inflammatory process. There is a localized and a diffuse form of the disorder with the localized or nodular version amenable to limited, even arthroscopic resection. The treatment strategy for diffuse PVNS, however, has to address the tendency of the lesion to recur quickly following an incomplete resection. Our objective is to evaluate the results of a uniformly applied, multimodal treatment protocol for diffuse PVNS consisting of surgery and radiation. METHODS: During the period of 1990 to the present, 19 patients underwent surgical resection for PVNS of the knee by the same surgical team. Of these, 8 patients underwent staged procedures for diffuse PVNS consisting of an anterior arthrotomy and synovectomy followed 3 months later by posterior arthrotomy and synovectomy. After wound healing was complete, patients underwent external beam radiotherapy, most commonly consisting of 3000 cGy in 15 fractions. Patients were followed postoperatively at 3 - 6 month intervals by physical exam and magnetic resonance imaging (MRI). Five patients who completed treatment between 1995 and 1998 form the basis for this report. RESULTS: The study group consists of three females and two males with an average age of 25 years (range 14 - 43 years) at the time of surgery. The average follow-up interval was 30 months (range 5-57 months). Three patients presented with recurrent disease after either an anterior arthrotomy or arthroscopy by another surgeon, one patient presented after two previous arthroscopies. Average post-operative knee extension at the most recent examination was +3 deg (range 0 - 15 deg) and average flexion was 127 deg (range 115 - 135 deg). Four of five patients had no complaints of pain nor reported any restriction of desired activities; the youngest two patients (17 and 25 years old) were athletically active. Four patients had no knee effusion at their last visit. One patient who was 47 years old had a small effusion and occasional activity related pain and was noted radiographically to have developed a moderate amount of degenerative osteoarthrosis of the knee in the five year interval since treatment. There were no recurrences. CONCLUSION: As evidenced by the finding that 4 out of 5 of the study patients presented to us with recurrent disease, anterior synovectomy or arthroscopy alone is probably inadequate treatment for this disorder. The extent of tumor in diffuse PVNS is easily underestimated and requires thorough anterior and posterior knee exploration as tumor often extends extraarticularly, particularly posteriorly along the semimembranosus tendon complex. Most published reports on knee PVNS are generally retrospective analyses, often incorporating various treatments and extents of disease. We have demonstrated that a protocol consisting of staged anterior and posterior synovectomy with adjuvant low dose external beam radiation for diffuse PVNS of the knee can provide excellent functional results with a low risk of recurrence.
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