Deventer Niklas, Budny Tymoteusz, Gosheger Georg, Rachbauer Anna, Puetzler Jan, Theil Jan Christoph, Kovtun Dmytrii, de Vaal Marieke, Deventer Nils
Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
Department of General Paediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
J Bone Oncol. 2022 Feb 17;33:100417. doi: 10.1016/j.jbo.2022.100417. eCollection 2022 Apr.
Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor that represents about 4-5% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and may include intralesional curettage with adjuvants or, in rare cases, wide resection. In recent years the monoclonal antibody denosumab has been introduced as a potential (neo-)adjuvant systemic treatment option for patients with borderline resectable or unresectable lesions. Currently several studies reported that the use of denosumab prior to curettage possibly increase the risk of local recurrence.
In this retrospective study we reviewed 115 cases of GCT with a mean follow-up of 65.6 (24-404) months who underwent a surgical treatment with or without preoperative denosumab therapy in our institution. Potential risk factors for LR and complications were analyzed.
The study includes 47 male (40.9%) and 68 female (59.1%) patients with a mean age of 33.9 (10-77) years and a mean follow-up of 65.6 (24-404) months. Denosumab was used in 33 (28.7%) cases, in 14 cases (12.2%) in a neoadjuvant setting and in 17 cases preoperatively before re-curettage (14.8%) after LR. In 105 cases (91.3%) an intralesional curettage was performed. The overall LR rate was 47.8% (55 cases). Patients who underwent intralesional curettage and bone cement augmentation without neoadjuvant denosumab treatment had LR in 42.2% (38/90) of the cases. Patients who underwent neoadjuvant denosumab treatment prior to curettage had LR in 28.6% (4/14). Re-recurrence was frequent in patients with neoadjuvant denosumab treatment who had LR after initial curettage (50%, 8/16). After wide resection and endoprosthetic replacement one case (20%) of local recurrence was detectable (1/5 cases).
GCTB recurs frequently after intralesional curettage and cement augmentation. While denosumab is a potential (neo-)adjuvant treatment option that might be used for lesions that are difficult to resect, surgeons should be aware that LR is still frequent.
骨巨细胞瘤（GCTB）是一种局部侵袭性骨肿瘤，约占所有原发性骨肿瘤的4%-5%。其特点是生长迅速，手术治疗后可能复发，少数情况下会发生转移。手术治疗是主要治疗方法，可能包括病灶内刮除并辅以辅助治疗，或在罕见情况下进行广泛切除。近年来，单克隆抗体地诺单抗已被引入，作为边界可切除或不可切除病变患者的一种潜在（新）辅助全身治疗选择。目前有几项研究报告称，在刮除术前使用地诺单抗可能会增加局部复发的风险。
在这项回顾性研究中，我们回顾了115例骨巨细胞瘤患者，平均随访65.6（24-404）个月，这些患者在我们机构接受了有或无术前地诺单抗治疗的手术。分析了局部复发和并发症的潜在风险因素。
该研究包括47名男性（40.9%）和68名女性（59.1%）患者，平均年龄33.9（10-77）岁，平均随访65.6（24-404）个月。33例（28.7%）使用了地诺单抗，14例（12.2%）用于新辅助治疗，17例在局部复发后再次刮除术前（14.8%）术前使用。105例（91.3%）进行了病灶内刮除。总体局部复发率为47.8%（55例）。未接受新辅助地诺单抗治疗而进行病灶内刮除和骨水泥强化的患者，局部复发率为42.2%（38/90）。刮除术前接受新辅助地诺单抗治疗的患者，局部复发率为28.6%（4/14）。初始刮除后局部复发的新辅助地诺单抗治疗患者再次复发频繁（50%，8/16）。广泛切除并进行假体置换后，1例（20%）出现局部复发（1/5例）。
病灶内刮除和骨水泥强化后骨巨细胞瘤经常复发。虽然地诺单抗是一种潜在的（新）辅助治疗选择，可用于难以切除的病变，但外科医生应意识到局部复发仍然很常见。
