Giant cell tumor of bone (GCTB) is a locally aggressive tumor with 3% incidence of pulmonary metastasis. The standard treatment of GCTB had been surgery until denosumab was approved for these tumors.
Patients diagnosed to have GCTB in King Faisal Specialist Hospital and Research center, Riyadh, Saudi Arabia were eligible. The aim of this study was to evaluate the clinical outcome of GCTB in our institution in the era before and after denosumab.
We identified 42 patients treated in the period between May 2008 and November 2017. Median follow-up time was 57 months. Median age was 31 years. Twenty-Six (62%) patients were females and 16 (38%) were males. Primary tumor was located in upper limb in 21 (50%) patients - mostly in humerus and radius, in lower limb in 17(43%) patients, and in pelvis/axial skeleton/ribs 3(7%) patients. Thirty patients (71%) had >10 cm. Thirteen patients received neoadjuvant denosumab (median number of cycles 9), all had clinical benefit from therapy.41(98%) had surgery, 27 (64%) patients had enbolic resection and 14 (33%) had intralesional curettage. Fourteen patients (33%) had post-surgical relapse [3(7%) received neoadjuvant denosumab],6(14%) patients with local recurrence and 8(19%) patients with lung metastasis. Denosumab was given to those with metastatic disease (median number of cycles 5). One patient had complete response,2 patients had partial response,3 patients had stable disease and1 patient had progressive disease. Treatment was well tolerated with no incidence of nephrotoxicity, hypocalcemia or osteonecrosis of the jaw.Median recurrence free survival was not reached.
Denosumab is efficient and tolerable in unresectable/metastatic disease as well as in a neoadjuvant setting in locally advanced tumors to facilitate complete surgical resection or avoid mutilating surgery. The risk of recurrences after curettage of GCTB following denosumab raises questions about the optimal management of such cases. Due to rarity of this tumor,larger multicenteric trials should be initiated to clarify the optimal treatment option .
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.