Spondylectomy for Giant Cell Tumor After Denosumab Therapy

Cavalcante, Rodrigo; Marques, Rômulo Alberto Silva; Santos, Vinícius Gonçalves dos; Sabino, Eduardo; Junior, A. C. Fraga; Zaccariotti, Vladimir Arruda; Arruda, João; Fernandes, Yvens Barbosa

doi:10.1097/brs.0000000000001191

Cited by 25 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Imatinib (Novartis, East Hanover, NJ, USA) is the choice of drug for the treatment of lung metastasis; however, chemotherapy with Adriamycin and Cisplatin may be preferred (36) . Lately, Denosumab, a monoclonal antibody to RANKL, has been approved by the Food and Drug Administration in adjuvant therapy for primary tumor site (8,(37)(38)(39)(40)(41) , and it has also been used in the adjuvant treatment of lung metastasis (42) . There was no patient treated with Denosumab in this study population.…”

Section: Discussionmentioning

confidence: 99%

Giant Cell Tumor of the Sacrum and Current Treatment Strategies

Öner¹,

Akman²

2020

jtss

View full text Add to dashboard Cite

Objective: Giant cell tumor (GCT) is a benign local aggressive tumor seen mostly in the third and fourth decades. Sacrum is the most commonly affected spinal region, followed by thoracic, cervical and lumbar regions. Aim of this study is to evaluate the results of surgical treatment in sacral GCT and review the treatment options of GCT in this uncommon location. Materials and Methods: Between 2002 and 2018, online hospital database search was conducted for a diagnosis of sacrum and GCT. Patient records were evaluated for recurrence and called for last follow-up. Results: There were four patients (one male, three female) operated due to sacral GCT, included in the study. Mean follow-up was 49 (25 to 82) months. High speed burr, electrocauterization and phenol were used as adjuvant treatment in all cases. Cementing was used in two patients. Conclusion: En bloc resection is the most effective treatment method with the lowest recurrence rate, yet it has the highest morbidity. In addition to intralesional curettage, high speed burr, electrocauterization, phenol and cement as adjuvant therapies can be used in the treatment of GCTs to decrease local recurrence in sacral cases while protecting neural tissues.

show abstract

Section: Discussionmentioning

confidence: 99%

Giant Cell Tumor of the Sacrum and Current Treatment Strategies

Öner¹,

Akman²

2020

jtss

View full text Add to dashboard Cite

show abstract

“…Nevertheless, denosumab can “harden up the edges” of the SGCT, which represent the tumor calcification' it can also cause tumor shrinkage34, 35. The calcification and shrinkage of the tumor could facilitate the subsequent surgery and reduce the surgical risk34, 36.…”

Section: Discussionmentioning

confidence: 99%

“…The calcification and shrinkage of the tumor could facilitate the subsequent surgery and reduce the surgical risk34, 36. Thus, this could be used as a therapeutic modality for spinal GCT that cannot not be resected at initial presentation.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

Lin

Teng

et al. 2018

Orthopaedic Surgery

View full text Add to dashboard Cite

ObjectiveTo review the clinical details and further treatments for recurrent spinal giant cell tumors (SGCT), and to analyze the risk factors of recurrence and shed new light on the treatment options and prognosis of recurrent SGCT.MethodsA retrospective analysis of recurrent SGCT between April 2003 and January 2014 was performed. A total of 10 patients comprising 3 men and 7 women with a mean age of 28.9 years (range, 21–40 years) were included in the study. All complete clinical data, radiographs, CT, MRI, scans and pathological data were reviewed. The tumor locations and the regions involved were evaluated by CT and MRI. The blood supply of the tumors was evaluated by enhanced CT and MRI. The mean follow‐up was 81.3 months (range, 35.7–172.1 months).ResultsAll patients had Enneking stage 3 tumors; 9 (90%) of them had different extents of spinal canal involvement in the primary time period. All patients underwent intralesional resection during their first surgery. Only 1 patient received local adjuvant treatments; no patient underwent selective arterial embolization or used denosumab at that time. Only 1 patient underwent adjuvant radiotherapy postoperatively, and another patient used bisphosphonates. After recurrence, 1 patient was cured using denosumab, and 2 patients' disease was controlled through use of other medical treatments or adjuvant treatments. There were 3 repeated recurrences and 7 repeated surgical procedures were performed in 5 patients. There were 6 intralesional excisions and 1 decompression surgery. The mean relapse‐free time after the first surgery was 32.3 months (range, 10.5–62.6 months). The overall mean relapse‐free time was 40.2 months (range, 10.5–157 months). No distant metastasis was found in our series. At the final follow‐up, 4 patients were disease free, 3 patients' disease was under control, 2 has progressive disease aggravation, while 1 patient died as a result of progression of disease 133.9 months after first surgery.ConclusionIntralesional excision for recurrent spinal giant cell tumors is an effective option that may have satisfactory prognosis. However, the excision and the inactivation of the lesion should be carried out carefully and thoroughly without missing any corners. Early diagnosis of recurrence may be associated with better prognosis. Adjuvant treatments perioperatively and systemic medical treatments can decrease recurrence rates and can have therapeutic effects in the recurrent SGCT.

show abstract

“…Interestingly, denosumab is currently used as treatment for giant cell tumors as well as osteoporosis. 20,72 Long-term follow-up of patients who underwent postoperative PBT with or without denosumab might be warranted to clarify a supplemental benefit of this newly developed molecular-targeted therapy. Additionally, the potential influence of preoperative embolization on time to fusion was observed in this study.…”

Section: Discussionmentioning

confidence: 99%

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

View full text Add to dashboard Cite

OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

show abstract

Spondylectomy for Giant Cell Tumor After Denosumab Therapy

Cited by 25 publications

References 22 publications

Giant Cell Tumor of the Sacrum and Current Treatment Strategies

Giant Cell Tumor of the Sacrum and Current Treatment Strategies

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Contact Info

Product

Resources

About