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'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab.

Vaishya R, Agarwal AK, Vijay V - Cureus (2015)

Bottom Line: A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts.Denosumab may play a crucial role, especially in the management of such difficult lesions.We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedics, indraprastha Apollo Hospital.

ABSTRACT
Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

No MeSH data available.


Related in: MedlinePlus

Pre-denosumab histopathological picture from the left proximal humerus (Case #1) showing typical features of any giant cell tumor, including numerous multi-nucleated giant cells.
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FIG3: Pre-denosumab histopathological picture from the left proximal humerus (Case #1) showing typical features of any giant cell tumor, including numerous multi-nucleated giant cells.

Mentions: Extended curettage and bone cementing could not be done as sufficient bone stock was not available for the procedure and the lesion appeared to be unsalvageable. Hence, he was put on denosumab therapy. There was a dramatic response clinically as well as radiologically. At the end of six months, extended curettage and cementing were done as the lesion became more contained and salvageable (Figure 3).


'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab.

Vaishya R, Agarwal AK, Vijay V - Cureus (2015)

Pre-denosumab histopathological picture from the left proximal humerus (Case #1) showing typical features of any giant cell tumor, including numerous multi-nucleated giant cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524749&req=5

FIG3: Pre-denosumab histopathological picture from the left proximal humerus (Case #1) showing typical features of any giant cell tumor, including numerous multi-nucleated giant cells.
Mentions: Extended curettage and bone cementing could not be done as sufficient bone stock was not available for the procedure and the lesion appeared to be unsalvageable. Hence, he was put on denosumab therapy. There was a dramatic response clinically as well as radiologically. At the end of six months, extended curettage and cementing were done as the lesion became more contained and salvageable (Figure 3).

Bottom Line: A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts.Denosumab may play a crucial role, especially in the management of such difficult lesions.We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedics, indraprastha Apollo Hospital.

ABSTRACT
Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

No MeSH data available.


Related in: MedlinePlus