Background

Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor that represents about 4–5% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and may include intralesional curettage with adjuvants or, in rare cases, wide resection. In recent years the monoclonal antibody denosumab has been introduced as a potential (neo-)adjuvant systemic treatment option for patients with borderline resectable or unresectable lesions. Currently several studies reported that the use of denosumab prior to curettage possibly increase the risk of local recurrence.

Methods

In this retrospective study we reviewed 115 cases of GCT with a mean follow-up of 65.6 (24–404) months who underwent a surgical treatment with or without preoperative denosumab therapy in our institution. Potential risk factors for LR and complications were analyzed.

Results

The study includes 47 male (40.9%) and 68 female (59.1%) patients with a mean age of 33.9 (10–77) years and a mean follow-up of 65.6 (24–404) months. Denosumab was used in 33 (28.7%) cases, in 14 cases (12.2%) in a neoadjuvant setting and in 17 cases preoperatively before re-curettage (14.8%) after LR. In 105 cases (91.3%) an intralesional curettage was performed. The overall LR rate was 47.8% (55 cases). Patients who underwent intralesional curettage and bone cement augmentation without neoadjuvant denosumab treatment had LR in 42.2% (38/90) of the cases. Patients who underwent neoadjuvant denosumab treatment prior to curettage had LR in 28.6% (4/14). Re-recurrence was frequent in patients with neoadjuvant denosumab treatment who had LR after initial curettage (50%, 8/16). After wide resection and endoprosthetic replacement one case (20%) of local recurrence was detectable (1/5 cases).

Conclusions

GCTB recurs frequently after intralesional curettage and cement augmentation. While denosumab is a potential (neo-)adjuvant treatment option that might be used for lesions that are difficult to resect, surgeons should be aware that LR is still frequent.

中文翻译：

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骨巨细胞瘤：115例单中心研究

背景

骨巨细胞瘤 (GCTB) 是一种局部侵袭性骨肿瘤，约占所有原发性骨肿瘤的 4-5%。它的特点是侵袭性生长，手术治疗后可能复发，在极少数情况下会发生转移。手术治疗是主要治疗方法，可能包括带辅助的病灶内刮除术，或者在极少数情况下，广泛切除。近年来，单克隆抗体狄诺塞麦已被引入作为临界可切除或不可切除病变患者的潜在（新）辅助全身治疗选择。目前有几项研究报告说，在刮宫之前使用地诺单抗可能会增加局部复发的风险。

方法

在这项回顾性研究中，我们回顾了 115 例 GCT 病例，平均随访时间为 65.6（24-404）个月，他们在我们的机构接受了手术治疗，有或没有术前地诺单抗治疗。分析了 LR 和并发症的潜在危险因素。

结果

该研究包括 47 名男性 (40.9%) 和 68 名女性 (59.1%) 患者，平均年龄为 33.9 (10-77) 岁，平均随访时间为 65.6 (24-404) 个月。地诺单抗用于 33 例 (28.7%) 病例，14 例 (12.2%) 在新辅助环境中使用，17 例在 LR 后再次刮除术前使用 (14.8%)。在 105 例 (91.3%) 中进行了病灶内刮除术。总体 LR 率为 47.8%（55 例）。在没有新辅助地诺单抗治疗的情况下接受病灶内刮除术和骨水泥增强的患者在 42.2% (38/90) 的病例中有 LR。在刮宫前接受新辅助地诺单抗治疗的患者的 LR 为 28.6% (4/14)。在初次刮宫后出现 LR 的新辅助地诺单抗治疗患者中复发率很高（50%，8/16）。

结论

GCTB在病灶内刮除和骨水泥增强后经常复发。虽然狄诺塞麦是一种潜在的（新）辅助治疗选择，可用于难以切除的病变，但外科医生应该意识到 LR 仍然很常见。