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The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spine
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The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spine
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Journal Article
The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spine
2022
Overview
Background: Giant cell tumours (GCT) of the spine may be large at presentation and cause severe pain. The current recommended treatment is en bloc excision but it is associated with substantial morbidity and mortality. Denosumab is a monoclonal RANKL inhibitor that may be used neoadjuvantly. The goal of this study was to assess the effect of denosumab on tumour characteristics and symptom relief. Methods: We performed a retrospective review of 10 patients treated with denosumab as neoadjuvant and stand-alone treatment. Tumour measurements were taken before and after treatment, positron emission tomographic (PET) standardized uptake value (SUV) capitation was measured, and patients were interviewed for subjective pain responses. Clinical response was determined by volumetric reduction in tumour size, PET SUV capitation, the Boriani classification and improvement in pain symptoms. Results: Following treatment 70% of patients were pain free, with 50% noting improvement within 48 hours. Mean relative volumetric reduction in tumour volume was 40%. All pathology specimens confirmed elimination of giant cells. Improvement in Bilsky grading occurred in 4 of 10 cases and progression was halted in the remainder. Median baseline SUVmax was 14.7, and median SUVmax after treatment was 6.2. Seventy-eight percent of patients demonstrated intra lesional bone formation following treatment. Conclusion: This study demonstrates that neoadjuvant denosumab facilitates en bloc resection of GCT of the spine, reduces the likelihood of intraoperative morbidity and improves preoperative pain. We recommend routine use when Weinstein-Boriani-Biaginibased criteria are fulfilled for en bloc excision. Assuming that margins are disease free following surgery, we advocate cessation of treatment postoperatively.
Publisher
CMA Impact, Inc
Subject
