Denosumab in giant cell tumour of bone in the pelvis and sacrum: Long-term therapy or bone resection?

Andrea Sambri, Manuel R. Medellin, Costantino Errani, Laura Campanacci, Tomohiro Fujiwara, Davide Donati, Michael Parry, Robert Grimer

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Surgery of GCTB in sacrum and pelvis is challenging, with high rates of complications and local recurrence. Denosumab can consolidate the peripheral rim of the tumour, thus reducing the rate of morbidities of surgery. The aim of this paper is to evaluate the use of denosumab in pelvic/sacrum giant cell tumours of bone (GCTB). Patients and methods: We retrospectively reviewed a cohort of 26 patients with aggressive GCTB in sacrum or pelvis treated with denosumab at two referral centres. Clinical response and local recurrence were recorded and the radiologic responses were evaluated with the MDA criteria. Results: 69% of the pelvic GCTB treated with denosumab presented partial or good radiologic responses (type 2A or 2B) after 49 weeks of treatment. Denosumab was administered as adjuvant therapy prior and after surgery in 11 patients (group A), and as the only treatment in 15 patients (group B). In group A, 62% of local recurrence was observed in patients treated with intralesional curettage. No recurrences were identified after en bloc resection. In group B, 9 patients were on continuous bimonthly long term denosumab administration with type 2A and 2B responses. Six patients stopped denosumab and 66% remained stable after 10 months of follow-up. Conclusions: Long-term denosumab therapy can be considered with curative intent for pelvic and sacrum GCTB. If surgical intervention is required wide resection may be advisable to reduce the risk of recurrence.

Original languageEnglish
Pages (from-to)1-15
Number of pages15
JournalJournal of Orthopaedic Science
DOIs
Publication statusE-pub ahead of print - May 2019

Keywords

  • Giant cell tumor
  • Spine
  • Denosumab
  • En bloc resection
  • Spondylectomy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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