Perrin David Louis, Visgauss Julia D, Wilson David A, Griffin Anthony M, Abdul Razak Albiruni R, Ferguson Peter C, Wunder Jay S
Section of Orthopaedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada.
Department of Orthopedic Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, USA.
Bone Joint J. 2021 Jan;103-B(1):184-191. doi: 10.1302/0301-620X.103B1.BJJ-2020-0274.R1.
Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up.
Patients with GCTB of the limb considered high-risk for unsuccessful joint salvage, due to minimal periarticular and subchondral bone, large soft tissue mass, or pathological fracture, were treated with Denosumab followed by extended intralesional curettage with the goal of preserving the joint surface. Patients were followed for local recurrence, metastasis, and secondary sarcoma.
A total of 25 patients with a mean age of 33.8 years (18 to 67) with high-risk GCTB received median six cycles of Denosumab before surgery. Tumours occurred most commonly around the knee (17/25, 68%). The median follow-up was 57 months (interquartile range (IQR) 13 to 88). The joint was salvaged in 23 patients (92%). Two required knee arthroplasty due to intra-articular fracture and arthritis. Local recurrence developed in 11 patients (44%) at a mean of 32.5 months (3 to 75) following surgery, of whom four underwent repeat curettage and joint salvage. One patient developed secondary osteosarcoma and another benign GCT lung metastases.
The use of Denosumab for joint salvage was associated with a higher than expected rate of local recurrence at 44%. Neoadjuvant Denosumab for joint-sparing procedures should be considered with caution in light of these results. Cite this article: 2021;103-B(1):184-191.
对于骨巨细胞瘤（GCTB）行刮除术和保关节手术后，局部复发仍是一个具有挑战性的常见问题。我们之前报道了20例接受新辅助地诺单抗治疗的高危GCTB患者，中位随访30个月时局部复发率为15%。本研究的目的是确定使用地诺单抗后这一初步良好结果在更长随访期内是否得以维持。
因关节周围和软骨下骨量极少、软组织肿块较大或病理性骨折而被认为保关节手术失败风险高的肢体GCTB患者，接受地诺单抗治疗，随后进行扩大的病灶内刮除术，目标是保留关节面。对患者进行局部复发、转移和继发性肉瘤方面的随访。
共有25例平均年龄33.8岁（18至67岁）的高危GCTB患者在手术前接受了中位6周期的地诺单抗治疗。肿瘤最常见于膝关节周围（17/25，68%）。中位随访时间为57个月（四分位间距（IQR）13至88个月）。23例患者（92%）的关节得以保留。2例因关节内骨折和关节炎而行膝关节置换术。11例患者（44%）在术后平均32.5个月（3至75个月）出现局部复发，其中4例接受了再次刮除术和关节保留手术。1例患者发生继发性骨肉瘤，另1例出现良性GCT肺转移。
使用地诺单抗保关节与44%的局部复发率高于预期有关。鉴于这些结果，新辅助地诺单抗用于保关节手术应谨慎考虑。引用本文：2021;103-B(1):184-191。
