Role of Bisphosphonates as Adjuvants of Surgery in Giant Cell Tumor of Spine

Abstract

Background: The role of bisphosphonates is well established in giant cell tumor of bone (GCTB) of extremities, but its role in spine GCTB is still not established. Our main purpose was to evaluate the role of bisphosphonates in spinal GCTB with the help of radiologic assessment.Methods: A retrospective analysis of all spine GCTB patients who underwent an operation from July 2005 to January 2014 was done. Patients of spine GCTB in whom bisphosphonates were given constituted the study group. This group was compared to patients in whom bisphosphonates were not given. Preoperative and postoperative radiographs and CT scans were studied. A thorough evaluation of the presence of sclerosis was done on them. Bisphosphonates were considered to be effective if either sclerosis or new bone formation was present.Results: A total of 13 cases of spine GCT underwent operation from July 2005 to January 2014. All patients of GCTB spine who underwent an operation after 2008 at our institute were given bisphosphonates postoperatively. Of 13 cases, bisphosphonates were given postoperatively in 6 patients: 5 patients were female and 1 patient was male. Of these 6 patients, 3 patients had sacrum GCTB and 1 patient each had T9, T11, and L5 vertebrae GCTB. Average follow-up period was 39.33 months (minimum follow-up was 18 months and maximum follow-up was 72 months). Postoperative sclerosis was present in all 6 patients. No recurrence of the tumor was present in the bisphosphonate group, but 2 patients had a recurrence in the group that did not receive bisphosphonates.Conclusions: Bisphosphonates are effective and safe adjuvant therapy along with appropriate surgical intervention in spinal GCTBs and may have a role in decreasing the recurrence of this tumor.

Comprehensive treatment outcomes of giant cell tumor of the spine: A retrospective study

“…[ 10 ] Moreover, other studies have shown that neurological pain is also a salient feature of GCTB. [ 15 ] All patients in the present study experienced local pain, and 1 patient demonstrated a neurogenic bladder. Local pain is one of the most prominent complaints in patients with spinal GCTB, needing swift and effective pain management, regardless of age.…”

“…[ 14 ] However, some studies reported favorable outcomes after treatment with a combination of surgical treatment and adjuvant drug therapy. [ 9 , 10 , 15 , 20 ] The typical drug prescribed is denosumab. [ 9 , 20 , 21 ]…”

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

“…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.…”

Multimodal Management of Combined Posterior and Anterior Surgical Approach and Postoperative Pharmacological Therapy for Giant Cell Tumor of the Cervical Spine Encasing the Vertebral Artery: A Technical Case Report

“… 18 , 19 ) However, the efficacy and safety of denosumab treatment after surgery to prevent recurrence have not been fully established. 20 ) Bisphosphonate is another possible postoperative adjuvant treatment; 21 ) it inhibits osteoclast activity and has been shown to significantly prolong progression-free survival after subtotal resection for GCT. 22 ) Although the treatment strategy presented here is by no means the best, it may be helpful for surgeons to make a surgical plan assuming postoperative pharmacological therapy before surgery.…”