Zhang Shuai, Zhao JiaQi, Song Lei
Orthopedics Department, Southwest Hospital, The Army Military Medical University (The Third Military Medical University), Chongqing, People's Republic of China.
Cancer Manag Res. 2024 Dec 17;16:1823-1833. doi: 10.2147/CMAR.S480689. eCollection 2024.
To investigate the local recurrence rate, joint preservation status, and functional outcomes after extended curettage and postoperative denosumab treatment for Campanacci Grade III giant cell tumors of the extremities.
We retrospectively reviewed 23 patients with Campanacci Grade III GCTB of the extremities in our hospital between January 2017 and June 2023 who underwent extended curettage and postoperative denosumab administration alone, without preoperative denosumab treatment. Patients were followed-up for adverse events of denosumab, surgical outcomes, limb function of lesions, and local recurrence following extended curettage with postoperative denosumab.
All incisions healed without deep infections or internal fixation failure. The mean age of the patients at surgery was 36.6 years, and the mean follow-up was 35.8 months (range, 6-72 months). There of the 3 patients experienced a postoperative local recurrence. The recurrence rate was found to be 13.0%. Two patients were treated with repeat intralesional surgery with no additional recurrence two years later, and the other was treated with en bloc resection and reconstruction with a vascularized fibular graft. One patient experienced knee osteoarthritis without oral analgesics. No patient developed pulmonary metastases or malignant transformation of the GCTB. The mean Musculoskeletal Tumor Society functional score at the last follow up was 27.3 30 (range, 25-29). No serious adverse events were observed after the denosumab treatment.
Our observations suggest that extended curettage with postoperative denosumab administration is a reasonable option for treating Campanacci Grade III giant cell tumors of the extremities. Extended curettage with adjuvant denosumab therapy results in beneficial surgical downstaging, including a less morbid surgical procedure or delayed en bloc resection. Resection should be considered when the structural integrity cannot be regained after bone grafting or bone cement filling combined with internal fixation.
探讨扩大刮除术联合术后地诺单抗治疗Campanacci III级肢体骨巨细胞瘤后的局部复发率、关节保留情况及功能结局。
我们回顾性分析了2017年1月至2023年6月期间在我院接受单纯扩大刮除术及术后地诺单抗治疗、未进行术前地诺单抗治疗的23例Campanacci III级肢体骨巨细胞瘤患者。对患者进行随访，观察地诺单抗的不良事件、手术结果、病变肢体功能以及扩大刮除术联合术后地诺单抗治疗后的局部复发情况。
所有切口均愈合，无深部感染或内固定失败。患者手术时的平均年龄为36.6岁，平均随访时间为35.8个月（范围6 - 72个月）。3例患者术后出现局部复发。复发率为13.0%。2例患者接受了再次病灶内手术，两年后未再复发，另1例患者接受了整块切除并采用带血管腓骨移植重建。1例患者出现膝关节骨关节炎，无需口服镇痛药。无患者发生肺转移或骨巨细胞瘤恶变。末次随访时肌肉骨骼肿瘤学会功能评分的平均值为27.3（满分30分，范围25 - 29分）。地诺单抗治疗后未观察到严重不良事件。
我们的观察结果表明，扩大刮除术联合术后地诺单抗给药是治疗Campanacci III级肢体骨巨细胞瘤的合理选择。扩大刮除术联合辅助地诺单抗治疗可实现有益的手术降期，包括减少手术创伤或延迟整块切除。当骨移植或骨水泥填充联合内固定后无法恢复结构完整性时，应考虑进行切除。
