Niu Xiaohui, Yang Yongkun, Wong Kwok Chuen, Huang Zhen, Ding Yi, Zhang Wen
Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking, University, Beijing, People's Republic of China.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, People's Republic of China.
J Orthop Translat. 2018 Nov 7;18:100-108. doi: 10.1016/j.jot.2018.10.003. eCollection 2019 Jul.
Denosumab is gradually applied to refractory or unresectable giant cell tumour of the bone. Whether denosumab can effectively reduce the blood supply of tumour and bring benefit is worthy of study. The aim of the study is to evaluate the related changes after treatment: blood supply, surgical plan downstaging, surgical difficulty and oncological prognosis.
A self-case-control study was performed from June 2014 to November 2016, and 18 patients were enrolled. Patients received subcutaneous denosumab 120 mg every 4 weeks preoperatively, with additional doses administered on Days 8 and 15 during the first month of therapy. The initial treatment duration was 12 weeks. After 12 weeks treatment, enhanced CT examination was performed for evaluating whether surgical treatment was practicable. The patients received preoperative denosumab treatment for 5 (median 3, range 3-12) months in average. The microvessel density of tumour samples was calculated for evaluating tumour blood supply. The computed tomography (CT) enhancement rate was compared before and after treatment. The related changes of parameters were recorded as the following: clinical benefits, serious side effects, enhancement rate of CT, surgical plans, intraoperative blood loss, operative time, surgical difficulty, histological changes and local recurrence. The patients were followed up every 3 months postoperatively.
The average CT enhancement rate of lesions was 2.08 and 1.40 before and after treatment ( = 0.000), respectively. The unenhanced CT value was significantly increased after treatment ( = 0.038). The CT enhancement rate changed more significantly in pelvic or sacral lesions than that in limb lesions ( = 0.024). Sixteen cases underwent final surgery, and surgical plan was downstaged. The histological examination showed tumour cells were significantly reduced or even disappeared after treatment. The microvessel density decreased significantly after treatment. The mean postoperative follow-up was 18.8 (10-31) months, and five patients had local recurrence. The high local recurrence rate (4/6) in sacral tumours may be related to the increased difficulty of curettage.
Denosumab treatment can reduce the blood supply of giant cell tumour. The sacral or pelvic lesions changed more significantly than limb lesions. The surgical plan downstaging can also be achieved. The clear margin after denosumab treatment facilitated tumour resection but, increased difficult in curettage surgery, and high recurrence rate of sacral tumour is being concerned.
Denosumab is a new type of humanized monoclonal antibody which showed some effect in the treatment giant cell tumor of bone. Pre-operative treatment with denosamub can reduce intra-operative blood loss and down-stage surgical plan in suitable cases.
地诺单抗逐渐应用于难治性或不可切除的骨巨细胞瘤。地诺单抗能否有效减少肿瘤血供并带来益处值得研究。本研究的目的是评估治疗后的相关变化：血供、手术计划降期、手术难度和肿瘤学预后。
2014年6月至2016年11月进行了一项自身病例对照研究，纳入18例患者。患者术前每4周皮下注射地诺单抗120mg，在治疗的第一个月的第8天和第15天额外给药。初始治疗持续时间为12周。治疗12周后，进行增强CT检查以评估手术治疗是否可行。患者术前平均接受地诺单抗治疗5（中位数3，范围3 - 12）个月。计算肿瘤样本的微血管密度以评估肿瘤血供。比较治疗前后的计算机断层扫描（CT）增强率。记录参数的相关变化如下：临床获益、严重副作用、CT增强率、手术计划、术中出血量、手术时间、手术难度、组织学变化和局部复发。术后每3个月对患者进行随访。
治疗前后病变的平均CT增强率分别为2.08和1.40（P = 0.000）。治疗后平扫CT值显著增加（P = 0.038）。盆腔或骶骨病变的CT增强率变化比肢体病变更显著（P = 0.024）。16例患者接受了最终手术，手术计划降期。组织学检查显示治疗后肿瘤细胞显著减少甚至消失。治疗后微血管密度显著降低。术后平均随访18.8（10 - 31）个月，5例患者出现局部复发。骶骨肿瘤的高局部复发率（4/6）可能与刮除难度增加有关。
地诺单抗治疗可减少骨巨细胞瘤的血供。骶骨或盆腔病变的变化比肢体病变更显著。也可实现手术计划降期。地诺单抗治疗后切缘清晰有利于肿瘤切除，但刮除手术难度增加，骶骨肿瘤的高复发率令人关注。
地诺单抗是一种新型人源化单克隆抗体，在骨巨细胞瘤治疗中显示出一定效果。术前用地诺单抗治疗可减少术中出血量，并在合适病例中使手术计划降期。
