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Denosumab in the treatment of giant cell tumor of the spine. Preliminary report, review of the literature and protocol proposal

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Abstract

Background

The interest on the role of Denosumab in the treatment strategy of giant cell tumor of the spine is growing. En bloc resection is considered the Enneking appropriate treatment, but morbidity and functional loss are sometimes unacceptable. Denosumab could play a role as a stand-alone treatment, but also as preoperative treatment or as postoperative after intralesional surgery.

Materials and methods

A cohort of 10 out of 12 cases of spinal GCT consecutively treated with Denosumab are analyzed and discussed compared to the cases reported in the literature. A staging of the radiological effect of the treatment is proposed.

Results

The stand-alone and postoperative treatments are still running (12 to 88 months). One therapy was stopped after 15 months, once a satisfactory local effect was achieved, but the treatment had to be restarted 2 months later due to the recurrence of the erosive images. The new treatment was successful. At 1-year follow-up after the gross total excision followed by postoperative Denosumab treatment, no evidence of local recurrence was found. The preoperative treatment duration ranged from 3 to 24 months. No local recurrence followed the en bloc resections.

Conclusions

Denosumab alone is effective in relieving pain, increasing the ossification and sometimes reducing the tumor volume. It can be considered an excellent solution in spine GCTs whose surgical treatment cannot be Enneking appropriate or is associated with unacceptable morbidity or loss of functions. It is still impossible to state when to safely stop the treatment. Denosumab also plays a role as preoperative protocol.

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Acknowledgments

The AA are indebted with Mr. Carlo Piovani for his unevaluable work of image storage and editing and for providing an excellent artistic visualization of the proposed staging of the levels of efficacy.

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy

    Stefano Boriani & Riccardo Cecchinato

  2. University Department of Orthopedics, IRCCS Policlinico di Pavia, Pavia, Italy

    Fabrizio Cuzzocrea

  3. Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Stefano Bandiera & Alessandro Gasbarrini

  4. Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Marco Gambarotti

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  1. Stefano Boriani
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  2. Riccardo Cecchinato
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  4. Stefano Bandiera
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  5. Marco Gambarotti
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  6. Alessandro Gasbarrini
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Correspondence to Riccardo Cecchinato.

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Boriani, S., Cecchinato, R., Cuzzocrea, F. et al. Denosumab in the treatment of giant cell tumor of the spine. Preliminary report, review of the literature and protocol proposal. Eur Spine J 29, 257–271 (2020). https://doi.org/10.1007/s00586-019-05997-0

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