Total neurological recovery after surgical decompression and treatment with denosumab of large unresectable spinal giant cell tumour expanding to mediastinum

Abstract

There is a controversy over the medical treatment of unresectable spinal giant cell tumour (GCT) regarding dosing and duration. We studied a spinal GCT case that had expanded to the thoracic spinal canal and mediastinum and was successfully treated by surgical decompression and denosumab. A woman in her 30s presented with weakness in both the lower extremities. MRI revealed a large tumour in the posterior mediastinum expanding from the thoracic vertebrae (T3–6), which compressed the spinal cord. The patient underwent urgent spinal decompression with instrumentation and her tissue was sent for a pathology study. Histologically and immunohistochemistry confirmed the diagnosis of GCT. Since it was an unresectable tumour, this patient was treated with denosumab. Her neurological problem resolved after 6 months of treatment. After 4 years of follow-up, the patient displayed no further progression and no side effects from long-term denosumab usage.

Denosumab induction and Zoledronic acid maintenance therapy for recurrent unresectable giant cell tumour of the distal tibia: A case report with sustained tumour control after drug withdrawal

“…Some concerns are the possible side effects associated with the prolonged treatment such as arthralgia (grade 1–2: 50 %), chronic muscle pain (33 %), peripheral neuropathy (11 %), fatigue (17 %), skin rash (9 %), electrolyte disturbances (4 %), osteonecrosis of the jaw (ONJ), (5–9 %), atypical bone fractures (4 %) and malignant transformation (1 %) [39] , [48] , [47] . Various approaches have been proposed to reduce the cumulative dose-related toxicity and high treatment costs [43] of long-term DM use, including treatment discontinuation [48] , “drug holidays” [55] and increased dose intervals [50] , [56] , [57] , [58] , [59] .…”