Efficacy of denosumab in joint preservation for patients with giant cell tumour of the bone |
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| Affiliation: | 1. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada;2. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto M5G 1X5, ON, Canada;3. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada;4. Musculoskeletal Division, Department of Medical Imaging, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada;5. Department of Medical Oncology, Mount Sinai Hospital, Toronto M5G 1X5, ON, Canada;1. Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran;2. Department of Pathology, Dena Hospital, Shiraz, Iran;3. Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran;1. Department of Radiology, Research Institute of Radiological Science, YUHS-KRIBB Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, South Korea;2. Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, South Korea;3. Department of Pathology, Severance Hospital, Yonsei University of College of Medicine, South Korea;4. Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, South korea;1. Attending Physician, Department of Oral & Maxillofacial–Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Resident, Department of Oral & Maxillofacial–Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;3. Resident, Department of Oral & Maxillofacial–Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;4. Associate Professor, Department of Oral & Maxillofacial–Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;6. Professor, Department of Neurosurgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;5. Professor, Department of Oral & Maxillofacial–Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;1. First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China;2. Department of Bone Oncology, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China;3. Department of Orthopedics, The 960th Hospital of the People''s Liberation Army, Jinan, China;4. Department of Bone Oncology, Tianjin Hospital, Tianjin, China;5. Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China;1. Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking, University, Beijing, People''s Republic of China;2. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, People''s Republic of China;3. Department of Pathology, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People''s Republic of China |
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| Abstract: | BackgroundGiant cell tumour of the bone (GCTB) is an aggressive osteolytic primary tumour. GCTB is rich in osteoclast-like giant cells and contains mononuclear cells that express RANK ligand (RANKL), a key mediator of osteoclast activation. The potential therapeutic effect of denosumab was investigated with special reference to its role in joint preservation.MethodsIn this prospective non-randomised study patients with GCTB received denosumab for 6–11 months preoperatively. Serial radiographs and biopsy and resection tumour specimens were used to monitor response to denosumab.ResultsAll 20 patients experienced pain relief in the first month of treatment. All patients demonstrated a positive radiographic response with improved subchondral and cortical bone which allowed intralesional tumour resection and preservation of the joint and articular surface in 18 cases. Histological examination following denosumab revealed rarely detectable osteoclast-like giant cells. There was an obvious increase in osteoid matrix and woven bone which showed rare RANK staining amongst the mononuclear cells and only focal RANKL positivity. At median 30 months follow-up after resection, local tumour recurrence occurred in three patients.ConclusionDenosumab provides favourable and consistent clinical, radiographic and pathologic responses which facilitates less aggressive surgical treatment, especially joint preservation. However, the local recurrence rate for GCTB following resection does not seem to be affected by denosumab and remains a concern. |
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| Keywords: | Giant cell tumour of the bone Denosumab Histopathological findings Radiological effects Joint preservation |
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