Similar Local Control between Phenol- and Ethanol-treated Giant
Cell Tumors of Bone
Wei-Hsin Lin MD, Tsung-Yu Lan MD,
Chih-Yu Chen MD, Karl Wu MD, Rong-Sen Yang MD
Received: 18 October 2010/Accepted: 22 June 2011/Published online: 6 July 2011
? The Association of Bone and Joint Surgeons1 2011
treated with curettage, adjuvant therapy, and cementation.
Phenol is a commonly used adjuvant associated with local
control rates ranging from 9% to 25%. However, it is
corrosive to the eyes, skin, and respiratory tract. Ethanol is
readily available and does not cause chemical burns on
contact, but it is unclear whether ethanol can achieve
similar local control rates as phenol for treating GCTs.
We evaluated (1) the recurrence rate
and recurrence-free Kaplan-Meier survival function, (2)
Musculoskeletal Tumor Society (MSTS) functional score
Giant cell tumors (GCTs) of bone often are
(1993 version), and (3) complications of two groups of
patients with GCTs treated with extensive curettage, local
adjuvant therapy with phenol or ethanol, and cement
reconstruction, to determine if ethanol was a reasonable
alternative to phenol.
Patients and Methods
We retrospectively reviewed all 26
patients with GCTs in the long bones of extremities treated
with curettage, high-speed burring, phenolization, and
cementation between May 1995 and November 2001, and
35 patients treated with the same protocol, except phenol
was replaced with 95% ethanol, between November 2001
and November 2007. The recurrence rates, Kaplan-Meier
recurrence-free survival curves, and MSTS functional
scores of these two treatment groups were compared with
Fisher’s exact test, Tarone-Ware test, and Mann-Whitney
U test, respectively. The minimum followup was 36
months (mean, 58 months; range, 36–156 months).
Local recurrence rates were similar in the two
groups: 11% in the ethanol group and 12% in the phenol
group. The survival curves (using local recurrence as an
endpoint) of the two groups were similar. The mean MSTS
functional score was 27.3 (91%) for the ethanol group and
26.9 (90%) for the phenol group.
Ethanol is a reasonable alternative to phenol
when adjuvant therapy is considered in the treatment of
GCTs of long bones.
Level of Evidence
Level III, therapeutic study. See
Guidelines for Authors for a complete description of levels
GCTs account for 15% of benign and 3% to 8% of all bone
tumors , and sometimes exhibit aggressive local
Each author certifies that he has no commercial associations (eg,
consultancies, stock ownership, equity interest, patent/licensing
arrangements, etc) that might pose a conflict of interest in connection
with the submitted article.
Each author certifies that his institution either has waived or does not
require approval for the human protocol for this investigation and that
all investigations were conducted in conformity with ethical
principles of research.
This work was performed at National Taiwan University Hospital.
Department of Orthopedics, National Taiwan University
Hospital Hsinchu Branch, Hsinchu City, Taiwan
T.-Y. Lan, K. Wu
Department of Orthopedics, Far-Eastern Memorial Hospital,
Department of Orthopedic Surgery, Taipei Medical University
Shuang-Ho Hospital, Taipei, Taiwan
R.-S. Yang (&)
Department of Orthopedics, College of Medicine, National
Taiwan University and Hospital, Number7, Chung-Shan South
Road, Taipei, Taiwan
Clin Orthop Relat Res (2011) 469:3200–3208
behavior . Wide resection results in low rates of local
recurrence but is associated with substantial morbidity and
loss of function . Intralesional curettage preserves
function [26, 45] but historically is associated with recur-
rence rates ranging from 25% to 50% [42, 44]. To improve
local control, authors have used various adjuvant therapies
such as phenolization , cryotherapy with liquid nitro-
gen , H2O2 rinse , electrocautery , and
cementation . Among these, phenolization combined
with cement packing is a commonly used treatment regi-
men [20, 26, 38]. However, phenol is a corrosive
substance. It requires careful handling and can cause
chemical burns, a complication that prompted the authors
of one report to discontinue its use in the treatment of
Ethanol is readily available in most surgical suites and
has been used as adjunctive treatment for various tumors,
such as hepatocarcinoma [40, 41], thyroid lesions ,
pheochromocytoma , osteoid osteoma , hemangi-
oma [5, 10], and skeletal metastases [9, 19]. Ethanol also
was used in the treatment of GCTs in two case series [23,
33], neither of which found ethanol-related complications.
We therefore asked whether there was any difference in
the: (1) recurrence rate and recurrence-free survival; (2)
MSTS functional score; and (3) rate of complications
between two groups of patients with GCTs whose surgical
protocol differed only in the choice of local adjuvant
(phenol or ethanol).
Patients and Methods
With approval from our hospital’s institutional ethics
board, we retrospectively reviewed the medical charts of
114 patients diagnosed with GCTs of bone between May
1995 and November 2007. Among these, 88 had lesions in
the long bones of the extremities. Sixty-seven were treated
by the senior author (RSY) with curettage, adjuvant ther-
apy with a chemical agent (phenol or ethanol), and
cementation as the primary treatment; the other 21 patients
were excluded because 16 had received wide excision (by
various surgeons) as the primary treatment and five were
treated with curettage and bone grafting (by other sur-
geons), without use of any local adjuvant. The indications
for this particular surgical regimen were: (1) GCT of the
long bone, and (2) reconstructable lesions defined as hav-
ing at least one intact column of bone after tumor removal.
The contraindications for surgery were: (1) tumors with
circumferential cortical loss, (2) tumors with extensive
articular loss or defect, and (3) presence of pathologic
femoral neck fracture. Six patients, four in the phenol
group and two in the ethanol group, were lost to followup
at 36 months postoperatively. Sixty-one patients were
available for final analysis. Twenty-six of the remaining 61
patients were treated between May 1995 and November
2001 and underwent adjuvant phenolization plus cement
reconstruction after curettage; the other 35 patients, treated
between November 2001 and November 2007, underwent
the same surgical protocol except phenol was replaced by
95% ethanol. The minimum followup was 36 months
(mean, 58 months; range, 36–156 months). No patients
were recalled specifically for this study; all data were
obtained from medical records and radiographs.
The tumors were graded radiographically by the Cam-
panacci classification system . The tumors in the phenol
group were all primary lesions. There were three Grade I,
20 Grade II, and three Grade III lesions in this group. The
ethanol group comprised 27 primary and eight recurrent
tumors, with five Grade I, 17 Grade II, and 13 Grade III
Categorical baseline variables between the two treat-
ment groups, including gender, tumor location, type of
lesion (primary or recurrent), Campanacci grade, presence
of soft tissue extension, pathologic fracture on presenta-
tion, and use of internal fixation, were compared using
Fisher’s exact test. The mean, range, and 95% confidence
interval of the difference were reported for continuous
variables, such as age and length of followup (Table 1).
All surgery was performed by one surgeon (RSY). Int-
ralesional curettage was performed through a cortical
window, followed by extensive high-speed burring of the
wall of the remaining cavity. We also used a steel brush to
scrape the lining of the cavity to maximize tumor removal.
Between May 1995 and November 2001, adjuvant therapy
was done with phenolization. Phenol crystals, commer-
cially available in glass bottles, were heated over a basin of
water until they melted, typically at 45? to 50?C. The liq-
uefied phenol then was poured into a stainless-steel bowl
and diluted with sterile water to 90% of concentration. The
soft tissues around the cavity were protected with a thick
layer of wet gauze. If the cavity was contained, it was filled
with 90% phenol, with care taken to avoid overflow and
spillage. If the cavity was uncontained, phenol was painted
over the cavity wall with a cotton swab or a small gauze
pad. After 2 minutes, phenol was suctioned out, followed
by normal saline irrigation. This chemical rinsing was
repeated three times. During the whole procedure, all
members of the surgical team wore a protective face shield,
a surgical mask, and two pairs of rubber surgical gloves.
Unused phenol was kept in a stainless steel bowl and
covered by a lid. Electrocautery was temporarily discon-
nected because the phenol was inflammable. Between
November 2001 and November 2007, commercially pur-
chased 95% ethanol was used in place of phenol. The same
surgical protocol was followed, with a couple exceptions:
(1) ethanol was poured into contained and uncontained
Volume 469, Number 11, November 2011Ethanol Treatment of Giant Cell Tumors3201
cavities, and (2) protective wet gauze was not applied
unless major vessels or nerves were in sight. Also, ethanol
often was used to wash the surrounding soft tissues to
decrease potential tumor seeding during curettage. After
adjuvant therapy, the cavity was reconstructed by poly-
methylmethacrylate (PMMA) cementation. If the lesion
was juxtaarticular, a layer of artificial bone substitute
(OSTEOSET1pellets; Wright Medical Technology Inc,
Arlington, TN, USA) was applied next to the articular
cartilage before PMMA cement was packed into the void.
This layer of bone substitute serves to prevent thermal
damage to the articular chondrocytes by the heat released
during curing. The cortical window then was covered with
OSTEOSET1. An internal fixation device was applied at
the surgeon’s discretion. All patients were blind to the type
of adjuvant they received.
The patients wore a protective splint on the extremity
until the wound healed and the sutures could be removed,
usually 10 to 14 days after surgery. ROM exercises then
were begun, and weightbearing was allowed to the
Followups occurred 1 week after discharge and at 3, 6,
12, 18, and 24 months postoperatively. After 2 years, the
patients were scheduled to be seen annually. They also
Table 1. Relevant demographic data, tumor characteristics, and followup results of the two cohorts
Variable Ethanol groupPhenol groupTotalp Value
Male15 14 29
Age (years)* 33.3 (14–52) 28.9 (13–64)
?1.5 – 10.2m
Distal femur1111 220.428
Proximal femur336 1.000
Proximal tibia57 12 0.330
Tibial diaphysis22 0.503
Distal tibia44 0.129
Distal radius11 1.000
Type of lesion0.016
Primary 27 2653
Grade II172037 0.035
Soft tissue extension0.020
Pathologic fracture on presentation0.504
Followup (months)*48.1 (36–76)70.8 (36–156)
?37.6 – ?7.8m
1.000Number of recurrences4 (11%)3 (12%)
MSTS score (points)*27.3 (23–29)26.9 (20–29)0.261
* Values are expressed as mean, with range in parentheses; the remaining values are expressed as number of patients; MSTS = Musculoskeletal
Tumor Society;m95% confidence interval of the difference.
3202Lin et al.Clinical Orthopaedics and Related Research1
were instructed to return at any time if pain developed in or
around the surgically treated site. The senior author (RSY)
inspected the surgical wound to determine the status of
healing, and documented any sign of complications, such
as dehiscence, prolonged erythema or swelling, persistent
discharge, and ulceration. The MSTS rating score  was
used to evaluate function. This score, rated by the senior
author (RSY) at each visit by the patients, was available for
all patients. Only the MSTS score from the last visit for
each patient was used for statistical analysis. There were no
Orthogonal plane radiographs were obtained at each of
the intervals noted above, then on a yearly basis. The senior
author (RSY) and one of the two musculoskeletal radiol-
ogists (TS or CYH) in our institution independently
evaluated the radiographs for signs of local recurrence and
degeneration at each return visit. The radiologists were
blind to the type of local adjuvant used intraoperatively.
Local recurrence was diagnosed if one of the following
criteria was met: (1) greater than 5 mm of lysis around the
bone-cement interface; (2) extension of a lytic zone plus
recurring/progressing pain in the involved area; and (3)
appearance of a soft tissue mass near the previously
operated area, as noted by palpation and confirmed by
subsequent MRI. Radiographic signs of joint degeneration
included sclerosis, cysts, osteophytes, and defects or attri-
tion of articular surfaces with narrowing of the joint
Posteroanterior chest radiographs were taken at each
followup and if the patient complained of chest symptoms
such as persistent cough or dyspnea. CT of the chest was
performed if there was any suspicious lesion observed on
the chest radiograph or if the symptoms did not resolve and
were not explained by an apparent cause.
We compared the recurrence rates of the two treatment
groups by Fisher’s exact test. The Kaplan Meier survival
curves, using local recurrence as an endpoint, were com-
pared by the Tarone-Ware test of equality of survivor
functions. The MSTS functional scores were compared by
Mann-Whitney U test. All statistical tests were performed
using SPSS 13.0 software (SPSS Inc, Chicago, IL, USA).
There was no difference (p = 1.000) in recurrence rates
between the ethanol group (11%) and the phenol group
(12%). Three recurrences occurred in the phenol group,
yielding a rate of 12% (three of 26) whereas four of the
35 patients in the ethanol group experienced recurrence, for
a rate of 11% (Table 1). Combining both groups, the
median time to first local recurrence was 24 months (range,
6–48 months). In the phenol group, all three patients with
recurrence had Grade II primary lesions, with two located
in the distal femur and one in the proximal tibia. The two
distal femur lesions recurred at 24 and 48 months postop-
eratively, and the proximal tibial lesion recurred 36 months
postoperatively. We treated all recurrences with repeat
curettage, burring, brushing, local phenolization, and
cementation. Two of these lesions, one in the proximal
tibia and one in the distal femur, had no signs of recurrence
at 59 and 27 months after the second surgery, but the other
distal femur lesion was particularly recalcitrant to treat-
ment and had three additional soft tissue recurrences. In the
ethanol group, the four recurrences included: one recurrent
Grade III lesion in the proximal tibia that recurred again
6 months postoperatively; two primary lesions (Grades I
and III) in the distal ulna that recurred 11 and 12 months
postoperatively; and one primary Grade III lesion in the
distal tibia that recurred 24 months postoperatively. One of
the two distal ulna lesions had an episode of rerecurrence,
whereas the other distal ulna lesion, the proximal tibia
lesion, and the distal tibia lesion each had two episodes of
rerecurrence. All patients with these rerecurrences under-
went reoperation with additional curettage, burring,
brushing, ethanol adjuvant therapy, and cementation. No
signs of rerecurrence were noted at 36, 48, 40, and
33 months after the last operation for the distal ulna,
proximal tibia, the other distal ulna, and distal tibia lesions,
respectively. The recurrence-free survival rates in the two
treatment groups (Fig. 1) were similar (p = 0.759).
There was also no difference (p = 0.261) in the mean
MSTS functional rating score between the two groups
(phenol group, 26.9 points; range, 20–29 points, 95%
confidence interval = 23.7–30 points; ethanol group, 27.3
points; range, 23–29 points, 95% confidence interval =
24.6–30 points). The seven patients who experienced
recurrence had inferior MSTS scores than those who did
not (recurrence group: mean, 25.7 points; range, 23–27
points,95% confidenceinterval = 23.0–28.4
recurrence-free group: mean, 27.3 points; range, 20–29,
95% confidence interval = 24.5–30.0 points; Mann-Whit-
ney U test p value = 0.02).
No major wound complications were observed in either
the ethanol or the phenol group. Thirteen patients in the
ethanol group had a Grade III tumor that was uncontained
after curettage. None experienced neurovascular injuries,
soft tissue complications, or subsequent fracture. One
patient in the phenol group who underwent surgery at age
49 years had narrowing of the joint space in the medial
compartment of his surgically treated knee 11 years post-
operatively. One patient in the ethanol group with a
recurrent GCT of the distal radius had multiple nodular
pulmonary metastases that developed 13 months postop-
eratively. Metastasectomy was performed at 19 months
and 22 months postoperatively for left and right lung
Volume 469, Number 11, November 2011Ethanol Treatment of Giant Cell Tumors3203
lesions, respectively, because both had enlarged during
followup. At 36 months after the diagnosis of pulmonary
metastasis, the patient was stable despite the presence of
multiple nodular metastatic lesions in the lungs.
Intralesional curettage plus adjuvant therapy and cemen-
tation preserves function  and has been advocated as
the initial treatment of choice [3, 26] in GCTs of bone.
Chemical or physical adjuvants extend the margin of
intralesional surgery by inducing additional necrosis around
the curetted cavity, thus increasing the thoroughness of
tumor removal and reducing local recurrence. Among the
many adjuvant agents, phenol is commonly used and
achieves local control rates ranging from 9% [13, 27] to
25% . However, it is corrosive and causes chemical
burns on contact with skin and soft tissues. Ethanol causes
tumor necrosisby degeneratingcellular cytoplasm,
denaturing cellular proteins, and exerting a thromboem-
bolic effect on the small vessels supplying the tumor
[18, 41]. We therefore determined whether the recurrence
rate, recurrence-free survival, mean MSTS functional score,
and rate of complications differed between two groups of
patients with GCTs whose surgical protocol differed only in
the choice of local adjuvant (phenol or ethanol).
We acknowledge limitations of our study. First, we have
a limited number of patients and the study is underpowered
to statistically distinguish the local recurrence rates of the
two treatment groups. If a 5% difference in the rate of
recurrence was considered clinically important, nearly 800
patients would be needed in each group to detect a dif-
ference in recurrence rates with a power of 0.80. As the
incidence of GCT in the general population is low, an
adequately powered prospective randomized trial is likely
beyond the capabilities of one institution. Second, four
patients in the phenol group and two patients in the ethanol
group were lost to followup before 36 months postopera-
tively. If they had not been lost to followup, the rates of
Fig. 1A–C The Kaplan-Meier recurrence-free survival function with
95% confidence intervals for the (A) ethanol group is shown by the
solid lines and (B) for the phenol group with the dotted lines. (C) The
Kaplan-Meier recurrence-free survival rates of the ethanolization and
phenolization groups were similar (p = 0.759).
3204 Lin et al. Clinical Orthopaedics and Related Research1
recurrence could have ranged from 10% (three of 29) to
24% (seven of 29) in the phenol group and from 10% (four
of 38) to 16% (six of 38) in the ethanol group. Although
our limited sample size precluded a statistical difference in
recurrence rates from being detected, even between the two
most extreme values (24% and 10%), the difference
between 24% and 10% might indicate clinical importance.
Third, the two cohorts were not matched and therefore
heterogeneous in several baseline variables, including age,
type of lesion (primary or recurrent), number of Grades II
and III tumors, soft tissue extension, and length of fol-
lowup (Table 1). In addition to a shorter length of followup
and an older average age, the ethanol group had more
recurrent lesions, more Grades II and III tumors, and more
tumors with soft tissue extension. Because of the relatively
small numbers we could not determine how these factors
influenced the rate of recurrence. Fourth, all patients were
treated by one surgeon experienced in managing bone
tumors, whose surgical protocol for GCTs remained con-
stant except for a change in the choice of adjuvant therapy.
Although perhaps creating more homogeneous methods, a
single-surgeon series can introduce surgeon bias and be
less generalizable. Fifth, the tumors were present at many
sites. The number of lesions in each site therefore became
relatively small, which made meaningful subgroup analysis
based on tumor locations difficult to perform. Conse-
quently we were unable to adjust the potential influence of
tumor locations, such as the distal radius or proximal femur
, on recurrence. Sixth, The MSTS score (1993 version)
was rated by the physician. Comparison among data was
made by converting the score to percentage of expected
normal function . Although it was simple in format and
easy to use in the clinical setting, it did not include the
patient’s subjective perception of functional impairment.
The Toronto Extremity Salvage Score (TESS) , pub-
lished in 1996, is self-administered and reflects the
patient’s subjective perception of difficulty with various
activities. However, we were not aware of the TESS when
we started to collect GCT cases in 1995. Our functional
evaluation would have been more complete if patient sat-
isfaction had been factored in.
In our series, an 11% recurrence rate after ethanolization
and cementation was close to rates obtained with use of
various local adjuvants in other studies (Table 2). It also
was similar to our rate of recurrence with phenolization
plus cementation (12%). Although the value of adjuvant
therapy was questioned by some [2, 6], an in vitro study
showed that 95% ethanol, 5% phenol, 3% hydrogen per-
oxide, and 50% zinc chloride all reduced DNA content and
metabolic activity of cultured GCT cells . The authors
concluded that these chemicals could help improve local
control . The heat released during curing of PMMA
cement produced thermal and cytotoxic effects on the
remaining tumor cells on the cavity wall [29, 31]. Several
clinical reports indicated that packing the cavity with
PMMA cement reduced local recurrence rates [3, 24, 25].
Two recent large-scale clinical reviews [4, 16] found that
aggressive tumor removal with combined use of local
adjuvant(s) and cementation improved local control. Two
case series described the use of ethanol as local adjuvant
therapy in the treatment of GCT of bone. Oh et al. 
reported a recurrence rate of 9.5% (four of 42). Jones et al.
 treated 25 primary and 12 recurrent GCTs with
curettage and high-concentration ethanol, with five and
three recurrences, respectively. We believe that a combi-
nation of curettage, high-speed burring, local adjuvant
therapy, and cementation results in maximal tumor
removal. Based on the similar recurrence rates and recur-
rence-free survival curves between our phenol-treated and
ethanol-treated groups, we consider ethanol a reasonable
alternative to the more commonly used phenol.
Intralesional surgery often is followed by reconstruction
of the curetted cavity with bone grafting [6, 39] or PMMA
cementation [34, 46]. Cementation provides immediate
mechanical support, and allows for easier recognition of
recurrence [32, 36]. Frassica et al. studied subchondral
replacement with methylmethacrylate compared with
autogenous bone graft and concluded that cement did not
have a deleterious effect on subchondral cartilage .
Among the 22 patients in our study with a distal femur
lesion and 12 with a proximal tibia lesion who underwent
PMMA reconstruction, only one patient with a Grade I
proximal tibia tumor had narrowing of the joint space in the
medial compartment of his surgically treated knee 11 years
after the index procedure, when he was 60 years old. Given
the long interval between surgery and the diagnosis of
osteoarthritis, we do not consider PMMA as the major
cause of his degenerative changes.
Although we shifted from phenol to ethanol owing to
concerns regarding soft tissue complications, our data
cannot show a difference in rate of wound complications
between the phenol and ethanol groups because no such
event occurred in either group. It must be borne in mind,
however, that we exercised caution when handling and
applying phenol. Phenol has been advocated as a safer
alternative to liquid nitrogen , which reportedly is
associated with rates of postoperative fracture ranging from
5.9% to 41.7% because the depth of incited necrosis was
difficult to control [27, 28]. Yet phenol is still a corrosive
substance that can cause chemical burns at contact sites 
and, when inhaled, mucosal damage of the respiratory tract.
Long exposure to phenol can result in paralysis of
peripheral nerve endings and numbness . Absorption of
phenol through skin, mucosa, or open wounds may lead to
systemic poisoning that often manifests as central nervous
system symptoms . In the presence of a pathologic
Volume 469, Number 11, November 2011 Ethanol Treatment of Giant Cell Tumors3205
fracture, or after removal of an uncontained Grade III GCT,
application of phenol to the cavity poses substantial danger
because it may leak through the cortical cracks and cause
soft tissue damage. If important anatomic structures, such
as neurovascular bundles, come into contact with the
leaked phenol, serious complications can occur. However,
Oh et al.  and Jones et al. , in their respective series
of 42 and 37 GCTs, noted no ethanol-related complica-
tions. In our study, 13 patients in the ethanol group had a
Grade III tumor that was uncontained after tumor removal.
Ethanol was poured directly into these cavities and left in
place for a total of 6 minutes. None of these patients
experienced neurovascular injuries, soft tissue complica-
tions, or subsequent fracture.
The treatment of GCTs should be individualized. In
properly selected patients, modern curettage technique plus
local adjuvant therapy and PMMA cement reconstruction
preserve function and result in low rates of recurrence.
Wide resection should be reserved for patients with adverse
presentations such as circumferential cortical loss or
nonreconstructable pathologic fractures. The rate of
recurrence in our ethanol-treated group is equivalent to that
in our phenol-treated group. It is also comparable to those
obtained with phenol or other adjuvants reported in the
literature. The ease of use and lack of clinically noticeable
complications make ethanol a reasonable alternative to
phenol when adjuvant therapy is used in the treatment of
GCT of bone.
Dr. Chao-Yu Hsu for interpreting the imaging studies and producing
the formal radiographic reports. We also thank Dr. Chen-Tu Wu for
conducting the pathologic examinations of the surgical specimens.
We thank Dr. Tiffany Ting-Fang Shih and
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Table 2. Literature review of rate of recurrence and MSTS functional score
Adjuvant therapyMean followup
Malawer et al. 102 Liquid nitrogen + PMMA78 8% Good to excellent
in 92% of patients
Durr et al. 7 None61*43% NR
Ghert et al. 9Phenol + PMMA6213% NR
42 Electrocautery + PMMA
Turcotte et al. 37 Phenol 60*19% 89%
Zhen et al. 9250% Zinc chloride132 13%Good to excellent
in 93% of patients
Saiz et al.  40Phenol + PMMA 7613% 93%
Lackman et al. 63Phenol + PMMA1086% 93%
Oh et al. 42 Ethanol4910%NR
Jones et al. 25 primaryEthanol 4620% NR
Deheshi et al. 128None8014%93% (with PF)
87% (without PF)
Balke et al.  42H2O2 + PMMA60 12%NR
et al. 
74Phenol + PMMA6427%NR
Muramatsu et al. 23Liquid nitrogen + PMMA45 0%89%
Errani et al. 64Phenol + ethanol + PMMA91*13%91.7%
136 Phenol + ethanol18%93.5%
Current study26Phenol + PMMA5812%90%
35Ethanol + PMMA11%91%
NR = not reported; * = median followup; PMMA = polymethylmethacrylate cement; PF = pathologic fracture.
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