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Effect of denosumab in treatment of unresectable spine and sacrum giant cell tumor of bone

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Abstract

Giant cell tumor of bone (GCTB) is a rare tumor of the bone that is locally invasive. Surgery is the primary treatment that is usually done by intralesional curettage. In pelvis and spine surgery may be associated with high rate of complications, recently, Denosumab has been proposed for the treatment of these tumors in latter anatomical regions. Denosumab may be administered alone or as an adjuvant to surgery. This study aimed to assess the treatment effects of Denosumab in patients with unresectable GCTB. This study was a case series. Patients with unresectable GCTB of vertebra and sacrum were enrolled in this study. Patients received 120 mg of monthly Denosumab and additional doses on days 8th and 15th of treatment. Images of patients before and after treatment were evaluated. Nine patients with a median age of 30 years with spine and sacrum GCTB were included in this study. The median time of treatment with denosumab was 28 months (range: 3–67). Tumor control was seen in all patients. According to Inverse Choi density/size (ICDS), criteria objective response (complete response and partial response) was seen in 8 patients, and one had stable disease. Based on CT scan images, in 4 patients (44.44%), less than 50% of the transverse diameter of the tumor became ossified, and in the other five patients (55.55%), more than 50% of the tumor's transverse diameter became ossified. The median tumor volume before treatment was 829 cm3, and after treatment was 504 cm3 which was significantly reduced (P = 0.005). No complication related to therapy was seen. Tumor response was seen in all patients, and tumor control according to ICDS criteria was evident in all cases. This finding was in line with previous studies. Clinical improvement of signs and symptoms was also seen in all patients. Generally, our study demonstrates a sustained clinical benefit and tumor response with Denosumab, as tumor response ≥ 24 weeks was evident in all cases. No side effects were seen in patients despite long-term treatment with Denosumab.

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Authors and Affiliations

  1. Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    A. Arefpour & M. Shafieesabet

  2. Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

    M. Chehrassan & H. Ghandhari

  3. Department of Radiology, Loghman Hakim Hospital, Shihad Beheshti University of Medical Sciences (SBUMS), Tehran, Iran

    A. Ahmadzadehnanva

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  1. A. Arefpour
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  2. M. Shafieesabet
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  3. M. Chehrassan
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  4. A. Ahmadzadehnanva
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  5. H. Ghandhari
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Contributions

AMA: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data. MS: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data. MC: approved the version to be published. AA: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data. HG: drafted the work or revised it critically for important intellectual content.

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Correspondence to M. Chehrassan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Arefpour, A., Shafieesabet, M., Chehrassan, M. et al. Effect of denosumab in treatment of unresectable spine and sacrum giant cell tumor of bone. Musculoskelet Surg 108, 93–98 (2024). https://doi.org/10.1007/s12306-023-00799-6

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