Characteristics of phenol : Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma

Because of the typical metaphyseal-epiphyseal growth of giant cell tumors and chondroblastomas, the optimal result of an en bloc resection can usually only be achieved by a loss of joint function. For this reason, intralesional excision has prevailed, though it leads to a high rate of relapses. Adjuvant therapy involving irrigation of the remaining bone cavity with phenol can distinctly decrease the rate of relapse. Little is known about the amount of phenol applied that is absorbed. This study investigated the urinary excretion of phenol following the instillation of 102 ml of a 5% phenol solution. The method consisted of urine collection from 11 patients treated by phenol instillation preoperatively, and at 1, 3, 6, 12 and 24 h postoperatively. The urine specimens were analysed for phenol by mass spectrometry. Preoperatively, the value was 5.1 mg/l on average. The maximum concentration of 62 mg/l was found 1 h after instillation, with an average value of 41.5 mg/l, and after 3 h of 18.9 mg/l. A further rapid decrease in the excretion rate was recorded, with normal values being reached after 12 h. This means a maximum of 9% and an average of 2% of the instilled amount of phenol were excreted in the urine within 24 h postoperatively. By comparing these urinary concentrations to published standards, we conclude that the instillation of a 5% phenol solution into bony lesions is associated with a relatively low risk of systemic toxicity.