Francisco Xará-Leite1,2, Luís Coutinho3,4, Carolina Fleming5, Manuel Magalhães6, Vânia Oliveira3,7, Ricardo Rodrigues-Pinto8,9, Pedro Cardoso3,7. 1. Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. franciscoxdl@gmail.com. 2. Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal. franciscoxdl@gmail.com. 3. Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. 4. Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal. 5. Department of Pathology, Centro Hospitalar Universitário do Porto, Porto, Portugal. 6. Department of Oncology, Centro Hospitalar Universitário do Porto, Porto, Portugal. 7. Musculoskeletal Tumors Unit, Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal. 8. FEBOT Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. 9. Spinal Unit, Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Abstract
BACKGROUND: Bone giant cell tumors, although benign, may be locally aggressive and cause severe morbidity; in some cases, they can also disseminate at distance and cause death. Denosumab has been approved to treat unresectable bone giant cell tumors or when surgery is likely to result in severe morbidity. Furthermore, its curative potential has been recently suggested. CASE: An 18-year-old girl presented with a spinal giant cell tumor at T9. Neo-adjuvant denosumab was administered for 9 months with great clinical and analytical tolerance. A posterior left T9 costo-transversectomy and vertebral body curettage was performed and the spine stabilized. Interestingly, histopathology examination of the surgical specimens found no evidence of tumoral cells. Denosumab was reinstated until completion of 12 months of treatment. CONCLUSION: Denosumab has an important but still limited role in the treatment of spinal giant cell tumors. Here, it resulted in complete histological resolution of the tumor, potentially widening its applicability from a strictly neo-adjuvant to a curative role.
BACKGROUND:Bone giant cell tumors, although benign, may be locally aggressive and cause severe morbidity; in some cases, they can also disseminate at distance and cause death. Denosumab has been approved to treat unresectable bone giant cell tumors or when surgery is likely to result in severe morbidity. Furthermore, its curative potential has been recently suggested. CASE: An 18-year-old girl presented with a spinal giant cell tumor at T9. Neo-adjuvant denosumab was administered for 9 months with great clinical and analytical tolerance. A posterior left T9 costo-transversectomy and vertebral body curettage was performed and the spine stabilized. Interestingly, histopathology examination of the surgical specimens found no evidence of tumoral cells. Denosumab was reinstated until completion of 12 months of treatment. CONCLUSION:Denosumab has an important but still limited role in the treatment of spinal giant cell tumors. Here, it resulted in complete histological resolution of the tumor, potentially widening its applicability from a strictly neo-adjuvant to a curative role.
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