Giant cell tumors of the spine: has denosumab changed the treatment paradigm?

Goldschlager, Tony; Dea, Nicolas; Boyd, Michael; Reynolds, Jeremy; Patel, Shreyaskumar; Rhines, Laurence D.; Mendel, Ehud; Pacheco, Marina; Ramos, Edwin; Mattei, Tobias A.; Fisher, Charles G.

doi:10.3171/2014.10.spine13937

Cited by 74 publications

(50 citation statements)

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“…Based on the experience in our patient and other similar reports [3, 16–19, 36] where denosumab was effective in reducing GCT size and brought to elimination of 90% or more giant cells we would now use denosumab upfront in order to reduce tumor size in similar situations. However, such an approach is only feasible, if surgery can be postponed and local aggressiveness of the tumor does not urge for acute surgical intervention.…”

Section: Resultsmentioning

confidence: 88%

Denosumab treatment for progressive skull base giant cell tumor of bone in a 14 year old female – a case report and literature review

et al. 2017

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BackgroundGiant cell tumor of bone (GCT) is a rare primary bone tumor, which can metastasize and undergo malignant transformation. The standard treatment of GCT is surgery. In patients with unresectable or metastatic disease, additional therapeutic options are available. These include blocking of the receptor activator of NF-kappa B ligand (RANKL) signaling pathway, which plays a role in the pathogenesis of GCT of bone, via the anti-RANKL monoclonal antibody denosumab.Case PresentationHerein we report on a female teenager who presented in a very poor clinical condition (cachexia, diplopia, strabismus, dysphonia with palsy of cranial nerves V, VI, VIII, IX, X, XI and XII) due to progressive disease, after incomplete resection and adjuvant radiotherapy, of a GCT which affected the cervical spine (C1 and C2) as well as the skull base; and who had an impressive clinical response to denosumab therapy. To the best of our knowledge, this is the youngest patient ever reported with a skull base tumor treated with denosumab.ConclusionIn situations when surgery can be postponed and local aggressiveness of the tumor does not urge for acute surgical intervention, upfront use of denosumab in order to reduce the tumor size might be considered. Principally, the goal of denosumab therapy is to reduce tumor size as much as possible, with the ultimate goal to make local surgery (or as in our case re-surgery) amenable. However, improvement in quality of life, as demonstrated in our patient, is also an important aspect of such targeted therapies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13052-017-0353-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 88%

Denosumab treatment for progressive skull base giant cell tumor of bone in a 14 year old female – a case report and literature review

et al. 2017

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“…Hence, there was a reduction of tumor volume, and histologic evaluation post-lumbar spondylectomy showing a complete absence of the GCT inside the vertebra, and stromal neoplastic cells. This fact could bring to the spinal oncological team a different treatment paradigm 22 because a less invasive and very effective treatment could be tried.…”

Section: Discussionmentioning

confidence: 99%

Spondylectomy for Giant Cell Tumor After Denosumab Therapy

Cavalcante

Marques

Santos

et al. 2016

SPINE

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Study Design.A case report.Objective.To report a case of the lumbar giant cell tumor (GCT) utilizing a new clinical treatment modality (denosumab therapy), which showed a massive tumor reduction combined with the L4 spondylectomy.Summary of Background Data.There are some controversies about spinal GCT treatments. Denosumab has provided good clinical results in terms of tumor shrinkage, and local control in a short-time follow-up clinical study phase 2, although for spinal lesions, it has not been described. Nonetheless, “en bloc” spondylectomy has been accepted as being the best treatments modalities in terms of oncological control.Methods.A case study with follow-up examination and series radiological assessments 6 months after therapy started, followed by a complex spine surgery.Results.The denosumab therapy showed on the lumbar computed tomography scans follow-up 6 months later, a marked tumor regression around 90% associated to vertebral body calcification, facilitating a successful L4 spondylectomy with an anterior and posterior reconstruction. The patient recovered without neurological deficits.Conclusion.A new therapeutic modality for spinal GCT is available and showing striking clinical results; however, it is necessary for well-designed studies to answer the real role of denosumab therapy avoiding or facilitating complex spine surgeries as spondylectomies for spinal GCT.Level of Evidence: 5

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“…Nevertheless, denosumab can “harden up the edges” of the SGCT, which represent the tumor calcification' it can also cause tumor shrinkage34, 35. The calcification and shrinkage of the tumor could facilitate the subsequent surgery and reduce the surgical risk34, 36.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

Lin

Teng

et al. 2018

Orthopaedic Surgery

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ObjectiveTo review the clinical details and further treatments for recurrent spinal giant cell tumors (SGCT), and to analyze the risk factors of recurrence and shed new light on the treatment options and prognosis of recurrent SGCT.MethodsA retrospective analysis of recurrent SGCT between April 2003 and January 2014 was performed. A total of 10 patients comprising 3 men and 7 women with a mean age of 28.9 years (range, 21–40 years) were included in the study. All complete clinical data, radiographs, CT, MRI, scans and pathological data were reviewed. The tumor locations and the regions involved were evaluated by CT and MRI. The blood supply of the tumors was evaluated by enhanced CT and MRI. The mean follow‐up was 81.3 months (range, 35.7–172.1 months).ResultsAll patients had Enneking stage 3 tumors; 9 (90%) of them had different extents of spinal canal involvement in the primary time period. All patients underwent intralesional resection during their first surgery. Only 1 patient received local adjuvant treatments; no patient underwent selective arterial embolization or used denosumab at that time. Only 1 patient underwent adjuvant radiotherapy postoperatively, and another patient used bisphosphonates. After recurrence, 1 patient was cured using denosumab, and 2 patients' disease was controlled through use of other medical treatments or adjuvant treatments. There were 3 repeated recurrences and 7 repeated surgical procedures were performed in 5 patients. There were 6 intralesional excisions and 1 decompression surgery. The mean relapse‐free time after the first surgery was 32.3 months (range, 10.5–62.6 months). The overall mean relapse‐free time was 40.2 months (range, 10.5–157 months). No distant metastasis was found in our series. At the final follow‐up, 4 patients were disease free, 3 patients' disease was under control, 2 has progressive disease aggravation, while 1 patient died as a result of progression of disease 133.9 months after first surgery.ConclusionIntralesional excision for recurrent spinal giant cell tumors is an effective option that may have satisfactory prognosis. However, the excision and the inactivation of the lesion should be carried out carefully and thoroughly without missing any corners. Early diagnosis of recurrence may be associated with better prognosis. Adjuvant treatments perioperatively and systemic medical treatments can decrease recurrence rates and can have therapeutic effects in the recurrent SGCT.

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Giant cell tumors of the spine: has denosumab changed the treatment paradigm?

Cited by 74 publications

References 20 publications

Denosumab treatment for progressive skull base giant cell tumor of bone in a 14 year old female – a case report and literature review

Denosumab treatment for progressive skull base giant cell tumor of bone in a 14 year old female – a case report and literature review

Spondylectomy for Giant Cell Tumor After Denosumab Therapy

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

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