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Todi N, Hiltzik DM, Moore DD. Giant cell tumor of bone and secondary osteoarthritis. Heliyon 2024; 10:e30890. [PMID: 38807896 PMCID: PMC11130671 DOI: 10.1016/j.heliyon.2024.e30890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
Giant cell tumor of bone is a commonly encountered aggressive epiphyseal bone tumor, most often treated surgically. The natural history and presentation are classically described but the histopathology is poorly understood. Intralesional curettage is the mainstay of treatment, but there is significant variation in the use of adjuvant and cavity filling modalities. No gold standard has been agreed upon for treatment, and a variety of techniques are currently in use. Given its location, secondary osteoarthritis is a known long-term complication. This review examines the natural history of giant cell tumors, treatment options and complications, and subsequent development of osteoarthritis. Arthroplasty is usually indicated for secondary osteoarthritis although data is limited on its efficacy. Further directions will likely center on improved pharmacological treatments as well as improved arthroplasty techniques.
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Affiliation(s)
- Niket Todi
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - David M. Hiltzik
- Northwestern University, Department of Orthopaedic Surgery, 303 E Superior St, Chicago, IL, 60611, USA
| | - Drew D. Moore
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, Department of Orthopaedic Surgery, 586 Pioneer Dr, Rochester, MI, 48309, USA
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Elshenawy M, Arabi TZ, Ateya HA, Elhassan T, Ali SS, Othman RK, Alkhatib R, Elshentenawy A, Badran A. The Effectiveness of Denosumab in Middle Eastern Patients With Giant Cell Tumor of the Bone: A Single-Center, Retrospective Study. Cureus 2024; 16:e58292. [PMID: 38752067 PMCID: PMC11094665 DOI: 10.7759/cureus.58292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Giant cell tumor of the bone (GCTB) is an aggressive benign tumor, which constitutes 5% of all primary bone tumors. Denosumab, a receptor activator of nuclear factor κB ligand monoclonal antibody, inhibits osteoclast-induced bone destruction and has demonstrated promising results in patients with GCTB. However, the long-term efficacy of the drug has not been extensively studied, especially in the Middle East. METHODOLOGY In this study, we retrospectively analyzed the five-year progression-free survival (PFS) in patients with GCTB at a single Saudi center. PFS was defined as the time from diagnosis until disease progression, relapse, or death. Events were censored after five years from diagnosis. RESULTS Sixty-two patients with GCTB were included in the study. The median age at diagnosis was 31.16 years, and 38 (61.3%) patients were female. Twenty-nine patients (46.8%) received denosumab during the study period. The median duration of denosumab treatment was 5.06 months, and the median number of cycles was 6. The median PFS was not reached, and the five-year PFS rate was 60.3%. Age, gender, body mass index, performance status at presentation, and tumor location had no impact on five-year PFS. Denosumab treatment prolonged PFS; however, this was not statistically significant compared to non-denosumab patients (P = 0.603). CONCLUSIONS Denosumab does not seem to provide superior long-term outcomes compared to surgery alone. Although our findings are generally consistent with other studies in the literature, larger long-term studies are needed to confirm our findings.
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Affiliation(s)
- Mahmoud Elshenawy
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- Department of Clinical Oncology and Nuclear Medicine, Menoufiya University, Shebin El Kom, EGY
| | - Tarek Z Arabi
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Heba A Ateya
- Department of Medical Oncology, Cairo University, Cairo, EGY
| | - Tusneem Elhassan
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Saad S Ali
- College of Medicine, Alfaisal University, Riyadh, SAU
| | - Rana K Othman
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | - Ayman Elshentenawy
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Ahmed Badran
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, EGY
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Lipplaa A, Schreuder WH, Pichardo SEC, Gelderblom H. Denosumab in Giant Cell Rich Tumors of Bone: An Open-Label Multicenter Phase II Study. Oncologist 2023; 28:1005-e1104. [PMID: 37449658 PMCID: PMC10628576 DOI: 10.1093/oncolo/oyad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Since giant cell tumors of bone (GCTB) and other giant cell rich tumors of bone (GCRTB) share the histological presence of osteoclastic giant cells and expression of RANK/RANKL, we hypothesized that GCRTB will respond similarly to denosumab as GCTB. The primary objective of this study was to determine the efficacy of denosumab in patients with GCRTB that have recurred or require morbid surgery. METHODS In this open-label, multicenter, phase II trial, patients with GCRTB were included (June 2018-March 2020). Recruitment was stopped because of low accrual. Patients received denosumab (120 mg) subcutaneously (SC) on day 1 of every 4-week cycle with a loading dose of 120 mg SC on days 8 and 15. RESULTS Three patients were enrolled. One withdrew consent before start of study. The remaining patients had central giant cell granuloma of the jawbone (CGCG). Median treatment duration was 15 cycles (range 12-18). In both subjects, improvement in ossification of lesions was seen. Median follow-up was 28.5 months (range 20-37). One patient developed a recurrence for which surgery was performed. CONCLUSION Due to critical emerging real-world data of denosumab in GCRTBs, the study was prematurely stopped and not supportive of use of denosumab for this indication. (ClinicalTrials.gov Identifier: NCT03605199).
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Affiliation(s)
- Astrid Lipplaa
- Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem H Schreuder
- Oral and Maxillofacial Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Dentistry, University of Amsterdam, Amsterdam, The Netherlands
- Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sarina E C Pichardo
- Oral and Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Gelderblom
- Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Tan X, Zhang Y, Wei D, Yang Y, Xiang F. Denosumab for giant cell tumors of bone from 2010 to 2022: a bibliometric analysis. Clin Exp Med 2023; 23:3053-3075. [PMID: 37103655 DOI: 10.1007/s10238-023-01079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Giant cell tumors of the bone (GCTB) are considered moderately malignant bone tumors. Denosumab, as a neoadjuvant therapy, provides new possibilities for treating GCTB. However, even after multiple studies and long-term clinical trials, there are limitations in the treatment process. Research data and Medical Subject Headings terms related to denosumab and GCTB were collected from January 2010 to October 2022 using the Web of Science and MeSH ( https://meshb.nlm.nih.gov ) browsers. These data were imported into CiteSpace and VOSviewer softwares for bibliometric analysis. Overall, 445 publications on denosumab and GCTB were identified. Over the last 12 years, the growth rate of the total number of publications has remained relatively stable. The USA published the highest number of articles (83) and had the highest centrality (0.42). Amgen Inc. and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) First Ortoped Rizzoli were identified as the most influential institutions. Many authors have made outstanding contributions to this field. Lancet Oncology had the highest journal impact factor (54.433). Local recurrence and drug dosage are current research hotspots, and future development trends will mainly focus on prognostic markers of GCTB and the development of new therapies. Further research is required to analyze denosumab's safety and efficacy and understand its local recurrence of GCTB, to identify the optimal dose. Future progress in this field will likely focus on exploring new diagnostic and recurrence markers to monitor disease progression and examine new therapeutic targets and treatment strategies.
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Affiliation(s)
- Xiaoqi Tan
- Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Zhang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Daiqing Wei
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Yunkang Yang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
| | - Feifan Xiang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China.
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China.
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Expression of SATB2, RUNX2, and SOX9 and possible osteoblastic and chondroblastic differentiation in chondroblastoma. Pathol Res Pract 2023; 241:154239. [PMID: 36442415 DOI: 10.1016/j.prp.2022.154239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022]
Abstract
Chondroblastoma (CB) is histologically characterized by oval to polygonal-shaped mononuclear neoplastic cells, multinucleated osteoclastic giant cells, and eosinophilic matrix with occasional calcification. Genetically, the majority of CBs harbor H3F3B p.K36M mutation. Despite the historical nomenclature, it has been reported that the matrix of CB is similar to osteoid rather than true cartilage; however, it remains unclear whether neoplastic cells in CB have the potential for osteoblastic differentiation. To clarify this issue, we immunohistochemically examined the expression of osteogenic and chondrogenic markers (SATB2, RUNX2, p63, and SOX9) as well as H3K36M mutant protein in 33 cases of CB. All 33 cases of CB were positive for H3K36M, while SATB2, RUNX2, p63, and SOX9 were expressed in 30/33 (91%), 33/33 (100%), 29/33 (88%), and 31/32 (97%) CB cases, respectively. Our immunohistochemical results suggest that neoplastic cells in CB frequently express both osteogenic and chondrogenic markers and may have an intermediate feature of osteoblastic and chondroblastic nature.
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Toda Y, Ishihara S, Kawai A, Yoshida A. Blue lacy matrix in giant cell tumour of bone with or without denosumab therapy. Virchows Arch 2022:10.1007/s00428-022-03468-4. [DOI: 10.1007/s00428-022-03468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
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Bioactive glass selectively promotes cytotoxicity towards giant cell tumor of bone derived neoplastic stromal cells and induces MAPK signalling dependent autophagy. Bioact Mater 2022; 15:456-468. [PMID: 35386334 PMCID: PMC8958388 DOI: 10.1016/j.bioactmat.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 12/20/2022] Open
Abstract
Giant cell tumors of bone (GCTB) are associated with massive bone destructions and high recurrence rates. In a previous study, we observed cytotoxic effects of three different compositions of bioactive glasses (BGs) towards GCTSC but not bone marrow derived stromal cells (BMSC) indicating that BGs represent promising candidates for the development of new therapeutic approaches. In the current study we aimed to investigate the molecular mechanisms that are involved in BG induced cytotoxicity. We observed, that BG treatment was not associated with any signs of apoptosis, but rather led to a strong induction of mitogen activated protein kinases (MAPK) and, as a consequence, upregulation of several transcription factors specifically in GCTSC. Genome wide gene expression profiling further revealed a set of fifteen genes that were exclusively induced in GCTSC or induced significantly stronger in GCTSC compared to BMSC. BG treatment further induced autophagy that was significantly more pronounced in GCTSC compared to BMSC and could be inhibited by MAPK inhibitors. Together with the known osteogenic properties of BGs our findings support the suitability of BGs as therapeutic agents for the treatment of GCTB. However, these data have to be verified under in vivo conditions. Bioactive glasses (BG) are selectively cytotoxic towards neoplastic stromal cells. BG induced cell death is independent from apoptosis. BG activates mitogen activated protein kinases and transcription factors. BG trigger differential gene expression in neoplastic versus normal cells. BG induce autophagy.
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Muramatsu K, Tani Y, Seto T, Roces G, Yamamoto M, Ichihara Y, Sakai T. Two cases with giant cell tumor arising from the sternum: Diagnosis and options for treatment. J Orthop Sci 2022; 27:1143-1148. [PMID: 32001081 DOI: 10.1016/j.jos.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/12/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan; Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan.
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Tetsuya Seto
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Gaston Roces
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Manabu Yamamoto
- Department of Orthopedic Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, 749-8522, Japan
| | - Yusuke Ichihara
- Department of Orthopedic Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, 749-8522, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan
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Kimura A, Toda Y, Matsumoto Y, Yamamoto H, Yahiro K, Shimada E, Kanahori M, Oyama R, Fukushima S, Nakagawa M, Setsu N, Endo M, Fujiwara T, Matsunobu T, Oda Y, Nakashima Y. Nuclear β-catenin translocation plays a key role in osteoblast differentiation of giant cell tumor of bone. Sci Rep 2022; 12:13438. [PMID: 35927428 PMCID: PMC9352730 DOI: 10.1038/s41598-022-17728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Denosumab is a game-changing drug for giant cell tumor of bone (GCTB); however, its clinical biomarker regarding tumor ossification of GCTB has not been elucidated. In this study, we investigated the relationship between Wnt/β-catenin signaling and the ossification of GCTB and evaluated whether endogenous nuclear β-catenin expression predicted denosumab-induced bone formation in GCTB. Genuine patient-derived primary GCTB tumor stromal cells exhibited osteoblastic characteristics. Identified osteoblastic markers and nuclear β-catenin translocation were significantly upregulated via differentiation induction and were inhibited by treating with Wnt signaling inhibitor, GGTI-286, or selective Rac1-LEF inhibitor, NSC23766. Furthermore, we reviewed the endogenous ossification and nuclear β-catenin translocation of 86 GCTB clinical samples and elucidated that intra-tumoral ossification was significantly associated with the nuclear translocation. Three-dimensional quantitative analyses (n = 13) of tumoral CT images have revealed that the nuclear β-catenin translocation of naïve GCTB samples was significantly involved with the denosumab-induced tumor ossification. Our findings suggest a close relationship between the nuclear β-catenin translocation and the osteoblastic differentiation of GCTB. Investigations of the nuclear β-catenin in naïve GCTB samples may provide a promising biomarker for predicting the ossification of GCTB following denosumab treatment.
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Affiliation(s)
- Atsushi Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Yu Toda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan.
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yahiro
- Department of Orthopedic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eijiro Shimada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Masaya Kanahori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Ryunosuke Oyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Suguru Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center, Tokyo, Japan
| | - Makoto Nakagawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Nokitaka Setsu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Makoto Endo
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Toshifumi Fujiwara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Tomoya Matsunobu
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
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AlYami AH, Nazer A, Bashawieh HH, Dabroom AA, Saem Aldahar M, AlYami AA, AlMaeen BN. Outcomes in Bone Giant Cell Tumors Treated With Surgical Resection With and Without Denosumab Injection: A Single-Institution Retrospective Study. Cureus 2022; 14:e26869. [PMID: 35978757 PMCID: PMC9375832 DOI: 10.7759/cureus.26869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Giant cell tumors of the bone (GCTB) are rare, benign, aggressive, recurrent tumors that are most often found at the ends of long bones. They account for 5% of all primary bone tumors and 20% of all benign bone tumors. The clinical features of GCTB include local swelling, pain, and limitations in joint movement. Approximately half of GCTB arise around the knee joint, affecting either the distal femur or proximal tibia. Tissue biopsy reveals an excess of multinucleated giant cells on a stromal cell background, indicating a diagnosis. Intralesional curettage is used to treat GCTB and is associated with minimal disability; however, local recurrence may occur in many patients. Resection and endoprosthetic repair or bone graft reconstruction are often used to treat GCTB near the joint. To our knowledge, there are currently no studies on this topic in the city of Jeddah, where we conducted our study. Our aim was to evaluate the outcome of surgical resection accompanied by denosumab injection compared to that of surgery alone in treating GCTB. Methods: All cases of GCTB at King Abdulaziz Medical City, Jeddah, between January 2008 and December 2018, that fulfilled the inclusion and exclusion criteria were included. All cases of GCTB in the pre-specified period were classified as surgical resection with denosumab injection or surgical resection alone. The outcomes of the two modalities were compared. Recurrence was investigated in patients belonging to both the groups. Results: Twenty-six cases that met the inclusion criteria were included in the study and the data were analyzed. The subjects were divided into two groups: denosumab and surgery (n = 7) and surgery alone (n = 19). Patients treated with denosumab and surgery had a higher recurrence rate (57%); however, the difference was not significant (p = 0.407). Conclusion: Our study showed that when comparing local recurrence after curettage in patients treated with denosumab and patients who did not receive it, preoperative denosumab therapy was associated with an increased incidence of local recurrence. We recommend a systematic review that can include more studies in this field to acquire more definitive results regarding this topic.
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Burden of complications after giant cell tumor surgery. A single-center retrospective study of 192 cases. Orthop Traumatol Surg Res 2022; 108:103047. [PMID: 34500112 DOI: 10.1016/j.otsr.2021.103047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical complications are frequent with giant cell tumor of bone; recurrence is the best known and most widely studies; other causes of failure have been less well investigated. We therefore performed a retrospective study to identify and assess the main reasons for surgical revision. HYPOTHESIS Recurrence is the main cause of surgical revision in giant cell tumor of bone, but other complications, such as mechanical issues or infection, are underestimated. PATIENTS AND METHODS A single-center retrospective study included 192 patients (included from 2000 to 2016) undergoing first giant cell tumor of bone surgery in a bone tumor reference center. Surgery consisted in curettage for 152 patients (79%) and resection for 40 (21%). The 3 main reconstruction techniques were filling (136 patients; 71%), prosthesis (18 patients; 9%), and fusion (14 patients: 7%). Filling used cement in 9 cases (7%) and bone graft in 127 (93%). Cumulative incidence functions were calculated. RESULTS There were 171 revision procedures in 92 patients: 43 for mechanical reasons, 30 for infection, 86 for tumor recurrence, 12 for other causes. Cumulative incidence of revision at 10years was 36% (95% CI: 27-44) for recurrence, 26% (95% CI: 17-36) for mechanical causes, and 13% (95% CI: 9-19) for infection, for overall cumulative incidence of revision of 61% (95% CI: 50-69). DISCUSSION Risk of all-cause surgical revision in giant cell tumor of bone was 61% at 10years, with recurrence accounting for only half of cases. LEVEL OF EVIDENCE IV.
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Urakawa H, Nagano A, Machida R, Tanaka K, Kataoka T, Sekino Y, Nishida Y, Takahashi M, Kunisada T, Kawano M, Yoshida Y, Takagi T, Sato K, Hiruma T, Hatano H, Tsukushi S, Sakamoto A, Akisue T, Hiraoka K, Ozaki T. A randomized phase III trial of denosumab before curettage for giant cell tumor of bone. JCOG1610. Jpn J Clin Oncol 2022; 52:1021-1028. [PMID: 35472141 DOI: 10.1093/jjco/hyac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of JCOG1610 (randomized controlled phase III trial) was to confirm the superiority of preoperative denosumab to curettage with adjuvant local therapy for patients with giant cell tumor of bone without possible post-operative large bone defect. METHODS The primary endpoint was relapse-free survival and the total sample size was set at 106 patients. Patient accrual began in October 2017. However, the accrual was terminated in December 2020 due to a recommendation from the Data and Safety Monitoring Committee because of poor patient accrual. Now, we report the descriptive results obtained in this study. RESULTS A total of 18 patients had been registered from 13 Japanese institutions at the time of termination on December 2020. Eleven patients were assigned to Arm A (curettage and adjuvant local therapy) and 7 to Arm B (preoperative denosumab, curettage and adjuvant local therapy). Median follow-up period was 1.6 (range: 0.5-2.8) years. Protocol treatment was completed in all but one patient in Arm A who had a pathological fracture before surgery. All patients in Arm B were treated with five courses of preoperative denosumab. Relapse-free survival proportions in Arm A and B were 90.0% (95% confidence interval: 47.3-98.5) and 100% (100-100) at 1 year, and 60.0% (19.0-85.5) and 62.5% (14.2-89.3) at 2 years, respectively [hazard ratio (95% confidence interval): 1.51 (0.24-9.41)]. CONCLUSION In terms of relapse-free survival, the superiority of preoperative denosumab was not observed in patients with giant cell tumor of bone without possible post-operative large bone defect.
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Affiliation(s)
- Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University, Yufu, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Mitsuru Takahashi
- Department of Orthopaedic Surgery, Shizuoka Cancer Center, Sunto-Gun, Japan
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Oita University, Yufu, Japan
| | - Yukihiro Yoshida
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Tatsuya Takagi
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Kenji Sato
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Toru Hiruma
- Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroshi Hatano
- Department of Orthopedic Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Satoshi Tsukushi
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akio Sakamoto
- Department of Orthopedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Koji Hiraoka
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Nagano A, Urakawa H, Tanaka K, Ozaki T. Current management of giant-cell tumor of bone in the denosumab era. Jpn J Clin Oncol 2022; 52:411-416. [PMID: 35199172 DOI: 10.1093/jjco/hyac018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/14/2022] Open
Abstract
Giant-cell tumor of bone is a rare, locally aggressive and rarely metastasizing primary bone tumor. The mainstay of treatment remains controversial and is decided by the balance between adequate surgical margin and sufficient adjacent joint function. Although curettage with a high-speed burr and local adjuvants can maintain normal joint function, many reports have revealed a high local recurrence rate. Conversely, en bloc resection and reconstruction with prostheses for highly aggressive lesions have reportedly lower local recurrence rates and poorer functional outcomes. Denosumab-a full human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa β ligand-was approved by the Food and Drug Authority in 2013 for use in surgically unresectable or when resection is likely to result in severe morbidity for skeletally mature adolescents and adults with giant-cell tumor of bone. However, subsequent studies have suggested that the local recurrence rate would be increased by preoperative use of denosumab. In systematic reviews of the local recurrence rate after preoperative use of denosumab, conclusions vary due to the small sample sizes of the studies reviewed. Therefore, controversy regarding the treatment of giant-cell tumor of bone is ongoing. Here, this review elucidates the management of giant-cell tumor of bone, especially with the local adjuvant and neoadjuvant use of denosumab, and presents the current, evidence-based treatment for giant-cell tumor of bone.
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Affiliation(s)
- Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Hospital, Aichi, Japan
| | - Kazuhiro Tanaka
- Department of Endoprosthetic Surgery, Oita University, Yufu, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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14
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Asano N, Saito M, Kobayashi E, Morii T, Kikuta K, Watanabe I, Anazawa U, Takeuchi K, Suzuki Y, Susa M, Nishimoto K, Ishii R, Miyazaki N, Mrioka H, Kawai A, Horiuchi K, Nakayama R. Preoperative Denosumab Therapy Against Giant Cell Tumor of Bone is Associated with an Increased Risk of Local Recurrence After Curettage Surgery. Ann Surg Oncol 2022; 29:3992-4000. [PMID: 35175454 DOI: 10.1245/s10434-022-11411-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/18/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Denosumab has been shown to be highly effective at suppressing the progression of giant cell tumor of bone (GCTB). However, recent studies have observed a potential increased risk of local recurrence after surgery following the use of denosumab, raising concerns on the use of this agent against GCTB in combination with surgery. METHODS We retrospectively reviewed the medical records of 234 patients with GCTB who were surgically treated at multiple institutions from 1990 to 2017. Patient background, tumor characteristics, treatment methods, local recurrence-free survival rate, distant metastasis rate, oncologic outcome, and limb function at final follow-up were analyzed and compared between cases treated with and without denosumab. RESULTS The 3-year local recurrence-free survival rate was significantly lower in patients who underwent preoperative denosumab therapy (35.3%) compared with those treated without denosumab (79.9%) (P < 0.001). Among patients who were preoperatively treated with denosumab, those who had a local recurrence all underwent curettage surgery. CONCLUSIONS Preoperative denosumab therapy in combination with curettage surgery was significantly associated with an increased risk of local recurrence in Campanacci grade 3 tumors. Our data suggest that clinicians seeing GCTB patients should be aware to this increased risk when planning preoperative denosumab therapy.
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Affiliation(s)
- Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Masato Saito
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | - Kazutaka Kikuta
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Ukei Anazawa
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Katsuhito Takeuchi
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama City, Kanagawa, Japan
| | - Yoshihisa Suzuki
- Department of Orthopaedic Surgery, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kazumasa Nishimoto
- Department of Orthopaedic Surgery, Kawasaki Municipal Ida Hospital, Kawasaki City, Kanagawa, Japan
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Hideo Mrioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Furuta T, Kubo T, Sakuda T, Saito T, Kurisu K, Muragaki Y, Adachi N. Utility of intraoperative magnetic resonance imaging for giant cell tumor of bone after denosumab treatment: a pilot study. Acta Radiol 2022; 63:176-181. [PMID: 33517664 DOI: 10.1177/0284185121989515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is an intermediate but locally aggressive neoplasm. Current treatment of high-risk GCTB involves administration of denosumab, which inhibits bone destruction and promotes osteosclerosis. However, denosumab monotherapy is not a curative treatment for GCTB and surgical treatment remains required. Denosumab treatment complicates surgery, and the recurrence rate of GCTB is high (20%-30%). PURPOSE To examine the utility of intraoperative magnetic resonance imaging (iMRI) for detection and reduction of residual tumor after denosumab treatment and to investigate the utility of iMRI, which is not yet widely used. MATERIAL AND METHODS We enrolled five patients who received denosumab for a median period of eight months (range 6-12 months). Surgery was performed when the degree of osteosclerosis around the articular surface was deemed appropriate. We performed iMRI using a modified operation table to identify residual tumor after initial curettage and evaluated the rate of detection of residual tumor by iMRI, intraoperative and postoperative complications, exposure time of iMRI, and operation time. RESULTS Suspected residual tumor tissue was identified in all five cases and was confirmed by histopathology after additional curettage. The rate of detection of residual tumor by iMRI was 100%. Residual tumor was located in sites which were difficult to remove due to osteosclerosis. The iMRI was performed safely and without trouble. During the median follow-up period of 10 months (range 6-24 months), no adverse events or recurrences occurred. CONCLUSION Intraoperative MRI could contribute to the reduction of residual tumor tissue and it may prevent recurrence of GCTB after denosumab therapy.
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Affiliation(s)
- Taisuke Furuta
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Tadahiko Kubo
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Tomohiko Sakuda
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Taiichi Saito
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgey, Tokyo Women’s Medical University, Tokyo, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
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Hayashida K, Kawabata Y, Kato I, Kamiishi T, Matsuo K, Takeyama M, Inaba Y. Clinical and pathological analysis of giant cell tumor of bone with denosumab treatment and local recurrence. J Orthop Sci 2022; 27:215-221. [PMID: 33358447 DOI: 10.1016/j.jos.2020.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) is a primary bone tumor which comprises giant cells and two types of stromal cells. Recent studies have suggested therapeutic risks of denosumab. No previous studies have reported changes in serum TRACP-5b and SUVmax of 18F-FDG-PET/CT in recurred GCTB after denosumab treatment. Therefore, we assessed the relationship between clinical and pathological features of GCTB which recurred after denosumab treatment. METHODS We retrospectively reviewed the medical records of 26 patients with GCTB who underwent curettage between 2010 and 2018. Fourteen patients treated with denosumab were defined as the denosumab group. We evaluated TRACP-5b and SUVmax values in the denosumab group. H&E staining and immunohistochemistry for H3.3 G34W were performed for pathological assessment. Twelve patients treated without denosumab were defined as the non-denosumab group and compared with denosumab group. RESULTS The local recurrence rate in the denosumab group was 57.4%. The mean TRACP-5b and SUVmax values were significantly decreased after denosumab therapy (P < 0.001, 1077 ± 161 to 74 ± 9 mU/dL and 8.88 ± 0.40 to 3.79 ± 0.56, respectively). Both parameters significantly increased with local recurrence. H&E staining after denosumab treatment revealed the disappearance of giant cells and histological changes in stromal cells. Specimens of local recurrence subjected to H&E staining and immunohistochemistry for H3.3 G34W demonstrated almost identical features to those in the first biopsy. CONCLUSION Although denosumab can prevent GCTB from osteolysis, local recurrence cannot be reduced by denosumab treatment. The clinical and pathological results were almost the same as those before denosumab treatment, suggesting that the changes of GCTB by denosumab are reversible.
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Affiliation(s)
- Kenta Hayashida
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan
| | - Yusuke Kawabata
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan.
| | - Ikuma Kato
- Yokohama City University, Department of Molecular Pathology, Yokohama, Japan
| | - Takayuki Kamiishi
- Fujisawa City Hospital, Department of Orthopaedic Surgery, Fujisawa, Japan
| | - Kosuke Matsuo
- Fujisawa City Hospital, Department of Orthopaedic Surgery, Fujisawa, Japan
| | - Masanobu Takeyama
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan
| | - Yutaka Inaba
- Yokohama City University, Department of Orthopaedic Surgery, Yokohama, Japan
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Fujihara N, Hamada S, Yoshida M, Tsukushi S. Recurrent giant cell tumour of the distal ulna after en bloc resection with preoperative denosumab use. BMJ Case Rep 2021; 14:14/11/e245022. [PMID: 34764115 PMCID: PMC8586889 DOI: 10.1136/bcr-2021-245022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In recent years, denosumab has been used to treat giant cell tumour of bone (GCTB) not only in cases where surgery is complicated but also preoperatively to decrease the preoperative grade or to facilitate surgery for Campanacci grade II and III cases. However, there are no clear protocols regarding the preoperative use of denosumab before en bloc resection. There are a few reports of recurrent cases after en bloc resection; however, the association with the use of denosumab is unknown. We present the clinical, radiological and histopathological findings of a case of Campanacci grade III GCTB at the distal end of the ulna, which resulted in soft tissue recurrence after en bloc resection with the preoperative use of denosumab.
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Affiliation(s)
- Nasa Fujihara
- Orthopaedic, Aichi Cancer Center, Nagoya, Aichi, Japan
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18
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Tumor microenvironment in giant cell tumor of bone: evaluation of PD-L1 expression and SIRPα infiltration after denosumab treatment. Sci Rep 2021; 11:14821. [PMID: 34285260 PMCID: PMC8292371 DOI: 10.1038/s41598-021-94022-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Giant cell tumor of bone (GCTB) is an intermediate malignant bone tumor that is locally aggressive and rarely metastasizes. Denosumab, which is a receptor activator of nuclear factor kappa B ligand (RANKL) inhibitor, can be used to treat GCTB. We focused on potential immunotherapy for GCTB and investigated the tumor microenvironment of GCTB. Programmed death-ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase 1 (IDO1) expression and signal-regulatory protein alpha (SIRPα), forkhead box P3 (FOXP3), and cluster of differentiation 8 (CD8) infiltration were assessed by immunohistochemical studies of 137 tumor tissues from 96 patients. Of the naive primary specimens, 28% exhibited PD-L1 expression and 39% exhibited IDO1 expression. There was significantly more SIRPα+, FOXP3+, and CD8+ cell infiltration in PD-L1- and IDO1-positive tumors than in PD-L1- and IDO1-negative tumors. The frequency of PD-L1 expression and SIRPα+ cell infiltration in recurrent lesions treated with denosumab was significantly higher than in primary lesions and recurrent lesions not treated with denosumab. PD-L1 expression and higher SIRPα+ cell infiltration were significantly correlated with shorter recurrence-free survival. PD-L1 and SIRPα immune checkpoint inhibitors may provide clinical benefit in GCTB patients with recurrent lesions after denosumab therapy.
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19
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Sahito B, Ali SME, Kumar D, Kumar J, Hussain N, Lakho T. Role of denosumab before resection and reconstruction in giant cell tumors of bone: a single-centered retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:567-574. [PMID: 34050817 DOI: 10.1007/s00590-021-03012-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Denosumab has been approved by Food and Drug Authority in 2013 for use in surgically unresectable Giant cell tumor (GCT) to achieve resectable tumor margins. The aim of this study is to investigate the functional outcome and surgical convenience with the use of neoadjuvant denosumab before resection and reconstruction in Campanacci grade III GCT. METHODS We retrospectively reviewed 70 cases of Campanacci grade III GCT receiving resection and reconstruction between January 2014 and December 2019. They were stratified into two groups: one group of 29 patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of 41 patients did not receive denosumab before resection and reconstruction. Quality of life by musculoskeletal tumor society score where 0-7 means poor, 8-14 means fair, 15-22 means good; above 22 means excellent, incidence of tumor recurrence, intraoperative duration in minutes and postoperative positive margins were assessed for each cohort after 12 months follow-up. RESULTS There was no significant difference in musculoskeletal tumor society score (25.75 vs. 27.41; P = 0.178), incidence of recurrence (3.45% vs. 4.88%; P < 0.001), and postoperative positive margins (10.34% vs. 4.88%; P = 0.38) for both groups. However, the intraoperative duration (133.38 vs. 194.49; P < 0.001) was significantly higher in the non-denosumab group compared with denosumab group. CONCLUSIONS Neoadjuvant denosumab is equally effective considering postoperative functional outcomes and surgical convenience except intraoperative duration where it is highly helpful in saving the operating time duration. Easier identification, resection and lesser reconstruction are the key surgical convenience offered by neoadjuvant denosumab.
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Affiliation(s)
- Badaruddin Sahito
- Department of Orthopaedics, Dr Ruth KM Pfau Civil Hospital Karachi/Dow University of Health Sciences, Karachi, Pakistan
| | - Sheikh Muhammad Ebad Ali
- Department of Orthopaedics Unit II, Dr Ruth KM Pfau Civil Hospital Karachi, Baba e Urdu Road, Saddar, Karachi, Pakistan.
| | - Dileep Kumar
- Department of Orthopaedics, Dr Ruth KM Pfau Civil Hospital Karachi/Dow University of Health Sciences, Karachi, Pakistan
| | - Jagdesh Kumar
- Department of Orthopaedics, Dr Ruth KM Pfau Civil Hospital Karachi/Dow University of Health Sciences, Karachi, Pakistan
| | - Nauman Hussain
- Department of Orthopaedics, Dr Ruth KM Pfau Civil Hospital Karachi/Dow University of Health Sciences, Karachi, Pakistan
| | - Tahir Lakho
- Department of Orthopaedics, Dr Ruth KM Pfau Civil Hospital Karachi/Dow University of Health Sciences, Karachi, Pakistan
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The Role of Denosumab for Surgical Outcomes in Patients with Giant Cell Tumour of Bone: A Systematic Review. ACTA ACUST UNITED AC 2021; 28:1302-1313. [PMID: 33809979 PMCID: PMC8025825 DOI: 10.3390/curroncol28020124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Abstract
Background: The role of denosumab in patients with resectable giant cell tumour of bone remains unclear. We asked the following research question: for patients (aged ≥ 12 years) with resectable giant cell tumour of bone, what are the benefits and harms of denosumab compared with no denosumab in terms of (1) facilitation of surgery (operative time, blood loss), (2) disease recurrence, (3) pain control, (4) disease stability, and (5) adverse effects (e.g., malignant transformation, osteonecrosis of jaw, atypical femur fracture)? One previous systematic review addressed only one outcome-disease recurrence. Therefore, we undertook this new systematic review to address the above five outcomes. Methods: MEDLINE, EMBASE, PubMed, and Cochrane Database of Systematic Reviews databases were searched on June 30, 2020. Results: This systematic review included one previous systematic review and five comparative studies. Due to poor quality, non-randomized studies fraught with selection bias, it is difficult to determine if a significant difference exists in the outcomes for surgical giant cell tumour of bone with perioperative denosumab. There were no reported cases of adverse effects from denosumab. Conclusion: To date, there is insufficient evidence to understand the value of denosumab in the perioperative setting in patients with giant cell tumour of bone.
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21
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Zhao Y, Cai Z, Tang X, Du Z, Yang Y, Guo W. Preoperative Denosumab may increase the Risk of Local Recurrence of Giant-cell Tumor of Bone Treated with Curettage: A Systematic Review and Meta-analysis. J Cancer 2021; 12:508-517. [PMID: 33391447 PMCID: PMC7739008 DOI: 10.7150/jca.50575] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/18/2020] [Indexed: 11/05/2022] Open
Abstract
Objective: This systematic review and meta-analysis aimed to determine the effect of preoperative denosumab on the local recurrence of giant-cell tumor of bone (GCTB) treated with curettage. Methods: PubMed, Embase, Cochrane Library, and Web of Science were comprehensively searched. The following data were analyzed using meta-analysis: local recurrence rate of patients receiving denosumab followed by curettage (denosumab group), local recurrence rate of patients receiving curettage only (control group), and a comparison of the local recurrence rates of the two groups. Results: Nine studies that contained 672 patients with GCTB were included in this review. Patients in the denosumab group (preoperative denosumab followed by curettage) had a higher risk of local recurrence compared with those in the control group (curettage only) (odds ratio = 3.04, 95% confidence interval = 1.48-6.22, P < 0.01). The association between preoperative denosumab and local recurrence remained significant in most of the subgroup analyses, except for those with sample sizes < 59 (P = 0.09), sacral GCTB (P = 0.42), and usage of postoperative denosumab (P = 0.38). Conclusions: Preoperative denosumab may increase the risk of local recurrence of GCTB treated with curettage and should be used with caution in the management of GCTB.
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Affiliation(s)
- Yongzhao Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Zhenyu Cai
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
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Abstract
PURPOSE OF REVIEW Giant cell tumour of bone (GCTB) is an intermediate, locally aggressive primary bone tumour. In addition to local therapy, new drugs became available for this disease. Denosumab, a receptor activator of nuclear factor κ-B-ligand inhibitor, was introduced as systemic targeted therapy for advanced or inoperable and metastatic GCTB. Also, the bisphosphonate zoledronic acid has activity in GCTB by directly targeting the neoplastic stromal cells. RECENT FINDINGS In a small RCT, bisphosphonates were successful in controlling tumour growth and a higher apoptotic index of tumour cells was seen after zoledronic acid versus controls. Although bisphosphonate-loaded bone cement has not been studied to a large extent, it does not seem harmful and may constitute a logical local adjuvant. From the largest clinical trial to date, the risk-to-benefit ratio for denosumab in patients with advanced GCTB remains favourable, also in facilitating less morbid surgery. Concerns have arisen that recurrence rates would be higher than after conventional treatment, ranging from 20 to 100% in a systematic review, although this may be because of bias. H3F3A (G34W) driver mutations are helpful in the differentiation between GCTB and other giant cell-containing malignancies. H3.3-G34W proved sufficient to drive tumourigenesis. The cumulative incidence of malignancy in GCTB is estimated at 4%, of which primary malignancy 1.6% and secondary malignancy 2.4%, the latter mainly after radiation. To date, a potential causal relationship between denosumab and pulmonary metastases has not been confirmed; if they do not behave indolently, it would be advised to reassess diagnosis and consider malignancy. SUMMARY Denosumab remains a highly effective treatment option for patients with advanced GCTB. A short duration of 2-4 months neoadjuvant denosumab is advised to facilitate less morbid surgery and prevent incomplete curettage by macroscopic tumour alterations. Reduced dose intensity is being studied to reduce long term side-effects. Further research on bisphosphonates and other targets including H3.3-G34W remains warranted.
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Yayama T, Mori K, Nakamura A, Mimura T, Imai S. Denosumab Therapy for Giant-cell Tumor of the Lumbar Spine: A Case Report and Immunohistochemical Examination. J Orthop Case Rep 2020; 10:76-79. [PMID: 32953662 PMCID: PMC7476695 DOI: 10.13107/jocr.2020.v10.i02.1706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Denosumab, a monoclonal antibody that inhibits the receptor activator of nuclear factor-kappa (RANK) ligand, has been reported to reduce tumor size and progression, promote bone mineralization reconstruction, and increase bone density in patients with giant-cell tumor of bone (GCTB). However, information regarding the histopathological findings of spinal GCTB following denosumab therapy and the time course of the treatment is limited. Case Report We report the case of a 58-year-old woman with progressive low back pain for 3 months before admission. Radiological and histological examinations revealed L4 GCTB. The patients received 10 courses of denosumab, and the tumor was subsequently resected. The therapy resulted in reduction of tumor mass and replacement of the lesions with bone tissue, particularly at the extravertebral and intracanal mass lesions. Histological examination of resected vertebra revealed a notable decrease in the number of RANK-positive and cyclooxygenase-2-positive cells. However, few RANK-positive cells were present around the woven bone. Conclusion Denosumab therapy for spinal GCTB is effective for reducing the tumor stage, surgical complications, and neurological impairment progression; however, it does not lead to total elimination of GCT cells, and careful consideration is needed in terms of the surgical procedure and post-operative denosumab therapy.
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Affiliation(s)
- Takafumi Yayama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu 520-2192, Shiga, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu 520-2192, Shiga, Japan
| | - Akira Nakamura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu 520-2192, Shiga, Japan
| | - Tomohiro Mimura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu 520-2192, Shiga, Japan
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu 520-2192, Shiga, Japan
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Significance of EGFR/HER2 Expression and PIK3CA Mutations in Giant Cell Tumour of Bone Development. BIOMED RESEARCH INTERNATIONAL 2020. [DOI: 10.1155/2020/2931784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Giant Cell Tumour of Bone (GCTB) is a rare bone tumour. Locally aggressive and recurrent, it might evolve into pulmonary metastases. Our present work is aimed at investigating the involvement of the epidermal growth factor receptor (ErbB) family and its downstream effectors in the development and recurrence of GCTB. For this purpose, we used a cohort of 32 GCTB patients and we evaluated the clinicohistological features and the expression of RANKL, EGFR, and HER2. The mutation status of KRAS, PI3KCA, and PTEN gene as potential oncogene involved in GCTB was also evaluated. We found a significant correlation between advanced histological stages, overexpression of EGFR/HER2, and tumour recurrence. Moreover, two mutations were found in the PIK3CA gene: a missense mutation, 1634A>C, detected for the first time in GCTB patients, without influencing the stability of the protein, and a frameshift mutation, c.1658_1659delGTinsC, causing the loss of the protein kinase domain. Altogether, these results suggest that overexpression of HER2/EGFR, Campanacci, and histological stages could be used as a novel prognostic marker for GCTB recurrence.
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Metovic J, Annaratone L, Linari A, Osella-Abate S, Musuraca C, Veneziano F, Vignale C, Bertero L, Cassoni P, Ratto N, Comandone A, Grignani G, Piana R, Papotti M. Prognostic role of PD-L1 and immune-related gene expression profiles in giant cell tumors of bone. Cancer Immunol Immunother 2020; 69:1905-1916. [PMID: 32377818 DOI: 10.1007/s00262-020-02594-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
Giant cell tumor of bone (GCTB) is a locally aggressive and rarely metastatic tumor, with a relatively unpredictable clinical course. A retrospective series of 46 GCTB and a control group of 24 aneurysmal bone cysts (ABC) were selected with the aim of investigating the PD-L1 expression levels and immune-related gene expression profile, in correlation with clinicopathological features. PD-L1 and Ki67 were immunohistochemically tested in each case. Furthermore, comprehensive molecular analyses were carried out using NanoString technology and nCounter PanCancer Immune Profiling Panel, and the gene expression results were correlated with clinicopathological characteristics. PD-L1 expression was observed in 13/46 (28.3%) GCTB (and in 1/24, 4.2%, control ABC, only) and associated with a shorter disease free interval according to univariate analysis. Moreover, in PD-L1-positive lesions, three genes (CD27, CD6 and IL10) were significantly upregulated (p < 0.01), while two were downregulated (LCK and TLR8, showing borderline significance, p = 0.06). Interestingly, these genes can be related to maturation and immune tolerance of bone tissue microenvironment, suggesting a more immature/anergic phenotype of giant cell tumors. Our findings suggest that PD-L1 immunoreactivity may help to select GCTB patients with a higher risk of recurrence who could potentially benefit from immune checkpoint blockade.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, University of Turin, Turin, Italy
| | - Laura Annaratone
- Department of Medical Sciences, University of Turin, Turin, Italy
- Pathology Division, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | | | | | | | - Chiara Vignale
- Department of Oncology, University of Turin, Turin, Italy
| | - Luca Bertero
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nicola Ratto
- Division of Orthopedics, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Alessandro Comandone
- Division of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy
- ASL Città di Torino, Turin, Italy
| | | | - Raimondo Piana
- Division of Orthopedics, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy.
- Anatomia Patologica, Città della Salute e della Scienza Hospital, University of Turin, Via Santena 7, 10126, Turin, Italy.
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Is Treatment with Denosumab Associated with Local Recurrence in Patients with Giant Cell Tumor of Bone Treated with Curettage? A Systematic Review. Clin Orthop Relat Res 2020; 478:1076-1085. [PMID: 31794487 PMCID: PMC7170677 DOI: 10.1097/corr.0000000000001074] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Denosumab, a monoclonal antibody that binds to receptor activation of nuclear factor-kappa ß ligand (RANKL), has been used as a drug to treat aggressive giant cell tumors of bone. It is unclear whether preoperative denosumab therapy is associated with the local recurrence risk in patients with giant cell tumors of bone treated with curettage. Early evidence suggests that denosumab treatment is associated with a reduction in local recurrence, but other studies have questioned that premise. Curettage after a short course of denosumab (3 to 4 months) has been recommended, especially for large, aggressive giant cell tumors in which complete curettage is difficult to achieve. No randomized studies have documented the benefit of this approach, and some investigators have reported higher local recurrence after denosumab treatment. Due to this confusion, we performed a systematic analysis of existing reports to attempt to answer this question and determine whether the appropriate preoperative denosumab therapy duration could be established. QUESTIONS/PURPOSES (1) Is the use of preoperative denosumab associated with local recurrence risk in patients with giant cell tumors of bone treated with curettage compared with those treated with curettage alone? (2) Is the preoperative denosumab therapy duration associated with local recurrence after curettage? METHODS We searched the PubMed, EMBASE, and CENTRAL databases on April 26, 2019 and included both randomized and non-randomized studies that compared local recurrence between patients who had giant cell tumors of bone and were treated with curettage after preoperative denosumab and patients treated with curettage alone. Two authors independently screened the studies. There were no randomized studies dealing with denosumab in giant cell tumors of bone, and generally, denosumab was used for more aggressive tumors. We assessed the quality of the included studies using the Risk of Bias Assessment tool for Non-randomized Studies, with a moderate overall risk of bias. We registered our protocol in PROSPERO (registration number CRD42019133288). We selected seven eligible studies involving 619 patients for the final analysis. RESULTS The proportion of patients with local recurrence ranged from 20% to 100% in the curettage with preoperative denosumab group and ranged from 0% to 50% in the curettage-alone group. The odds ratio of local recurrence ranged from 1.07 to 37.80 in no more than 6 months of preoperative denosumab duration group and ranged from 0.60 to 28.33 in more than 6 months of preoperative denosumab duration group. CONCLUSIONS The available evidence for the benefit of denosumab in more aggressive giant cell tumors is inconclusive, and denosumab treatment may even be associated with an increase in the proportion of patients experiencing local recurrence. Because there are no randomized studies and the existing studies are of poor quality due to indication bias (the most aggressive Campanacci 3 lesions or those where even a resection would be difficult and result in morbidity are generally the patients who are treated with denosumab), the evidence to suggest a disadvantage is weak. Denosumab treatment should be viewed with caution until more definitive, randomized studies documenting a benefit (or not) have been conducted. Furthermore, we could not find evidence to suggest an appropriate length of preoperative denosumab before curettage.
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Chen X, Li H, Zhu S, Wang Y, Qian W. Pre-operative denosumab is associated with higher risk of local recurrence in giant cell tumor of bone: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:256. [PMID: 32312263 PMCID: PMC7171828 DOI: 10.1186/s12891-020-03294-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background In 2013, denosumab was introduced as peri-operative adjuvant treatment for giant cell tumor (GCT) of bone as it inhibits osteoclast activity. It is suggested that denosumab relives pain, facilitate curettage in lesions requiring resection initially. However, controversy remains whether denosumab increases the risk of local recurrence after surgery. Methods Medline, Embase and the Cochrane Library were comprehensively searched in June 2019 to identify studies investigating the clinical outcome of GCT of bone with and without peri-operative denosumab after surgery. Data were gathered and a meta-analysis was conducted. Result Ten studies with 1082 cases (169 in denosumab group, 913 in control group) were included. Overall, denosumab was associated with significantly higher risk of recurrence(P < 0.02) and inferior 5 year recurrence free survival(P = 0.000). Denosumab and curettage has a relatively higher risk of recurrence comparing to curettage alone(P = 0.07). The risk of recurrence is not significantly increased if denosumab was administered both preoperatively and postoperatively(P = 0.24). Conclusion Administration of denosumab is associated with increased risk of recurrence due to a variety of reasons, though it is proven effective in relieving pain, enabling curettage and improved functional outcome. Post-operative denosumab is recommended as it continuously suppress/eliminate residue tumor cells.
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Affiliation(s)
- Xi Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Hairui Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Shibai Zhu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Yiou Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
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Abstract
Purpose of review Giant cell tumor of bone (GCTB) is an uncommon benign primary bone tumor, consisting of receptor activator of nuclear factor kappa-B (RANK) expressing reactive osteoclast-like giant cells and neoplastic spindle-shaped cells. Denosumab was approved by FDA in 2013 and by EMA in 2014 to treat adults and skeletally mature adolescents with unresectable GCTB or when resection is likely to result in severe morbidity. However, there is much discussion regarding the optimal applied treatment strategy. Recent findings Neoadjuvant treatment of GCTB with denosumab can effectively downstage tumors to facilitate less morbid surgery or completely avoid the need for resection, but there is concern about local recurrence postsurgery. Definitive treatment of unresectable GTCB improves symptoms and halts tumor progression. The optimal treatment duration is unclear and long-term treatment is associated with adverse events like osteonecrosis of the jaw (ONJ) and atypical femoral fractures. Denosumab maintenance dose interval is currently being investigated. Summary For the related but heterogenous group of giant cell rich tumors of bone, like aneurysmal bone cysts (ABC) and central giant cell granuloma (CGCG), denosumab is a new treatment modality under investigation. Given the effectiveness in GCTB, this could be a promising treatment option for selected patients with advanced disease.
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Omlor GW, Lange J, Streit M, Gantz S, Merle C, Germann T, Mechtersheimer G, Fellenberg J, Lehner B. Retrospective analysis of 51 intralesionally treated cases with progressed giant cell tumor of the bone: local adjuvant use of hydrogen peroxide reduces the risk for tumor recurrence. World J Surg Oncol 2019; 17:73. [PMID: 31014317 PMCID: PMC6480805 DOI: 10.1186/s12957-019-1613-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Giant cell tumor of the bone (GCT) has high local recurrence rates and the prognosis is hard to predict. We therefore retrospectively analyzed clinical outcome and recurrences of 51 GCT cases focusing on the effects of adjuvant local use of hydrogen peroxide. METHODS The series enclosed 51 advanced GCT cases of the upper and lower extremities (n = 27 Campanacci grade III; n = 24 grade II; n = 39 surgery at our institution, n = 12 elsewhere). Mean follow-up was 88.3 (± 62.0) months. Surgical details, histology, metastases, recurrences, and interview-based data on satisfaction and function including the Musculoskeletal Tumor Society (MSTS) score were evaluated. It was investigated whether hydrogen peroxide was additionally used or not to clean the tumor cavity after curettage as we hypothesized influence on recurrences. To analyze the underlying mechanisms, GCT-derived stromal cell lines were cultured in vitro and tested for cell viability and apoptosis after treatment with hydrogen peroxide. Statistical analysis was performed with Student's t tests, analysis of variance (ANOVA) with post hoc testing, Mann-Whitney U tests, chi-square tests, Kaplan-Meier analysis, and multivariate Cox regression analysis. RESULTS The whole series had 21 recurrences (41%). Eleven recurrences were found (28%) after surgery at our institution. Kaplan-Meier analysis of cumulative recurrence-free survival revealed at 2 years follow-up 69% (72%, only our institution) and at 10 years follow-up 54% (68%, only our institution). Intralesional resection was performed by vigorous curettage, burring, and defect filling with either polymethylmethacrylate bone cement (n = 45) or cancellous bone from the iliac crest (n = 6). Univariate chi-square analysis showed significantly lower recurrence rate after bone cement filling (2.3-fold, p = 0.024). Cleaning of the lesion cavity with hydrogen peroxide significantly reduced recurrence rate (whole collective 2.9-fold, p = 0.004; our institution 2.8-fold, p = 0.04) and significantly increased cumulative recurrence-free survival rate (whole collective at 10 years follow-up 74% versus 31%, p = 0.002; our institution 79% versus 48%, p = 0.02) compared to cases without hydrogen peroxide treatment. In multivariate analysis, significant risk factors for recurrence were pathological fracture (hazard ratio 3.7; p = 0.04), high mitosis rate (hazard ratio 15.6; p = 0.01), and lack of hydrogen peroxide use (hazard ratio 6.0; p = 0.02). In vitro cell culture analyses found apoptotic nature of hydrogen peroxide induced GCT cell death. CONCLUSIONS The present series proved for the first time that additional cleaning of the tumor cavity with hydrogen peroxide before defect filling significantly reduced recurrence rate and significantly increased recurrence-free survival in advanced but intralesionally treated GCT cases.
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Affiliation(s)
- Georg W Omlor
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jessica Lange
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Marcus Streit
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Simone Gantz
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Merle
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Germann
- Institute of Pathology Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
| | - Gunhild Mechtersheimer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, 69120, Heidelberg, Germany
| | - Jörg Fellenberg
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Burkhard Lehner
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Puri A, Gulia A, Hegde P, Verma V, Rekhi B. Neoadjuvant denosumab: its role and results in operable cases of giant cell tumour of bone. Bone Joint J 2019; 101-B:170-177. [PMID: 30700112 DOI: 10.1302/0301-620x.101b2.bjj-2018-0907.r2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to evaluate the efficacy of preoperative denosumab in achieving prospectively decided intention of therapy in operable giant cell tumour of bone (GCTB) patients, and to document local recurrence-free survival (LRFS). PATIENTS AND METHODS A total of 44 patients received preoperative denosumab: 22 to facilitate curettage, 16 to facilitate resection, and six with intent of converting resection to curettage. There were 26 male and 18 female patients. The mean age was 27 years (13 to 47). RESULTS The mean number of denosumab treatments was five (2 to 7) per patient. In 42 of 44 patients (95%), denosumab helped to achieve prospectively decided intention. A total of 41 patients were available for follow-up at a mean follow-up of 34 months (24 to 48). There were 12 local recurrences (29%), in 11 patients (11/25, 44%) who had curettage and in one patient (1/16, 6%) who had resection. The mean time to local recurrence was 16 months (8 to 25). The LRFS was 76% at two years: 94% for cases with resection and 64% for cases with curettage (p = 0.013). CONCLUSION Although local control rates are unlikely to improve with use of preoperative denosumab, a short preoperative course of denosumab can facilitate surgery in certain cases of operable GCTB, with a high risk of local recurrence making curettage or resection technically easier. It may also help in converting a lesion requiring resection to a lesion that could possibly be treated with curettage.
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Affiliation(s)
- A Puri
- Tata Memorial Centre, HBNI, Mumbai, India
| | - A Gulia
- Tata Memorial Centre, HBNI, Mumbai, India
| | - P Hegde
- Tata Memorial Centre, HBNI, Mumbai, India
| | - V Verma
- Tata Memorial Centre, HBNI, Mumbai, India
| | - B Rekhi
- Tata Memorial Centre, HBNI, Mumbai, India
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Alaqaili SI, Abduljabbar AM, Altaho AJ, Khan AA, Alherabi JA. Malignant Sarcomatous Transformation of Benign Giant Cell Tumor of Bone after Treatment with Denosumab Therapy: A Literature Review of Reported Cases. Cureus 2018; 10:e3792. [PMID: 30868006 PMCID: PMC6402735 DOI: 10.7759/cureus.3792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Giant cell tumor of bone (GCTB) is a biologically benign and locally aggressive tumor that most often affects the epiphyseal and metaphyseal sites of long bones in the young adult population. Overexpression of receptor activator of nuclear factor kappa B ligand (RANKL) by cancerous mesenchymal stromal cells stimulates a signal transduction cascade that recruits and activates multinucleated osteoclast-like giant cells, resulting in pathologic bone resorption. Denosumab, an RANKL inhibitor that blocks the RANKL-mediated osteoclast activation, has been recently approved by the United States Food and Drug Administration (FDA) for the treatment of aggressive GCTB. Although uncommon, several studies reported drug-related malignant morphological transformation of benign GCTB following treatment with denosumab therapy. The aim of the article was to review the clinicopathological characteristics of all the reported cases of malignant sarcomatous transformation of GCTB after treatment with denosumab therapy in patients without any history of prior exposure to radiotherapy.
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