Denosumab in long-term treatment of patients with giant cell tumor of bone

Diedkov A.G., Kostyuk V.Y., Boychuk S.I., Maksimenko B.V.

Summary. The standard treatment of giant cell tumor of bone (GCP) is aggressive curettage followed by phenol application, liquid nitrogen and cementation, or wide resection of the part of bone with reconstruction. But, resection within healthy tissues and also in some cases of curettage in cases of pelvic lessions or axial skeletal can be the reason of serious complications and patient’s disability. Conservative treatment with denosumab is suggested to avoid mentioned surgery as alternative. This study was analyzed the possibility of long-term use of denosumab, when completely removal of tumor is impossible. 14 patients with GCP of pelvic bones and axial skeleton were included in our study, all patients received treatment between 2012 and 2019 and remain under observation. The evaluation criteria were remission duration and complication rate. The median follow-up from the start of denosumab was 54 months (range 16–112 months). 6 patients had a sacral tumor with lesions S1, S2; 5 patients — pelvic bones and 3 — vertebrae. Disease progression after discontinuation of denosumab was observed in 12 of 14 patients (85.7%). Relapses with clinical and radiological manifestations were revealed after 3–6 months in 9 patients, in 3 patients remission lasted from 2 to 6 years, 1 patient had disease progression after 2 months. Patients received from13 to 60 injections of denosumab, 12 monthly then once every 3 months as maintenance therapy after signs of progression. None of the 14 patients were found to have malignant transformation or metastasis during the treatment and follow-up period, and there were no signs of osteonecrosis of the jaw. The use of denosumab for the treatment in conditionally inoperable patients with GCT helps to achieve long-term remission under conditions of continuous drug administration, and allows to avoid the patient’s disability and avoid postoperative complications for a long time.

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