Management of eosinophilic granuloma occurring in the appendicular skeleton in children

Clin Orthop Surg. 2009 Jun;1(2):63-7. doi: 10.4055/cios.2009.1.2.63. Epub 2009 May 26.

Abstract

Background: We compared indomethacin therapy with the more aggressive approaches of anti-cancer chemotherapy and surgery in the treatment of isolated Langerhans cell histiocytosis (LCH) of bone in children.

Methods: Comparisons were made with respect to healing of the lesion without recurrence, time to radiological healing of the lesion, time to functional recovery, and complications related to treatment.

Results: Complete radiologic healing of the lesion (mean, 15.3 months) and functional recovery (mean, 5.6 months) were observed in all patients treated with either approach. No significant differences were noted in the time to complete radiologic healing or the time to functional recovery between the two groups. There were no recurrences with either approach until the last follow-up (mean, 56 months). Complications were common with anti-cancer chemotherapy, but indomethacin was well-tolerated.

Conclusions: Indomethacin seems to be effective for treating isolated LCH of bone in children. Hence, morbidities associated with aggressive treatment approaches such as anti-cancer chemotherapy or surgery can be avoided.

Keywords: Children; Indomethacin; Langerhans cell histiocytosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bone Diseases / diagnostic imaging
  • Bone Diseases / drug therapy*
  • Child
  • Child, Preschool
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Eosinophilic Granuloma / diagnostic imaging
  • Eosinophilic Granuloma / drug therapy*
  • Female
  • Humans
  • Indomethacin / therapeutic use*
  • Infant
  • Male
  • Radiography
  • Radionuclide Imaging
  • Recurrence

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase Inhibitors
  • Indomethacin