Outcome of lung metastases due to bone giant cell tumor initially managed with observation

Shinji Tsukamoto, Giovanni Ciani, Andreas F. Mavrogenis, Cristina Ferrari, Manabu Akahane, Yasuhito Tanaka, Michele Rocca, Alessandra Longhi, Costantino Errani

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The outcomes of patients with lung metastases from giant cell tumor of bone (GCTB) vary from spontaneous regression to uncontrolled growth. To investigate whether observation is an appropriate first-line management approach for patients with lung metastases from GCTB, we evaluated the outcomes of patients who were initially managed by observation. Methods: We retrospectively reviewed the data of 22 patients with lung metastases from histologically confirmed GCTB who received observation as a first-line treatment approach. The median follow-up period was 116 months. Results: Disease progression occurred in 12 patients (54.5%). The median interval between the discovery of lung metastases and progression was 8 months. Eight patients underwent metastasectomy following initial observation. The median interval between the discovery of lung metastases and treatment by metastasectomy was 13.5 months. None of the patients experienced spontaneous regression. Of the 22 patients, 36.4% needed a metastasectomy, and 9.1% required denosumab treatment during the course of the follow-up period. Disease progression occurred in 45.5% of the 11 patients with lung nodules ≤ 5 mm, while all five of the patients with lung nodules > 5 mm experienced disease progression. Progression-free survival was significantly worse in the group with lung nodules > 5 mm compared to the group with lung nodules ≤ 5 mm (p = 0.022). Conclusions: Observation is a safe first-line method of managing patients with lung metastases from GCTB. According to radiological imaging, approximately half of the patients progressed, and approximately half required a metastasectomy or denosumab treatment. However, patients with lung nodules > 5 mm should receive careful observation because of the high rate of disease progression in this group.
Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Orthopaedic Surgery and Research
Volume15
Issue number1
DOIs
Publication statusPublished - Nov 7 2020

Keywords

  • Denosumab
  • Giant cell tumor of bone
  • Lungs
  • Metastasectomy
  • Metastasis
  • Observation

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