The widely used disinfectant chlorhexidine gluconate (CHG) appears to be essentially the most effective irrigation solution to be used as a part of the surgical procedure of bone tumors, suggests an experimental study in The Journal of Bone & Joint Surgery. The journal is published within the Lippincott portfolio in partnership with Wolters Kluwer.

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

CHG shows highest cytotoxicity against chondrosarcoma and giant cell tumors

Some patients with bone tumors undergo a surgery called intralesional curettage. On this procedure, the tumor is scraped away while preserving as much healthy bone as possible. A standard adjuvant treatment is to irrigate the operative area of the bone with some form of chemical solution. This irrigation is performed to scale back the variety of remaining cells that might potentially result in tumor reoccurrence and reseeding.

Several different solutions have been used for irrigation of the tumor bed, including saline, ethanol, and various disinfectants. Dr. Thompson and colleagues performed a series of experiments to find out which of those solutions has the best cytotoxic (cell-killing) effects against bone tumor cells.

The experiments used cultures of two sorts of bone tumors: giant cell tumor, a benign but aggressive tumor; and chondrosarcoma, a form of bone cancer. Tumor cell cultures were treated with one in every 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 several treatments.

Of the six treatments, only CHG had cell-killing effectiveness corresponding to a control solution with 100% cytotoxicity, and this end result was observed whatever the treatment period (i.e., 2 minutes or 5 minutes).

Not one of the other solutions approached the cell-killing effectiveness of CHG. Only two solutions (sterile water and hydrogen peroxide) were superior to a control treatment with low cytotoxicity. The opposite three solutions tested – saline, ethanol, and povidone-iodine – showed little or no cytotoxicity.

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

The brand new study shows that CHG is very effective in killing bone tumor cells – a minimum of under laboratory conditions. “Subsequently, the usage of a 0.05% CHG solution clinically could function a possible chemical adjuvant during intralesional curettage of chondrosarcoma and [giant cell tumors],” Dr. Thompson and coauthors conclude.

The researchers emphasize that further studies shall be needed to guage the outcomes of CHG irrigation in patients undergoing surgery. Dr. Thompson comments: “We imagine it is vital to proceed to explore higher ways to realize durable local control of benign aggressive tumors like giant cell tumor of bone, that are related to a high risk of local reoccurrence when treated with conventional prolonged intralesional curettage.”

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Journal reference:

DOI: 10.2106/JBJS.22.00404