Naofumi Asano1, Masato Saito2,3, Eisuke Kobayashi3, Takeshi Morii4, Kazutaka Kikuta5, Itsuo Watanabe6, Ukei Anazawa6, Katsuhito Takeuchi7, Yoshihisa Suzuki8, Michiro Susa9, Kazumasa Nishimoto10, Ryota Ishii11, Naoki Miyazaki11, Hideo Mrioka12, Akira Kawai3, Keisuke Horiuchi9, Robert Nakayama2. 1. Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. nasano@keio.jp. 2. Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. 3. Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan. 4. Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, Japan. 5. Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan. 6. Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan. 7. Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama City, Kanagawa, Japan. 8. Department of Orthopaedic Surgery, Tachikawa Hospital, Tachikawa-shi, Tokyo, Japan. 9. Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan. 10. Department of Orthopaedic Surgery, Kawasaki Municipal Ida Hospital, Kawasaki City, Kanagawa, Japan. 11. Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan. 12. Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan.
Abstract
INTRODUCTION: Denosumab has been shown to be highly effective at suppressing the progression of giant cell tumor of bone (GCTB). However, recent studies have observed a potential increased risk of local recurrence after surgery following the use of denosumab, raising concerns on the use of this agent against GCTB in combination with surgery. METHODS: We retrospectively reviewed the medical records of 234 patients with GCTB who were surgically treated at multiple institutions from 1990 to 2017. Patient background, tumor characteristics, treatment methods, local recurrence-free survival rate, distant metastasis rate, oncologic outcome, and limb function at final follow-up were analyzed and compared between cases treated with and without denosumab. RESULTS: The 3-year local recurrence-free survival rate was significantly lower in patients who underwent preoperative denosumab therapy (35.3%) compared with those treated without denosumab (79.9%) (P < 0.001). Among patients who were preoperatively treated with denosumab, those who had a local recurrence all underwent curettage surgery. CONCLUSIONS: Preoperative denosumab therapy in combination with curettage surgery was significantly associated with an increased risk of local recurrence in Campanacci grade 3 tumors. Our data suggest that clinicians seeing GCTB patients should be aware to this increased risk when planning preoperative denosumab therapy.
INTRODUCTION: Denosumab has been shown to be highly effective at suppressing the progression of giant cell tumor of bone (GCTB). However, recent studies have observed a potential increased risk of local recurrence after surgery following the use of denosumab, raising concerns on the use of this agent against GCTB in combination with surgery. METHODS: We retrospectively reviewed the medical records of 234 patients with GCTB who were surgically treated at multiple institutions from 1990 to 2017. Patient background, tumor characteristics, treatment methods, local recurrence-free survival rate, distant metastasis rate, oncologic outcome, and limb function at final follow-up were analyzed and compared between cases treated with and without denosumab. RESULTS: The 3-year local recurrence-free survival rate was significantly lower in patients who underwent preoperative denosumab therapy (35.3%) compared with those treated without denosumab (79.9%) (P < 0.001). Among patients who were preoperatively treated with denosumab, those who had a local recurrence all underwent curettage surgery. CONCLUSIONS: Preoperative denosumab therapy in combination with curettage surgery was significantly associated with an increased risk of local recurrence in Campanacci grade 3 tumors. Our data suggest that clinicians seeing GCTB patients should be aware to this increased risk when planning preoperative denosumab therapy.
Authors: Michael D Eckhoff; Matthew E Wells; Osvaldo Padilla; Elizabeth M Polfer; Christopher J Castagno; Ahmed M Thabet; Shaimaa Elzamly; Harry L Wilson; Rajiv Rajani Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2022-10-13