Beresford-Cleary Nicolas, Dandurand Charlotte, Mawhinney Gerard, Kaiser Radek, Alageel Musab, Reynolds Jeremy
Department of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Vancouver Spine Surgery Institute, Vancouver General Hospital, Vancouver, BC, Canada.
Global Spine J. 2025 Jan 9:21925682251314378. doi: 10.1177/21925682251314378.
Retrospective Cohort Study.
The current recommended treatment for Giant Cell Tumour (GCT) of the spine is en bloc excision. Denosumab is a monoclonal antibody reducing osteoclast activity that shows promising results when used as a neo - adjuvant treatment. However, the current literature remains limited. The purpose of this study was to assess the effect of denosumab on tumour characteristics and symptom relief in the acute phase of treatment of spinal GCT.
We performed a retrospective review of 16 patients treated with denosumab as neo-adjuvant and stand - alone treatment. MRI and PET tumour characteristics were taken before and after treatment and patients were interviewed for subjective pain responses.
Following treatment, all patients showed improvement of pain, of which 68.7% of patients were pain free with 43.75% noting improvement within 48 hours. Mean relative volumetric reduction in tumour volume was 37.3% ( < .001). Eight patients showed high grade of Bilsky classification (Epidural spinal cord compression scale - ESCC) with seven of them showing significant improvement to low grade of ESCC ( = .016). Median baseline PET Standardised Uptake Value (SUV)max was 14.57 and post treatment was 4.8 ( < .001).
This study provides necessary insight to the limited literature on the use of denosumab for spinal GCT in the acute phase. The clinical and radiographic responses observed demonstrate the critical role that neo-adjuvant denosumab has by reducing the tumour burden around critical adjacent neurovascular structures before eventual resection, significant pain improvement even with presence of fractured vertebra.
回顾性队列研究。
目前对于脊柱巨细胞瘤（GCT）的推荐治疗方法是整块切除。地诺单抗是一种可降低破骨细胞活性的单克隆抗体，作为新辅助治疗时显示出有前景的结果。然而，目前的文献仍然有限。本研究的目的是评估地诺单抗在脊柱GCT治疗急性期对肿瘤特征和症状缓解的影响。
我们对16例接受地诺单抗新辅助治疗和单独治疗的患者进行了回顾性分析。在治疗前后获取MRI和PET肿瘤特征，并对患者进行主观疼痛反应访谈。
治疗后，所有患者的疼痛均有改善，其中68.7%的患者疼痛消失，43.75%的患者在48小时内疼痛有所改善。肿瘤体积的平均相对缩小率为37.3%（P <.001）。8例患者表现为高级别的比尔斯基分类（硬膜外脊髓压迫量表 - ESCC），其中7例显示ESCC级别显著改善为低级别（P =.016）。PET标准化摄取值（SUV）最大值的基线中位数为14.57，治疗后为4.8（P <.001）。
本研究为急性期使用地诺单抗治疗脊柱GCT的有限文献提供了必要的见解。观察到的临床和影像学反应表明，新辅助地诺单抗在最终切除前减轻关键相邻神经血管结构周围的肿瘤负担方面发挥了关键作用，即使存在椎体骨折，疼痛也有显著改善。
