Regression of Giant Cell Tumor of the Cervical Spine With Bisphosphonate as Single Therapy

Gille, Olivier; Oliveira, Bruno de Azevedo; Guérin, Patrick M.; Lepreux, Sébastien; Richez, Christophe; Vital, Jean-Marc

doi:10.1097/brs.0b013e31823ed70d

Cited by 32 publications

(17 citation statements)

References 9 publications

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“…Biologic modalities have the advantages of targeted and repeated therapy. Clinical studies have already proved that intravenous or peroral administration of bisphosphonates reduce the recurrence of GCT (Arpornchayanon and Leerapun, 2008;Tse et al, 2008;Balke et al, 2010;Nishisho et al, 2011;Gille et al, 2012). Bisphosphonates (BPs) can block the bone resorption activity and promote osteoblast activity.…”

Section: Stimulation Of Osteogenic Differentiation In Stromal Cells Omentioning

confidence: 99%

Stimulation of Osteogenic Differentiation in Stromal Cells of Giant Cell Tumour of Bone by Zoledronic Acid

Yang¹,

Zheng²,

Li³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Therapeutic effects of zoledronic acid (ZOL) on giant cell tumour of bone (GCT) have been proven. Apoptosis induction was considered to be one of the mechanisms of ZOL tumour inhibition. In this study, we presented the possibility of an osteogenic differentiation stimulation mechanism of ZOL and further investigated dosage and time effects. We treated stromal cells of GCT (GCTSC) with ZOL for 48 hours at different concentrations (0 μM, 0.01 μM, 0.1 μM, 1 μM, 5 μM, 30 μM) and assessed apoptotic and osteogenic differentiation markers with immunohistochemical techniques and real-time quantitative RT-PCR. Our results suggested that ZOL enhanced mRNA expression of Cbfa-1, osterix and osteocalcin genes with a maximum effect at 1μM in GCTSC. Time course experiments indicated a time dependent osteogenic differentiation effect. In conclusion, ZOL may be considered as an adjuvant in the treatment of GCT not only by inducing apoptosis but also by stimulating osteogenic differentiation of remaining tumor stromal cells after surgery.

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Section: Stimulation Of Osteogenic Differentiation In Stromal Cells Omentioning

confidence: 99%

Stimulation of Osteogenic Differentiation in Stromal Cells of Giant Cell Tumour of Bone by Zoledronic Acid

Yang¹,

Zheng²,

Li³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…6,14 Some other medical therapies have already been considered for the management of GCTs. Worthy of mentioning is the use of bisphosphonates, which have been shown to induce tumor regression in isolated case reports, 1,10 and which have been demonstrated to significantly reduce the rates of local recurrence. 12,21 Thus, curing GCT involves extensive decision making and weighing of probabilities.…”

mentioning

confidence: 99%

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

Goldschlager

Dea²,

Boyd³

et al. 2015

SPI

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OBJECT Giant cell tumors (GCTs) of the spine are rare and complex to treat. They have a propensity for local recurrence and the potential to metastasize. Treatment is currently surgical and presents unique challenges due to the proximity of neural structures and the need for reconstruction. Denosumab has been shown in clinical trials to be an effective treatment for GCT, but has not yet been studied specifically in GCT of the spine or as a surgical adjunct. To the authors' knowledge this is the first such reported series. METHODS A multicenter, prospective series of 5 patients with GCT of the spine treated with denosumab were included. Patient demographic data, oncological history, neurological status, tumor staging, treatment details and adverse events, surgical procedure, complications, radiological and histological responses, and patient outcome were analyzed. RESULTS All patients were women, with a mean age of 38 years, and presented with pain; 2 patients had additional neurological signs and symptoms. The mean duration of symptoms was 62 weeks. No patient had a prior tumor or metastatic disease at presentation. All patients had Enneking Stage III tumors and were treated with monthly cycles of 120 mg of denosumab, with initial additional loading doses on Days 8 and 15. Patients were given daily supplements of calcium (500 mg) and vitamin D (400 IU). There were no denosumab-related adverse events. All patients had a radiological response to denosumab. One patient failed to have a histological response to denosumab, with > 90% of tumor cells found to be viable on histological investigation. CONCLUSIONS This study reports the early experience of using denosumab in the treatment of spinal GCT. The results demonstrate a clinically beneficial radiological response and an impressive histological response in most but not all patients. Further experience with denosumab and longer patient follow-up is required. Denosumab has the potential to change the treatment paradigm for spinal GCT.

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“…Gille et al . report a case of cervical GCT treated with zoledronic acid alone for 6 months (6 doses); the lesion had marked regression clinically and radiologically after 36 months follow‐up30. We do not recommend bisphosphonates as monotherapy for primary SGCT, but this treatment can be used to reduce the recurrence rate of SGCT postoperatively and to treat recurrent SGCT that are not suitable for resection.…”

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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Regression of Giant Cell Tumor of the Cervical Spine With Bisphosphonate as Single Therapy

Cited by 32 publications

References 9 publications

Stimulation of Osteogenic Differentiation in Stromal Cells of Giant Cell Tumour of Bone by Zoledronic Acid

Stimulation of Osteogenic Differentiation in Stromal Cells of Giant Cell Tumour of Bone by Zoledronic Acid

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

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

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