Author: PQ Wu, MD, PHD
As mentioned in our article- ‘Adjuvant therapy after tumor removal - reduces the recurrence significantly’, since intralesional curettage cannot remove the tumor completely, some of the more active tumors may recur after surgery. Hence, to reduce tumor recurrence, cryotherapy is very important! 
 
However, how do we use liquid nitrogen for cryotherapy during surgery? We have two common methods-
 
I. Direct Pouring
 

Direct Pouring, as the name suggests, pours liquid nitrogen into the bone cavity completely. Dr. Marcove invented this method at the Sloan-Kettering Hospital in New York in the 1960s. Like pouring the boiled water, the method pours liquid nitrogen directly into the bone to kill the tumor. The effectiveness is quite good, but the orthopedic surgeon must be quite careful to protect nearby skins before freezing and have considerable experience! Therefore, although the effectiveness of this tumor treatment is quite good, complications would easily occur. Hence, it’s not really popular in the orthopedic community.

 
 
II. Liquid Nitrogen Spray System

Liquid nitrogen was loaded into a special spray gun, aimed to the treatment target, and sprayed in the form of gas. Compared to the direct pouring method, the spray system is relatively safe. However, it takes a longer time and has a limited applicable range since the sprays can only freeze smaller areas.

Liquid nitrogen spray system produced by Brymill Corporation from the United States 

The use of the liquid nitrogen spray system to treat the giant cell tumor at the thigh

 
III.FNEC (Freezing Ethanol Composite)

To improve the shortcomings of the cryotherapy mentioned above, our new cryotherapy technology, FNEC, has been developed. We mix ethanol and liquid nitrogen at a certain ratio to obtain an FNEC of minus 114 degrees Celsius. The FNEC can then be placed in the bone tumor site for cryotherapy with considerable easiness. We are currently working on the application for new medical technologies at the Ministry of Health and Welfare. 

With the aforementioned cryotherapies, we expect a great reduction of tumor recurrence rate and better quality of life to patients!