Sahito Badaruddin, Ali Sheikh Muhammad Ebad, Kumar Dileep, Kumar Jagdesh, Hussain Nauman, Lakho Tahir
Department of Orthopaedics, Dr Ruth KM Pfau Civil Hospital Karachi/Dow University of Health Sciences, Karachi, Pakistan.
Department of Orthopaedics Unit II, Dr Ruth KM Pfau Civil Hospital Karachi, Baba e Urdu Road, Saddar, Karachi, Pakistan.
Eur J Orthop Surg Traumatol. 2022 Apr;32(3):567-574. doi: 10.1007/s00590-021-03012-1. Epub 2021 May 29.
Denosumab has been approved by Food and Drug Authority in 2013 for use in surgically unresectable Giant cell tumor (GCT) to achieve resectable tumor margins. The aim of this study is to investigate the functional outcome and surgical convenience with the use of neoadjuvant denosumab before resection and reconstruction in Campanacci grade III GCT.
We retrospectively reviewed 70 cases of Campanacci grade III GCT receiving resection and reconstruction between January 2014 and December 2019. They were stratified into two groups: one group of 29 patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of 41 patients did not receive denosumab before resection and reconstruction. Quality of life by musculoskeletal tumor society score where 0-7 means poor, 8-14 means fair, 15-22 means good; above 22 means excellent, incidence of tumor recurrence, intraoperative duration in minutes and postoperative positive margins were assessed for each cohort after 12 months follow-up.
There was no significant difference in musculoskeletal tumor society score (25.75 vs. 27.41; P = 0.178), incidence of recurrence (3.45% vs. 4.88%; P < 0.001), and postoperative positive margins (10.34% vs. 4.88%; P = 0.38) for both groups. However, the intraoperative duration (133.38 vs. 194.49; P < 0.001) was significantly higher in the non-denosumab group compared with denosumab group.
Neoadjuvant denosumab is equally effective considering postoperative functional outcomes and surgical convenience except intraoperative duration where it is highly helpful in saving the operating time duration. Easier identification, resection and lesser reconstruction are the key surgical convenience offered by neoadjuvant denosumab.
地诺单抗于2013年获美国食品药品监督管理局批准，用于治疗手术无法切除的骨巨细胞瘤（GCT），以实现肿瘤边缘可切除。本研究旨在探讨在坎帕纳奇III级GCT切除和重建前使用新辅助地诺单抗后的功能结局和手术便利性。
我们回顾性分析了2014年1月至2019年12月期间接受切除和重建的70例坎帕纳奇III级GCT患者。他们被分为两组：一组29例患者在切除和重建前接受每周一次120mg地诺单抗治疗，共4周；另一组41例患者在切除和重建前未接受地诺单抗治疗。采用肌肉骨骼肿瘤学会评分评估生活质量，0 - 7分为差，8 - 14分为一般，15 - 22分为良好，22分以上为优秀；随访12个月后，评估每个队列的肿瘤复发率、术中时长（分钟）和术后切缘阳性率。
两组患者的肌肉骨骼肿瘤学会评分（25.75对27.41；P = 0.178）、复发率（3.45%对4.88%；P < 0.001）和术后切缘阳性率（10.34%对4.88%；P = 0.38）无显著差异。然而，未使用地诺单抗组的术中时长（133.38对194.49；P < 0.001）显著高于使用地诺单抗组。
考虑到术后功能结局和手术便利性，新辅助地诺单抗同样有效，除了术中时长，它在节省手术时间方面非常有帮助。新辅助地诺单抗提供的关键手术便利性包括更容易识别、切除和更少的重建。
