Preoperative denosumab treatment with curettage may be a risk factor for recurrence of giant cell tumor of bone

Abstract

Purpose: Giant cell tumor of bone (GCTB) is a local aggressive bone tumor, histologically classified as intermediate malignancy. Recently, the RANKL inhibitor, denosumab, was developed as a novel and effective treatment option for GCTB. Since the risk of preoperative use of denosumab with curettage had been previously reported, this study aimed to investigate the relationship between recurrences and clinicopathological features associated with adjuvant denosumab treatment in GCTB. Methods: A total of 87 GCTB cases were treated at our institution. We reviewed 66 patients with conventional-type GCTB occurring in the extremities and analyzed 78 surgical treatments, including curettages and resections, with clinicopathological features and denosumab treatment. Results: GCTB lesions, including 66 primary and 12 recurring, underwent surgical treatment like curettage and resection. Recurrence-free survivals in 78 GCTB surgeries were 78.7% in 3 years and 71.9% in 5 years. In the resected cases of GCTBs, there was no recurrence either with or without denosumab. In curettage cases, 3-year recurrence-free survivals were 0.0% ( n = 3) in preoperative treatment of denosumab, 66.7% ( n = 6) in postoperative treatment, and 76.6% ( n = 43) in no treatment. Interestingly, three preoperative treatment cases demonstrated low MIB-1 index despite 100% recurrence. The other clinicopathological factors did not contribute much to the risk of recurrence in curettage cases. Conclusion: Our findings revealed the use of denosumab in GCTB, prior to curettage, to possibly increase the risk of local recurrence. Together with previous reports, our finding might provide information for beneficial treatment of GCTB.

Giant cell tumor of bone – Analysis of 213 cases involving extra‐craniofacial bones

“…Denosumab, a RANK ligand inhibitor, is frequently used now in the treatment of GCTB, especially for unresectable tumors. 27 , 28 Favorable outcome following its use have been reported 46 , 47 but some recent studies reported otherwise. 48 , 49 By multivariate analysis, our study shows that denosumab therapy increases the risk for local recurrence as a significant trend level ( P = 0.053).…”

Giant cell tumor of bone: A single center study of 115 cases

“…For various clinicopathological factors like age, gender or localization of GCTB but even for joint affection or the presence of metastases no significant association with local recurrence was found in the recent study. Sano et al [14] did not find any association between various clinicopathological factors such as age, gender, surgical site, Campanacci grade or pathological fracture and local recurrence either in a study of 87 patients with GCTB.…”

“…There is a debate if denosumab administered before curettage may increase the likelihood of local recurrence [13] . Sano et al [14] demonstrated in a study of 87 patients with GCTB that the use of denosumab prior to curettage possibly increase the risk of local recurrence. Tsukamoto et al [13] conclude in a systematic review that neoadjuvant denosumab application may increase the likelihood of local recurrence after intralesional curettage of GCTB.…”

The Efficacy and Safety of Denosumab for Treating Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis

“…Totally, we only included a total of 11 studies in our meta-analysis. 4,10,16,19,30,31,[34][35][36][37] We summarize the paper selection in Figure 1. We describe the baseline characteristics of our studies in Table 1.…”