Abstract
Despite early promising results with denosumab treatment in giant cell tumor of bone (GCTB), recent studies have raised concerns about a high local recurrence rate following preoperative denosumab administration and joint preservation surgery. This retrospective study evaluated data from 25 high-risk GCT patients (Campanacci grade II or III with features like soft tissue extension, pathological fracture, minimal periarticular or subarticular bone) treated with five doses of neoadjuvant denosumab injection followed by either curettage and cementing (n = 13) or joint reconstruction with fibular graft/endoprosthesis (n = 12) between 2014 and 2019. With an average follow-up of 40 months, the study found only one patient of local recurrence. All patients were independently ambulant, with a mean MSTS score of 26.32. Subgroup analysis revealed an MSTS score of 27.76 in the joint preservation group, and 24.75 in the excision with reconstruction/prosthetic replacement group (unpaired t-test, p-value < 0.001). Five patients experienced postoperative complications, including two infections, one recurrence, one mediolateral instability in the prosthetic component, and one restriction of wrist movement. A short course of neoadjuvant denosumab, followed by curettage and cementing or wide excision with joint reconstruction/prosthetic replacement, appears to be an effective strategy for high-risk GCTB patients. This approach not only minimizes surgical morbidity but also does not increase the local recurrence rate. The short course regimen may present a cost-effective and practical option in clinical practice.
Similar content being viewed by others
Data Availability
The data will be shared on request.
References
Puri A, Agarwal M (2007) Treatment of giant cell tumor of bone: current concepts. Indian J Orthop 41(2):101–108
Montgomery C, Couch C, Emory CL, Nicholas R (2019) Giant cell tumor of bone: review of current literature, evaluation, and treatment options. J Knee Surg 32(4):331–336
van der Heijden L, van der Geest IC, Schreuder HW, van de Sande MA, Dijkstra PD (2014) Liquid nitrogen or phenolization for giant cell tumor of bone?: A comparative cohort study of various standard treatments at two tertiary referral centers. J Bone Joint Surg Am 96-A(5):e35
Arbeitsgemeinschaft K, Becker WT, Dohle J, Bernd L, Braun A, Cserhati M et al (2008) Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 90:1060–1067
Algawahmed H, Turcotte R, Farrokhyar F, Ghert M (2010) High-speed burring with and without the use of surgical adjuvants in the intralesional management of giant cell tumor of bone: a systematic review and meta-analysis. Sarcoma 2010:586090. https://doi.org/10.1155/2010/586090
Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G et al (2008) Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 134:969–978
Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E et al (2010) Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 36:1–7
Li H, Gao J, Gao Y, Lin N, Zheng M, Ye Z (2020) Denosumab in giant cell tumor of bone: current status and pitfalls. Front Oncol 10:580605
Medellin MR, Fujiwara T, Tillman RM, Jeys LM, Gregory J, Stevenson JD et al (2018) Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture. Bone Joint J 100-B(12):1626–32
Luengo-Alonso G, Mellado-Romero M, Shemesh S, Ramos-Pascua L, Pretell-Mazzini J (2019) Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature. Arch Orthop Trauma Surg 139(10):1339–1349
Puri A, Gulia A, Hegde P, Verma V, Rekhi B (2019) Neoadjuvant denosumab. Bone Joint J 101-B(2):170–7
Chawla S, Blay J-Y, Rutkowski P, Cesne AL, Reichart P, Gelderblom H et al (2019) Denosumab in patients with giant-cell tumour of bone: a multicentre, open-label, phase 2 study. Lancet Oncol 20(12):1719–1729
Boriani S, Cecchinato R, Cuzzocrea F, Bandiera S, Gambarotti M, Gasbarrini A (2020) Denosumab in the treatment of giant cell tumor of the spine. Preliminary report, review of the literature and protocol proposal. Eur Spine J 29(2):257–71
Yayan J (2020) Denosumab for effective tumor size reduction in patients with giant cell tumors of the bone: a systematic review and meta-analysis. Cancer Control 27(3):1073274820934822
Jamshidi K, Gharehdaghi M, Hajialiloo SS, Mirkazemi M, Ghaffarzadehgan K, Izanloo A (2018) Denosumab in patients with giant cell tumor and its recurrence: a systematic review. Arch Bone Jt Surg 6(4):260–268
Perrin DL, Visgauss JD, Wilson DA, Griffin AM, Abdul Razak AR, Ferguson PC et al (2021) The role of denosumab in joint preservation for patients with giant cell tumour of bone. Bone Joint J 103-B(1):184–91
XGEVA® (denosumab) (2018) Full prescribing information. Amgen Inc., Thousand Oaks, CA. [Online] Available: https://www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/xgeva/xgeva_pi.pdf. Accessed 4 Apr 2021
Thomas D, Henshaw R, Skubitz K et al (2010) Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncol 11:275–280
Chinder PS, Hindiskere S, Doddarangappa S, Pal U (2019) Evaluation of local recurrence in giant-cell tumor of bone treated by neoadjuvant denosumab. Clin Orthop Surg 11(3):352–360
Scoccianti G, Totti F, Scorianz M, Baldi G, Roselli G, Beltrami G et al (2018) Preoperative denosumab with curettage and cryotherapy in giant cell tumor of bone: is there an increased risk of local recurrence? Clin Orthop Relat Res 476(9):1783–1790
Campanacci M, Baldini N, Boriani S, Sudanese A (1987) Giant-cell tumor of bone. J Bone Joint Surg Am 69(1):106–114
van Langevelde K, McCarthy CL (2020) Radiological findings of denosumab treatment for giant cell tumours of bone. Skeletal Radiol 49:1345–1358
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246
Siddiqui MA, Seng C, Tan MH (2014) Risk factors for recurrence of giant cell tumours of bone. J Orthop Surg 22(1):108–110 (Hong Kong)
Cheng DD, Hu T, Zhang HZ, Huang J, Yang QC (2015) Factors affecting the recurrence of giant cell tumor of bone after surgery: a clinicopathological study of 80 cases from a single center. Cell Physiol Biochem 36(5):1961–1970
Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ (2005) Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res 435:211–218
Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G et al (2008) Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 134:969–978
van der Heijden L, Dijkstra PD, Campanacci DA, Gibbons CL, van de Sande MA (2013) Giant cell tumor with pathologic fracture: should we curette or resect? Clin Orthop Relat Res 471(3):820–829
Lange T, Stehling C, Frohlich B, Klingenhofer M, Kunkel P, Schneppenheim R et al (2013) Denosumab: a potential new and innovative treatment option for aneurysmal bone cysts. Eur Spine J 22(6):1417–1422
Palmerini E, Ruggieri P, Angelini A, Boriani S, Campanacci D, Milano GM et al (2018) Denosumab in patients with aneurysmal bone cysts: a case series with preliminary results. Tumori 104(5):344–351
Dürr HR, Grahneis F, Baur-Melnyk A, Knösel T, Birkenmaier C, Jansson V et al (2019) Aneurysmal bone cyst: results of an off label treatment with denosumab. BMC Musculoskelet Disord 20:456
Kurucu N, Akyuz C, Ergen FB, Yalcin B, Kosemehmetoglu K, Ayvaz M et al (2018) Denosumab treatment in aneurysmal bone cyst: Evaluation of nine cases. Pediatr Blood Cancer 65(4):e26926
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Level of evidence: III
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Tripathy, S.K., Das Majumdar, S., Pradhan, S.S. et al. A Short Course of Preoperative Denosumab Injection Followed by Surgery in High-Risk Giant Cell Tumors of the Extremities: A Retrospective Study. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-01990-2
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s13193-024-01990-2