Clinical and pathological analysis of giant cell tumor of bone with denosumab treatment and local recurrence

Hayashida, Kenta; Kawabata, Yusuke; Kato, Ikuo; Kamiishi, Takayuki; Matsuo, Kazuya; Takeyama, Masanobu; Inaba, Yutaka

doi:10.1016/j.jos.2020.11.005

Cited by 15 publications

(16 citation statements)

References 30 publications

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“…In a retrospective study of 30 patients with sacral GCTB, Chen et al found that preoperative denosumab treatment reduced pain and neurological deficits in 80% of patients [99]. Tartrate-resistant acid phosphatase 5b expression is a useful tumor marker during denosumab treatment [100,101]. Lin et al reported the prognosis of 18 patients with sacral GCTB who underwent embolization alone [102].…”

Section: Giant Cell Tumor Of the Sacrummentioning

confidence: 99%

Current Concepts in the Treatment of Giant Cell Tumors of Bone

Tsukamoto

Mavrogenis

Kido

et al. 2021

Cancers

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The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.

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Section: Giant Cell Tumor Of the Sacrummentioning

confidence: 99%

Current Concepts in the Treatment of Giant Cell Tumors of Bone

Tsukamoto

Mavrogenis

Kido

et al. 2021

Cancers

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“…The changes of the SI could be explained by the histological manifestations of reduced cellularity, new fibrosis, and new ossification (Figures 2E and 3G). This finding could be further supported by the reduction of SUVmax in PET/CT after denosumab treatment (Figure 1D), which was also attributed to the elimination of the giant cells 8,25,30,31 . X-ray and CT examinations were used to evaluate the development of new ossification as well as increased cortical thickness 4,12,14,15,19,29,32,33 .…”

Section: Discussionmentioning

confidence: 63%

“…extensive fibrosis and ossification leading to severe adhesion to the nerves and a greater difficulty to determine an adequate margin during curettage. 4,6,10,11,13,15,19,24,25,34 In this study, although the two protocols of neo-adjuvant denosumab did not lead to a significant reduction of CT or MRI enhancement, more than half of the cases in the ultrashort group and 70% cases in the conventional group showed mild or poor vascularity of the tumor after neo-adjuvant denosumab treatment (Table 4). In accord with this result, the EBL was significantly lower in this study (about 1500 mL) than the historical cases without denosumab treatment (more than 3000 mL).…”

Section: Radiological and Histological Response Induced By Ultra-shor...mentioning

confidence: 57%

“…This finding could be further supported by the reduction of SUVmax in PET/CT after denosumab treatment (Figure 1D), which was also attributed to the elimination of the giant cells. 8,25,30,31 X-ray and CT examinations were used to evaluate the development of new ossification as well as increased cortical thickness. 4,12,14,15,19,29,32,33 In this study, we observed new ossification and reappearance of cortical integrity around the soft-tissue mass in both ultra-short group (15.6% and 12.5%) and conventional group (65.2% and 56.5%), with higher frequency in the latter group (Figure 3A-C).…”

Section: Radiological and Histological Response Induced By Ultra-shor...mentioning

confidence: 99%

“…19 It was not surprising that neo-adjuvant denosumab was associated with a high recurrent rate in most of the previous studies, as denosumab could only inhibit the proliferation of stromal tumor cells rather than eliminate them. 6,10,11,14,23 After a long-term duration of neo-adjuvant denosumab treatment (e.g., 3 months) for the purpose of downstaging, 4,6,10,11,13,15,19,24,25 new fibrosis and ossification of the tumor matrix as well as the sclerotic, thick cortical rim around the tumor occurred, making it difficult for surgeons to determine the extent of the tumor to perform an adequate curettage. 6,9,10 Moreover, the quiescent stromal tumor cells would reside in the lacunae of newly-formed lamellar or woven bone, 6,10,11,14,23 and would reactivate when the microenvironment was free of denosumab, leading to recurrence.…”

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confidence: 99%

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Ultra-Short Course of Neo-Adjuvant Denosumab for Nerve-Sparing Surgery for Giant Cell Tumor of Bone in Sacrum

Liang

Liu

Yang

et al. 2021

Spine

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Study Deign. This was a retrospective study about sacral giant cell tumor of bone (GCTB).Objective. This study aimed to investigate whether ultra-short course of neo-adjuvant denosumab treatment for sacral GCTB could (1) induce radiological and histological response? (2) Facilitate nerve-sparing surgery? (3) Achieve satisfactory oncological and functional outcomes? Summary of Background Data. Previous reports on long course of neo-adjuvant denosumab treatment for GCTB showed significant tumor response and a relatively high recurrent rate after curettage. Methods. Sixty-six patients with sacral GCTB treated with neoadjuvant denosumab and nerve-sparing surgery were categorized into ultra-short course group ( 3 doses and operation within D21 since 1st dose, 41 patients) or conventional group (>3 doses or operation after D21 since 1st dose, 25 patients). The radiological and histological response, operative data, oncological and functional outcomes were compared. Results. The ultra-short course group demonstrated fewer doses of neo-adjuvant denosumab (mean: 2.1 vs. 4.8, P < 0.001) and shorter time to surgery (12.2 days vs. 72.3days, P < 0.001). Similar patterns of radiological and histological response were observed in the two groups with less fibrosis and ossification in the ultra-short course group. The operative duration (199.9 min vs. 187.8 min, P ¼ 0.364) and estimated blood loss (1552.4 mL vs. 1474.0 mL, P ¼ 0.740) were comparable. Most (94.8%) of the patients received adjuvant denosumab. After a mean follow-up of 29.4 months, three cases (8.8%) and five cases (20.8%) showed local recurrence in each group (P ¼ 0.255). The estimated recurrence-free survival (56.2 vs. 51.2 months, P ¼ 0.210) and the functional status [Motor-Urination-Defecation scores: 25.9 vs. 25.7, P ¼ 0.762] did not differ between the two groups. Conclusion. Ultra-short course of neo-adjuvant denosumab for sacral GCTB could elicit radiological and histological responses as conventional course did. The less degree of fibrosis and ossification might facilitate nerve-sparing surgery and help to achieve satisfactory local control and functional status.

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