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Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases
OBJECTIVE: Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery is the commonly used treatment; however, recurrence remains a problem. Receptor activator of nuclear factor kappa B (RANKL) is responsible for the formation of osteoclastic cells. Discovery of RANKL...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Turkish Association of Orthopaedics and Traumatology
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197547/ https://www.ncbi.nlm.nih.gov/pubmed/27784623 http://dx.doi.org/10.1016/j.aott.2016.03.004 |
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author | Deveci, Mehmet Ali Paydaş, Semra Gönlüşen, Gülfiliz Özkan, Cenk Biçer, Ömer Sunkar Tekin, Mustafa |
author_facet | Deveci, Mehmet Ali Paydaş, Semra Gönlüşen, Gülfiliz Özkan, Cenk Biçer, Ömer Sunkar Tekin, Mustafa |
author_sort | Deveci, Mehmet Ali |
collection | PubMed |
description | OBJECTIVE: Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery is the commonly used treatment; however, recurrence remains a problem. Receptor activator of nuclear factor kappa B (RANKL) is responsible for the formation of osteoclastic cells. Discovery of RANKL and its human monoclonal antibody, denosumab, led to use of denosumab for treatment of GCT. The aim of this study was to evaluate clinical and pathological results of treatment of GCT with denosumab and to assess adverse effect profile and recurrence rate. METHODS: Thirteen patients with 14 lesions were enrolled in the study. Mean age was 38.3 years. Patients were given subcutaneous injections of denosumab (120 mg) every 4 weeks (with additional doses on days 0, 8 and 15 in cycle 1 only) and were radiologically evaluated for tumor response. Pain and functional status were measured using Visual Analog Score (VAS) and Musculoskeletal Tumor Society Score (MSTS). Adverse effects were analyzed after each cycle. RESULTS: Participants were 5 men and 8 women. Mean follow-up was 17 months. One lesion was Campanacci grade I, 8 were grade II, and 5 were grade III. Eight lesions were recurrent, and remaining were primary lesions. After average of 9 cycles (range: 4–17 cycles), all tumors underwent radiological regression. Ten lesions were removed surgically. More than 90% of giant cells were found to have regressed in all pathological specimens. On last follow-up, average VAS was 1 and MSTS was 87%. Fatigue and joint and muscle pain after injections was reported by 46% of patients, and mild hypocalcaemia was seen in 1 patient. CONCLUSION: Denosumab has been shown to be a successful drug in treatment of GCT. Denosumab can be used as neoadjuvant for all recurrent lesions, grade II lesions with high surgical risk, grade III lesions, and metastatic cases of GCT. LEVEL OF EVIDENCE: Level IV, Therapeutic study |
format | Online Article Text |
id | pubmed-6197547 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Turkish Association of Orthopaedics and Traumatology |
record_format | MEDLINE/PubMed |
spelling | pubmed-61975472018-10-24 Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases Deveci, Mehmet Ali Paydaş, Semra Gönlüşen, Gülfiliz Özkan, Cenk Biçer, Ömer Sunkar Tekin, Mustafa Acta Orthop Traumatol Turc Original Article OBJECTIVE: Giant cell tumor of bone (GCT) is a primary, osteolytic, benign tumor of the bone. Surgery is the commonly used treatment; however, recurrence remains a problem. Receptor activator of nuclear factor kappa B (RANKL) is responsible for the formation of osteoclastic cells. Discovery of RANKL and its human monoclonal antibody, denosumab, led to use of denosumab for treatment of GCT. The aim of this study was to evaluate clinical and pathological results of treatment of GCT with denosumab and to assess adverse effect profile and recurrence rate. METHODS: Thirteen patients with 14 lesions were enrolled in the study. Mean age was 38.3 years. Patients were given subcutaneous injections of denosumab (120 mg) every 4 weeks (with additional doses on days 0, 8 and 15 in cycle 1 only) and were radiologically evaluated for tumor response. Pain and functional status were measured using Visual Analog Score (VAS) and Musculoskeletal Tumor Society Score (MSTS). Adverse effects were analyzed after each cycle. RESULTS: Participants were 5 men and 8 women. Mean follow-up was 17 months. One lesion was Campanacci grade I, 8 were grade II, and 5 were grade III. Eight lesions were recurrent, and remaining were primary lesions. After average of 9 cycles (range: 4–17 cycles), all tumors underwent radiological regression. Ten lesions were removed surgically. More than 90% of giant cells were found to have regressed in all pathological specimens. On last follow-up, average VAS was 1 and MSTS was 87%. Fatigue and joint and muscle pain after injections was reported by 46% of patients, and mild hypocalcaemia was seen in 1 patient. CONCLUSION: Denosumab has been shown to be a successful drug in treatment of GCT. Denosumab can be used as neoadjuvant for all recurrent lesions, grade II lesions with high surgical risk, grade III lesions, and metastatic cases of GCT. LEVEL OF EVIDENCE: Level IV, Therapeutic study Turkish Association of Orthopaedics and Traumatology 2017-01 2016-10-24 /pmc/articles/PMC6197547/ /pubmed/27784623 http://dx.doi.org/10.1016/j.aott.2016.03.004 Text en © 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Deveci, Mehmet Ali Paydaş, Semra Gönlüşen, Gülfiliz Özkan, Cenk Biçer, Ömer Sunkar Tekin, Mustafa Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases |
title | Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases |
title_full | Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases |
title_fullStr | Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases |
title_full_unstemmed | Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases |
title_short | Clinical and pathological results of denosumab treatment for giant cell tumors of bone: Prospective study of 14 cases |
title_sort | clinical and pathological results of denosumab treatment for giant cell tumors of bone: prospective study of 14 cases |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197547/ https://www.ncbi.nlm.nih.gov/pubmed/27784623 http://dx.doi.org/10.1016/j.aott.2016.03.004 |
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