Cyberknife stereotactic radiosurgery and denosumab for giant cell tumour of the skull base: Case report

Abstract

Giant cell tumours (GCT) of the skull is a rare entity with only small number of cases reported in literature and optimal treatment is yet to be determined. These tumours have shown high recurrence rates after incomplete surgery, usually occurring during the first year. Even with new surgical techniques a complete resection in skull base tumours is not always possible without functional compromise. Therefore, adjuvant therapy is essential to enhance local control and quality of life. We report a rare case of a 34-year-old male with giant cell tumour (GCT) of the skull base involving the petrous bone, clivus and sphenoid body. The patient received Cyberknife stereotactic radiosurgery (CK SRS) and denosumab after surgery. This combined therapy allowed local control and tumour reduction with secondary neurological improvement during a 4-year follow up.

Stereotactic body radiotherapy for lung metastases in a patient with giant cell tumor of bone: a case report and literature review

“…T h e a p p l i c a t i o n o f S B RT i n G C T B r e m a i n s controversial, with evidence limited to a few case reports (17)(18)(19)(20)(21)(22). The authors of these reports concluded that SBRT offers a radiological regression benefit and improved symptoms.…”

Unresectable Clival Giant Cell Tumor, Tumor Control With Denosumab After Relapse: A Case Report and Systematic Review of the Literature

“…Radiotherapy was the most commonly treatment used (13/25, 52%) as an adjuvant therapy, except in our case where a systemic treatment with denosumab was started following surgery. In addition to radiation, 2 patients (Table 1: cases 12 and 19) were administered intravenous zoledronate (4 mg, once a month) and denosumab, respectively 3,4…”

“…In addition to radiation, 2 patients (Table 1: cases 12 and 19) were administered intravenous zoledronate (4 mg, once a month) and denosumab, respectively. 3,4 Overall, recurrence occurred in 9 cases after their first treatment, with an average time of 5.3 months (range: 2 wk to 24 mo). Most of them (6/9 cases, 67%) only underwent surgery with a partial resection on diagnosis.…”

“…After a mean follow-up period of 26.5 months from diagnosis (range: 3 to 129 mo), the majority of patients (15/25, 60%) were alive with a residual tumor. Five patients presented persisting mild symptoms or clinical signs at their last follow-up examination 4,10,17. One patient showed evidence of tumor regrowth and was prepared for a resurgery 10.…”

“…Because of their rarity and challenging location, there are no standard treatments for clival GCTs. A complete surgical resection is not always feasible with a high risk of local recurrence; therefore, the establishment of adjuvant treatments and strategies is essential to enhance local control and quality of life 4. Denosumab, a human monoclonal antibody to receptor activator of nuclear factor kappa B ligand (RANKL), known to be overexpressed in GCT, has gained a firm position in the systemic treatment of unresectable GCTs 5,6.…”