CHG may be the most effective irrigation solution for use during surgical treatment of bone tumors

CHG may be the most effective irrigation solution for use during surgical treatment of bone tumors

The widely used disinfectant chlorhexidine gluconate (CHG) appears to be the most effective irrigation solution for use in the surgical treatment of bone tumors, suggests an experimental study in the Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in collaboration with Wolters Kluwer.

Of the various solutions used to eliminate remaining tumor cells after surgery, a 0.05% CHG solution appears to be the most effective at killing cultured bone tumor cells, according to the laboratory study by Matthew J. Thompson, MD, of the University of Washington, Seattle, and colleagues.

CHG shows the highest cytotoxicity against chondrosarcoma and giant cell tumors

Some patients with bone tumors undergo a surgical procedure called intralesional curettage. This procedure involves scraping away the tumor while preserving as much healthy bone as possible. A common adjuvant treatment involves irrigating the surgical area of ​​the bone with some type of chemical solution. This flushing is done to reduce the number of remaining cells, which could potentially lead to tumor recurrence and reseeding.

Several different solutions were used to flush the tumor bed, including saline, ethanol, and various disinfectants. Dr. Thompson and colleagues conducted a series of experiments to determine which of these solutions had the greatest cytotoxic (cell-killing) effects against bone tumor cells.

The experiments used cultures of two types of bone tumors: giant cell tumor, 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% saline, 70% ethanol, 3% hydrogen peroxide, 0.05% CHG, and 0.3% povidone-iodine. Cytotoxicity was compared for the different treatments.

Of the six treatments, only CHG had cell-killing efficacy equivalent to a control solution with 100% cytotoxicity, and this result was observed regardless of treatment duration (i.e., 2 minutes or 5 minutes).

None of the other solutions matched the cell-killing effectiveness of CHG. Only two solutions (sterile water and hydrogen peroxide) were superior to a control treatment with low cytotoxicity. The other three solutions tested – saline, ethanol and povidone-iodine – showed little or no cytotoxicity.

Chlorhexidine is a well-known disinfectant with various medical uses, including as a topical antiseptic before surgery. The researchers write: “[CHG] is widely used and readily available, with demonstrated in vivo safety in other surgical applications and lower predicted toxicity compared to some currently used agents.

The new study shows that CHG is highly effective in killing bone tumor cells - at least under laboratory conditions. “Therefore, the use of a 0.05 percent CHG solution could serve clinically as a potential chemical adjuvant during intralesional curettage of chondrosarcoma and [giant cell tumors],” conclude Dr. Thompson and co-authors.

The researchers emphasize that further studies are needed to evaluate the outcomes of CHG irrigation in patients undergoing surgery. Dr. Thompson comments: "We believe it is important to continue to explore better ways to achieve durable local control of benign aggressive tumors such as giant cell tumors of bone, which are associated with a high risk of local recurrence when treated with conventional extended intralesional curettage."

Source:

Wolters Klüwer

Reference:

Moore, C., et al. (2022) Cytotoxic effects of common irrigation solutions on chondrosarcoma and giant cell tumors of bone. The Journal of Bone and Joint Surgery. doi.org/10.2106/JBJS.22.00404.

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