Utility of intraoperative magnetic resonance imaging for giant cell tumor of bone after denosumab treatment: a pilot study

Abstract

Background Giant cell tumor of bone (GCTB) is an intermediate but locally aggressive neoplasm. Current treatment of high-risk GCTB involves administration of denosumab, which inhibits bone destruction and promotes osteosclerosis. However, denosumab monotherapy is not a curative treatment for GCTB and surgical treatment remains required. Denosumab treatment complicates surgery, and the recurrence rate of GCTB is high (20%–30%). Purpose To examine the utility of intraoperative magnetic resonance imaging (iMRI) for detection and reduction of residual tumor after denosumab treatment and to investigate the utility of iMRI, which is not yet widely used. Material and Methods We enrolled five patients who received denosumab for a median period of eight months (range 6–12 months). Surgery was performed when the degree of osteosclerosis around the articular surface was deemed appropriate. We performed iMRI using a modified operation table to identify residual tumor after initial curettage and evaluated the rate of detection of residual tumor by iMRI, intraoperative and postoperative complications, exposure time of iMRI, and operation time. Results Suspected residual tumor tissue was identified in all five cases and was confirmed by histopathology after additional curettage. The rate of detection of residual tumor by iMRI was 100%. Residual tumor was located in sites which were difficult to remove due to osteosclerosis. The iMRI was performed safely and without trouble. During the median follow-up period of 10 months (range 6–24 months), no adverse events or recurrences occurred. Conclusion Intraoperative MRI could contribute to the reduction of residual tumor tissue and it may prevent recurrence of GCTB after denosumab therapy.

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

“…In difficult-to-treat GCTBs conservative approaches have been conceptualized on the basis of breaking the vicious cycle established at the TME level in GCTB [5] , [12] . BPs like ZA are, besides their osteoclast inhibitory effects, believed to impair tumour growth by targeting both cellular components, MNGCs, and mutated H3F3A G34W + cells [18] , [19] , [20] , [21] , [22] , [23] , while RANKL inhibitors suppress only the osteoclastogenesis with limited direct effects on tumour cells [3] , [22] , [24] .…”

Information-guided Surgery Centered on Intraoperative Magnetic Resonance Imaging Guarantees Surgical Safety with Low Mortality

“…More recently, iMRI has been utilized by other departments in their surgeries, such as bone tumors in orthopedics and liver cancer in gastrointestinal surgery. 36 ) It is also expected that iMRI will be more widely used in other fields.…”

State of the Art and New Concepts in Giant Cell Tumor of Bone: Imaging Features and Tumor Characteristics

“…In this regard, Furuta et al [ 105 ] recently investigated the utility of intraoperative MRI for detection of residual tumors during surgical curettage in five patients with GCTB who received denosumab. The study demonstrated that iMRI was able to identify in all five cases suspected residual tumor tissue, confirmed by histopathology after additional curettage (detection rate was 100%), suggesting iMRI may represent a useful tool to promptly identify residual tumors and consequently prevent local recurrence.…”