Retrospective cohort study of 68 sacral giant cell tumours treated with nerve-sparing surgery and evaluation on therapeutic benefits of denosumab therapy

Abstract

Aims To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs). Methods This is a retrospective cohort study of patients with GCT who presented between January 2011 and July 2017. Intralesional curettage was performed and patients treated from 2015 to 2017 also received denosumab therapy. The patients were divided into three groups: Cohort 1: control group (n = 36); cohort 2: adjuvant denosumab group (n = 9); and cohort 3: neo- and adjuvant-denosumab group (n = 17). Results There were 68 patients within the study period. Six patients were lost to follow-up. The mean follow-up was 47.7 months (SD 23.2). Preoperative denosumab was found to reduce intraoperative haemorrhage and was associated with shorter operating time for tumour volume > 200 cm3. A total of 17 patients (27.4%) developed local recurrence. The locoregional control rate was 77.8% (7/9) and 87.5% (14/16) respectively for cohorts 2 and 3, in comparison to 66.7% (24/36) of the control group. The recurrence-free survival (RFS) rate was significantly higher for adjuvant denosumab group versus those without adjuvant denosumab during the first two years: 100% vs 83.8% at one year and 95.0% vs 70.3% at two years. No significant difference was found for the three-year RFS rate. Conclusion Preoperative denosumab therapy was found to reduce intraoperative haemorrhage and was associated with shorter operating times. Adjuvant denosumab was useful to prevent early recurrence during the first two years after surgery. Cite this article: Bone Joint J 2020;102-B(2):177–185.

Preoperative Denosumab may increase the Risk of Local Recurrence of Giant-cell Tumor of Bone Treated with Curettage: A Systematic Review and Meta-analysis

“…Postoperative denosumab (120 mg) is subcutaneously injected monthly in 2 years after the surgery. However, in clinical practice, the duration of preoperative or postoperative denosumab varied a lot because of high expenses and patient's response to the drug [28]. Therefore, multicenter randomized controlled trials should be conducted to further determine the effect of preoperative denosumab on the local recurrence of GCTB treated with curettage and explore the best duration of preoperative denosumab in the future.…”

Managing Sacral Giant Cell Tumor with Surgery and Various Adjuvant Therapies

“…This rate was lower than most rates previously reported by using other adjuvant therapies [31][32][33]. Recently, Lim et al [34] evaluated therapeutic bene ts of denosumab on nerve-sparing surgery in SGCT. They reported the similar local recurrence rate (3/17, 17.6%) in neo-and adjuvant denosumab group.…”

The Role of Denosumab for Surgical Outcomes in Patients with Giant Cell Tumour of Bone: A Systematic Review

“…The initial primary literature search, after removal of duplicates, resulted in 446 citations, from which 137 were identified to be eligible for full-text review. Among these, seven met our pre-planned study criteria [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ] and their reference lists were manually search but no further eligible papers were found. A screen of conference abstracts yielded one abstract that met the study selection criteria [ 24 ].…”

“…A screen of conference abstracts yielded one abstract that met the study selection criteria [ 24 ]. Of these eight publications passing the initial screen, five underwent data extraction and were analyzed in this systematic review [ 17 , 18 , 19 , 20 , 21 ]. Three publications [ 22 , 23 , 24 ] did not undergo data extraction as they were detailed in the included systematic review [ 16 ].…”

“…Of the five articles, one was a retrospective, case-matched control study [ 17 ] and four were retrospective cohort studies [ 18 , 19 , 20 , 21 ]. All studies had very small number of patients who received DENO (seven to 30 patients).…”