PDF(Pubmed)
Abstract：
Giant cell tumor of bone (GCTB) is a locally aggressive intermediate bone tumor. Denosumab has shown effectiveness in GCTB treatment; however, the benefits of denosumab de-escalation for unresectable GCTB have not been well discussed. The present study investigated the efficacy and safety of denosumab de-escalation for GCTB. The medical records of 9 patients with unresectable GCTB or resectable GCTB not eligible for resection, who received de-escalated denosumab treatment at Okayama University Hospital (Okayama, Japan) between April 2014 and December 2021, were retrospectively reviewed. The denosumab treatment interval was gradually extended to every 8, 12 and 24 weeks. The radiographic changes and clinical symptoms during standard and de-escalated denosumab therapy were assessed. The denosumab interval was de-escalated after a median of 12 months of a standard 4-weekly treatment. Imaging showed that the re-ossification of osteolytic lesions obtained with the 4-weekly treatment were sustained with 8- and 12-weekly treatments. The extraskeletal masses reduced significantly with standard treatment, while tumor reduction was sustained during de-escalated treatment. During the 24-weekly treatment, 2 patients remained stable, while 2 patients developed local recurrence. The clinical symptoms improved significantly with standard treatment and remained improved during de-escalated treatment. There were severe adverse events including osteonecrosis of the jaw (2 patients), atypical femoral fracture (1 patient) and malignant transformation of GCTB (1 patient). In conclusion, 12-weekly de-escalated denosumab treatment showed clinical benefits as a maintenance treatment in patients with unresectable GCTB, in addition to sustained stable tumor control and improved clinical symptoms with standard treatment. A 24-weekly treatment can also be administered, with careful attention paid to detecting local recurrence.
摘要：
骨巨细胞瘤（GCTB）是一种局部侵袭性中间骨肿瘤。Denosumab已在GCTB治疗中显示出有效性；然而，denosumab降级对不可切除的GCTB的益处尚未得到很好的讨论.本研究调查了地诺单抗降阶梯治疗GCTB的有效性和安全性。9例无法切除的GCTB或无法切除的GCTB患者的病历，他在冈山大学医院(冈山，日本）在2014年4月至2021年12月之间进行了回顾性审查。denosumab治疗间隔逐渐延长至每8、12和24周。评估了标准和降级的denosumab治疗期间的影像学变化和临床症状。标准4周治疗的中位数为12个月后，denosumab间隔逐渐降低。成像显示，每周4次治疗获得的溶骨性病变的再骨化在每周8次和每周12次治疗中得以维持。标准治疗后，骨外肿块显著减少，而在降级治疗期间肿瘤减少持续。在24周治疗期间，2名患者保持稳定，2例患者出现局部复发。在标准治疗下，临床症状显着改善，在降级治疗期间仍保持改善。有严重的不良事件，包括颌骨坏死（2例），非典型股骨骨折（1例）和GCTB恶变（1例）。总之,在不可切除的GCTB患者中，每周12次降级的denosumab治疗显示出作为维持治疗的临床益处，除了持续稳定的肿瘤控制和改善临床症状与标准治疗。也可以进行24周治疗，仔细注意检测局部复发。
