Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy

Yonezawa, Noritaka; Murakami, Hideki; Kato, Satoshi; Takeuchi, Akihiko; Tsuchiya, Hiroyuki

doi:10.1007/s00586-017-5086-7

Cited by 21 publications

(11 citation statements)

References 18 publications

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“…A critical review of these published studies identified 60 studies that met the inclusion criteria for the present meta-analysis (Table 1). 11,12,44,60 -116 The www.clinicaltrials.gov website showed 7 ongoing studies of denosumab in the treatment of GCTB. The majority of the studies examined for this meta-analysis were case reports, case series studies, and nonrandomized, uncontrolled, open-label phase II studies (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Most participants in the studies analyzed were from case series studies, followed by the nonrandomized, uncontrolled, openlabel phase II studies, and then case reports. 90 Tsukamoto et al 92 Matcuk et al 106 Bilgetekin et al 62 Xará-Leite et al 65 Marinova et al 68 Kinoshita et al 70 Osaka et al 71 Liu et al 74 Wu et al 84 Law et al 85 Satcher et al 87 Yonezawa et al 89 Bardakhchyan et al 91 (continued) Menon et al 95 Inoue et al 97 Cavalcante et al 99 Yamagishi et al 100 Kajiwara et al 101 Nakazawa et al Setsu et al 103 Aponte-Tinao et al 104 Park et al 105 Vaishya et al 107 Gossai et al 109 Watanabe et al 110 Mattei et al 111 Hakozaki et al 112 Aghaloo et al 113 Rossi et al 114 Akaike Abbreviation: SD, standard deviation a The majority of study participants were women, and the median age was 30. There was no significant difference in the duration of treatment and follow-up time.…”

Section: Proportion Of Participants In Each Study Design Typementioning

confidence: 99%

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Denosumab for Effective Tumor Size Reduction in Patients With Giant Cell Tumors of the Bone: A Systematic Review and Meta-Analysis

Yayan

2020

Cancer Control

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Background: Denosumab is a human monoclonal antibody that has been used successfully in the treatment of giant cell tumors of bone. These tumors are rare and, in principle, benign, but they are highly aggressive, locally advanced, osteolytic bone tumors that can metastasize to the lungs. Denosumab is an effective treatment when these tumors cannot be surgically removed or when surgical resection is likely to lead to severe morbidity (eg, loss of limbs or joints). The aim of this systematic review and meta-analysis was to investigate patients with giant cell tumors of bone who experienced tumor progression during treatment with denosumab and to compare them with patients who experienced reduction of their giant cell tumors of bone during treatment with denosumab. Methods: Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for trials submitted by January 7, 2020, that reported the efficacy and safety of denosumab in patients with giant cell tumors of bone. Results: Sixty studies were reviewed, involving a total of 1074 patients who had giant cell tumors of bone and were treated with denosumab. Of the 60 studies, 58% of the patients were from case series studies, 39% from open-label phase II studies, and 3% from case reports. The response rate for denosumab as a treatment for giant cell tumors of bone was 97.5%, with statistical significance ( P < .0001). Pain in the limbs was statistically the most common adverse event for denosumab treatment in case series studies ( P < .0001). No treatment-related deaths occurred in the reviewed studies. Conclusion: Cumulative evidence supports the addition of surgery to optimal medical therapy with denosumab to reduce tumor size, clinical symptoms, and mortality among patients with giant cell tumors of bone.

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Section: Resultsmentioning

confidence: 99%

Section: Proportion Of Participants In Each Study Design Typementioning

confidence: 99%

Denosumab for Effective Tumor Size Reduction in Patients With Giant Cell Tumors of the Bone: A Systematic Review and Meta-Analysis

Yayan

2020

Cancer Control

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“…We reviewed studies on aggressive GCT published over the past 20 years according to PRISMA statement, and 52 studies were involved ( Figure 10 ). 15 - 66 There were 60 patients with 53 CT scans and 39 MRI scans, of whom 21 patients underwent enhanced scans simultaneously. The typical and atypical features were summarized according to the diagnostic standards in the present study ( Table 2 ) and the frequency of the features was similar.…”

Section: Resultsmentioning

confidence: 99%

Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center

Yuan

Zhang

Yang

et al. 2021

Global Spine Journal

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Study Design: Retrospective study. Objectives: Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy. Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed. Results: Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid–fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%. Conclusions: Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.

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“…Some authors have suggested that bone cement injection induces cytotoxic tumor necrosis [22, 23]. Trials of monoclonal antibody therapy for GCT, including denosumab as neoadjuvant chemotherapy, have shown favorable effects in combination with surgical downstaging, even in cases with extraosseous epidural extent [24]. Refai et al [19] and Mahajan et al [25] reported a combined approach in two cases that used preoperative embolization of the tumor vascular supply, followed by complete resection and postoperative radiotherapy, with no recurrence at 12 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

Total Spondylectomy for Upper Thoracic Spine Giant Cell Tumor: A Case Report

et al. 2019

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Introduction: Giant cell tumors (GCT) are benign lesions that are generally locally aggressive tumors with occasional malignant behavior. These tumors are most frequently encountered in long bones; however, they also occur rarely in the spine. GCT of the spine are rare pathological entities, and spinal involvement shows a sacral predilection, with only a few cases involving the supra-sacral segment (mobile spine). Only a few cases of thoracic spinal GCT are reported in the literature; these tumors are particularly uncommon in the thoracic segment. Presentation of Case: A 29-year-old man presented with a complaint of neck pain over the previous six months that radiated to his left hand. GCT of the upper thoracic spine was diagnosed, which was surgically managed using a 2-stage approach involving total resection of the tumor followed by spondylectomy and multilevel spinal fixation. Discussion: Accurate diagnosis of vertebral column lesions, and choosing an optimum management plan are crucial. In the majority of cases, En-bloc resection of GCTs is not feasible ought to the close contact of the lesion with the spinal cord. Larger studies are encouraged to ascertain the efficacy of variable management approaches, particularly compared with piecemeal resection techniques. Conclusion: Spinal GCT are a unique group of tumors with an uncommon and unexpected presentation. Although surgery is the mainstay of treatment for spinal GCT, the management of this tumor can be challenging. No clear management algorithm has been established, and the tumor displays an unpredictable course. Therefore, each case needs tailored treatment.

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Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy

Cited by 21 publications

References 18 publications

Denosumab for Effective Tumor Size Reduction in Patients With Giant Cell Tumors of the Bone: A Systematic Review and Meta-Analysis

Denosumab for Effective Tumor Size Reduction in Patients With Giant Cell Tumors of the Bone: A Systematic Review and Meta-Analysis

Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center

Total Spondylectomy for Upper Thoracic Spine Giant Cell Tumor: A Case Report

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