Radiotherapy for Pigmented Villonodular Synovitis

M Wagner, CG Morris, JD Reith, MT Scarborough, WM Mendenhall

Hong Kong J Radiol 2006;9:15-20

Objective: To report outcomes after radiotherapy used to treat diffuse pigmented villonodular synovitis.

Patients and Methods: Between 1969 and 2000, 4 patients with pigmented villonodular synovitis were treated with radiotherapy at the Department of Radiation Oncology, Health Science Center, University of Florida, Florida, USA. Three patients had benign disease while the fourth developed diffuse metastases. Mean follow-up was 196 months (range, 70 to 439 months). All patients had both intra- and extra-articular involvement. Joints involved included the knee (n = 2), hip (n = 1), and spine (n = 1). Extra-articular extension included involvement of bone, muscle, nerves, and/or vessels. Two patients received radiotherapy alone and 2 patients received postoperative radiotherapy. Two patients received 35 to 36 Gy in 18 fractions, 1 patient received 18.86 Gy in 15 fractions, and 1 patient received 45 Gy in 25 fractions.

Results: Two patients with benign pigmented villonodular synovitis were locally controlled; 1 patient progressed after 18.86 Gy. The patient with malignant pigmented villonodular synovitis developed a local recurrence and died with disseminated metastases 85 months after radiotherapy. No patient developed a late complication.

Conclusion: These limited data and a review of the literature suggest that moderate-dose radiotherapy may control benign diffuse pigmented villonodular synovitis. It is unlikely that radiotherapy alone will control malignant pigmented villonodular synovitis.