Barreto Bruno G, Santili Claudio, Guedes Alex, Moreira Fernando D, Paz Claudio Luiz Dsl
Department of Orthopedics and Traumatology, Hospital Aristides Maltez, Salvador 40285-001, Bahia, Brazil.
Department of Orthopedics and Traumatology, Hospital Santa Izabel, Salvador 40050-410, Bahia, Brazil.
World J Orthop. 2025 Mar 18;16(3):102520. doi: 10.5312/wjo.v16.i3.102520.
Giant cell tumor of bone (GCTB) is a rare, locally aggressive neoplasm that should be treated surgically, whenever possible. This treatment approach may be linked with greater morbidity besides functional impairment. Denosumab is a human monoclonal antibody. Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB, as it allows local control with a view to downstaging for a more conservative surgical procedure. However, there is no consensus in the literature regarding the optimal denosumab regimen for GCTB. Therefore, a wide discussion of denosumab regimen is necessary.
To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB.
A broad and systematic literature search was carried out using the PRISMA guidelines. We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab. Articles with fewer than five patients and in languages except Spanish, Portuguese and English were excluded. Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data.
1005 articles were screened, of which 26 articles met the inclusion criteria and were selected, totaling 1742 patients, 51.8% women and 48.2% men, with an average of 35 years of age. Treatment with denosumab was associated with high rates of clinical benefit (CB) and imaging response (IR), without changing local recurrence rates when compared to patients treated without denosumab, regardless of the therapeutic regimen adopted and the number of doses applied. The adverse events (AE) presented were mostly mild, with the exception of a malignant transformation to osteosarcoma.
Treatment of GCTB with denosumab is effective, showing high rates of CB and IR. The AE that occurred were mostly mild. We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.
骨巨细胞瘤（GCTB）是一种罕见的、具有局部侵袭性的肿瘤，只要有可能，就应进行手术治疗。这种治疗方法除了功能受损外，还可能导致更高的发病率。地诺单抗是一种人源单克隆抗体。其给药可抑制骨吸收，并已成为治疗GCTB的治疗手段之一，因为它可以实现局部控制，以便为更保守的手术程序进行降期。然而，关于GCTB的最佳地诺单抗治疗方案，文献中尚无共识。因此，有必要对地诺单抗治疗方案进行广泛讨论。
评估采用地诺单抗的各种治疗方案对GCTB患者的有效性。
按照PRISMA指南进行广泛而系统的文献检索。我们分析了报道使用地诺单抗治疗的骨骼成熟的GCTB患者的研究，无论其性别或种族如何。排除患者少于5例以及非西班牙语、葡萄牙语和英语的文章。由于数据的二分性质，进行了比例荟萃分析的统计分析。
共筛选了1005篇文章，其中26篇文章符合纳入标准并被选中，共有1742例患者，女性占51.8%，男性占48.2%，平均年龄35岁。与未使用地诺单抗治疗的患者相比，无论采用何种治疗方案和应用剂量的数量，地诺单抗治疗均具有较高的临床获益（CB）率和影像学反应（IR）率，且局部复发率未发生变化。出现的不良事件（AE）大多为轻度，除了恶变为骨肉瘤。
用地诺单抗治疗GCTB是有效的，显示出较高的CB和IR率。发生的AE大多为轻度。无论采用何种治疗方案，在考虑研究结果的文章之间我们未发现差异。
