Background Aneurysmal bone cyst (ABC) is a benign bone neoplasm that can sometimes be difficult to treat without en bloc resection or amputation. Treatment based on doxycycline-albumin-foam demonstrates healing response in the literature.
Purpose To describe a case of ABC treated with doxycycline-albumin-foam and the role of the Pharmacy Service (PS) in its design and preparation.
Material and methods This was a descriptive and retrospective clinical case. The Radiodiagnosis Unit (RU) conducted a literature review to find alternative treatments to avoid bone resection and ask for the PS collaboration in order to meet the requirements of stability and sterility. Studies suggest the use of doxycycline as a chemical ablation agent due to its antitumoural properties.
Results Seventeen-year-old male diagnosed with an unresectable ABC due to its location in L5 vertebra. Literature review showed several studies in which patients were treated with doxycycline-albumin-foam in order to avoid ABC relapse, but we did not find concise description of this preparation. The formulation was elaborated in our PS, combining doxycycline (200 mg) with albumin 20% (1,8 g) and mixed with sterile air (5 mL) to create a proper delivery system. In addition, iodinated contrast was added (2 mL) to guarantee an adequate visibility of the administration process. The procedure took place in a horizontal-laminar-airflow-cabin (grade A) and closed systems were used in order to assure foam sterility due to the special conditions that intervention required. First of all, we prepared the formulation with the aim of evaluating its physico-chemical properties. The foam was unstable (quick phase separation), so the components should be loaded separately in a syringe united by a closed-connector to another syringe that contained sterile air. Just before the administration in the RU the components were vigorously mixed into foam. The percutaneous treatment was well tolerated and the patient was discharged the following day. Two months after the treatment, a modest reduction of the lesion was observed in imaging techniques.
Conclusion The complex preparation performed from PS attained the therapeutic goals, obtaining sterile foam that meets the requirements necessary to treat this pathology, taking into account its location and the characteristics of the administration process.
No conflict of interest
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