Department of Musculoskeletal Tumor Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
Department of Orthopedics, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, 518035, China.
J Orthop Surg Res. 2024 Aug 17;19(1):488. doi: 10.1186/s13018-024-04981-9.
Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm with a high propensity for recurrence following intralesional curettage. The introduction of denosumab, a RANKL inhibitor, has shown potential in facilitating joint-sparing surgery. However, concerns exist regarding its impact on local recurrence rates. This study aimed to evaluate the efficacy and safety of combined preoperative denosumab with adjuvant microwave ablation (MWA) for the treatment of high-risk GCTB.
We conducted a retrospective review of 19 patients with high-risk GCTB who underwent preoperative denosumab treatment followed by curettage and adjuvant MWA. The primary outcome measure was the local recurrence rate, with secondary outcomes including functional status assessed by the Musculoskeletal Tumor Society (MSTS) score and safety profile of the treatment.
In this retrospective analysis, we evaluated the outcomes of 19 patients with high-risk GCTB treated with preoperative denosumab and adjuvant MWA. The median follow-up duration was 33.1 months, 3 patients (15.8%) experienced local recurrence at a median of 21.6 months postoperatively and the local recurrence-free survival was 81.2% at two years. Notably, no patient developed lung metastasis, and all recurrences were successfully managed with repeat curettage and MWA, with a mean MSTS score of 27.3. No patient required joint replacement due to tumor recurrence, resulting in a 100% joint preservation rate.
The combination of preoperative denosumab and adjuvant MWA is a feasible and effective strategy for the management of high-risk GCTB, providing effective local control with preserved joint function. This approach may offer a surgical alternative for young patients where joint preservation is paramount.
骨巨细胞瘤（GCTB）是一种局部侵袭性肿瘤，经腔内刮除术后复发率较高。RANKL 抑制剂地舒单抗的引入显示出在促进保关节手术方面的潜力。然而，人们对地舒单抗对局部复发率的影响存在担忧。本研究旨在评估术前联合地舒单抗与辅助微波消融（MWA）治疗高危 GCTB 的疗效和安全性。
我们对 19 例接受术前地舒单抗治疗后行刮除术及辅助 MWA 的高危 GCTB 患者进行回顾性研究。主要观察指标为局部复发率，次要观察指标包括功能状态（采用肌肉骨骼肿瘤学会（MSTS）评分评估）和治疗安全性。
在这项回顾性分析中，我们评估了 19 例接受术前地舒单抗和辅助 MWA 治疗的高危 GCTB 患者的结局。中位随访时间为 33.1 个月，3 例（15.8%）患者术后 21.6 个月时发生局部复发，2 年时局部无复发生存率为 81.2%。值得注意的是，无患者发生肺转移，所有复发均通过再次刮除和 MWA 成功治疗，MSTS 评分平均为 27.3。由于肿瘤复发，无患者需要关节置换，关节保留率为 100%。
术前地舒单抗联合辅助 MWA 是治疗高危 GCTB 的一种可行且有效的策略，可保留关节功能，实现有效的局部控制。对于需要保留关节的年轻患者，这种方法可能是一种替代手术的选择。
