The Megavoltage Radiation Therapy in Treatment of Patients With Advanced or Difficult Giant Cell Tumors of Bone

Ruka, W.; Rutkowski, Piotr; Morysiński, Tadeusz; Nowecki, Zbigniew; Zdzienicki, Marcin; Makuła, Donata; Ptaszyński, Konrad; Bylina, Elżbieta; Grzesiakowska, Urszula

doi:10.1016/j.ijrobp.2009.07.1704

Cited by 67 publications

(58 citation statements)

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“…Some suggest to administer active chemotherapy or radiotherapy in cases where surgical treatment cannot be administered and there is an extensive soft tissue invasion, especially in Grade III patients; however, malignant transformation may occur (33,34). In such cases, more radical surgical treatments may be preferred, if applicable.…”

Section: Discussionmentioning

confidence: 99%

Advantages of Pressurized-Spray Cryosurgery in Giant Cell Tumors of the Bone

2016

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Background: Giant Cell Tumor is considered a benign, local and aggressive tumor. Although considered a benign bone tumor, it is still the subject of discussion and research because of the associated local bone destruction, as well as high rates of recurrence and distant metastases. Options are being developed for both surgical techniques and adjuvant therapies. Aims: The present study evaluated the administration of cryotherapy via a pressurized-spray technique in giant cell tumors of the bone. Study Design: Cross-sectional study. Methods:The study included 40 patients who were treated with extensive curettage and cryotherapy at various locations during the period from February 2006 to December 2013. Informed consent forms were obtained from the participants and ethics committee approval was taken from the local ethics committee of Ondokuz Mayıs University. The pressurized-spray technique was performed using liquid nitrogen. The patients were evaluated with respect to age, gender, radiological appearance, treatment modality, duration of follow-up, skin problems and recurrence. Results: Twenty-one patients were female; 19 were male. The average age of the patients was 33 years (range: 16-72 years), and the average duration of follow-up was 43 months (range: 12-80 months). The average time from the onset of the complaints to the diagnosis was 6 months (range: 2-12 months). Based on the Campanacci classification: 9 patients were Grade I; 25 patients were Grade II; six patients were Grade III. The lesion was located in the femur in 14 patients, in the tibia in 11 patients, in the radius in 5 patients, in the pelvis in 4 patients, in the fibula in 3 patients, in the metatarsal in 2 patients and in the phalanges of the hand in one patient. One patient had postoperative early fracture. None of the patients had skin problems and infection. Three (7.5%) of the patients had recurrence. Conclusion: It was found that cryotherapy was highly effective in the lesions, especially those located in the femur and tibia and remained insufficient in the lesions expanded outside the cortex. Wound healing problems, infection and fracture risk are lower with this technique.

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Section: Discussionmentioning

confidence: 99%

Advantages of Pressurized-Spray Cryosurgery in Giant Cell Tumors of the Bone

2016

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“…Radiation therapy can be considered. Recently, seemingly improved local control in 65 of 77 patients (84%) was reported 14 . However, the main limitation of irradiation is the potentially high risk of sarcomatous transformation (5%-29%), especially for doses above 45 Gy 15 .…”

Section: Introductionmentioning

confidence: 99%

Denosumab and Giant Cell Tumour of Bone—A Review and Future Management Considerations

Xu¹,

Adams

Yu³

et al. 2013

Current Oncology

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specimen revealed a tumour mass with histologic features of pronounced osteogenesis and no more evidence of gctb. This case demonstrated a major tumour response to denosumab in the neoadjuvant setting, with a complete pathologic response.Is denosumab a breakthrough in the treatment of gctb? We reviewed the literature focusing on denosumab and gctb, and here we discuss the biggest questions related to the future management of gctb. GIANT CELL TUMOUR OF BONEAs one type of giant-cell-rich lesion of bone, gctb is characterized by the presence of numerous multinucleated osteoclast-type giant cells, and in this mesenchymal tumour, the mononuclear stromal cells are the neoplastic cell type 2 . The giant cells have been confirmed to express rankl and are responsible for the aggressive osteolytic nature of the tumour 3 . Although generally benign, atypical gctb may be associated with multiple local recurrences, multicentricity, pulmonary metastases, or lesions that cannot be removed surgically without causing substantial morbidity 4 . The World Health Organization therefore classifies gctb as "an aggressive, potentially malignant lesion" 5 .In the United States, gctb accounts for approximately 5% of all primary bone tumours and 20% of all benign bone tumours in adults 6 . About 50−60 new cases of gctb are managed by specialist health care services each year in the United Kingdom 7 . The disease is more common in China and India, where it constitutes approximately 20% of all primary bone tumours 5 . Giant cell tumour of bone occurs most commonly during the second to fourth decades of life (60%-75%) and has a maleto-female ratio in the range 1:1.2 to 1:1.5 2,5 . Most lesions develop in the long bones (75%-90%), with most cases (50%-65%) occurring near the knee 1,2,8 . Other frequent sites are the distal radius, proximal humerus, fibula, sacrum, and vertebral body (fewer than 3% of cases) 2,8 . In no reported case has gctb ABSTRACT Giant cell tumour of bone (gctb) is one type of giantcell-rich bone lesion characterized by the presence of numerous multinucleated osteoclast-type giant cells. Giant cells are known to express rankl (receptor activator of nuclear factor κB ligand) and are responsible for the aggressive osteolytic nature of the tumour. No available treatment option is definitively effective in curing this disease, especially in surgically unsalvageable cases. In recent years, several studies of denosumab in patients with advanced or unresectable gctb have shown objective changes in tumour composition, reduced bony destruction, and clinical benefit.Denosumab is a fully human monoclonal antibody that targets and binds with high affinity and specificity to rankl. Several large phase iii studies have shown that denosumab is more effective than bisphosphonates in reducing skeletal morbidity arising from a wide range of tumours and that it can delay bone metastasis. The relevant articles are reviewed here. The controversies related to the future use of denosumab in the treatment of gctb are discussed. KEY WORDSDenosuma...

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“…A recent large series of 122 patients treated with radiation to a median dose of 56 Gy at conventional fractionation showed an LC rate of 84% at 5 years. 12 The authors concluded that 50 Gy represented an adequate dose for GCTB with a minimum dose of 40 Gy. Pretreatment tumor size and the involvement of surrounding soft tissue have also been found to be prognostic for LC in patients treated with radiation.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] For patients with GCTB who cannot undergo surgery due to medical comorbidity, tumor extent, or predicted unacceptable functional outcome, radiation therapy is a therapeutic option. 3,5,12,13 There is no clear radiation dose-response relationship for GCTB. Our findings herein are consistent with our earlier publication in observing a LC rate of B80% with a radiation dose between 35 and 55 Gy.…”

Section: Discussionmentioning

confidence: 99%