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Title: | Giant cell tumors of the spine: Has denosumab changed the treatment paradigm?. | Authors: | Goldschlager T. ;Dea N.;Boyd M.;Reynolds J.;Patel S.;Rhines L.D.;Mendel E.;Pacheco M.;Ramos E.;Mattei T.A.;Fisher C.G. | Institution: | (Goldschlager, Dea, Boyd, Fisher) Combined Neurosurgical and Orthopaedic Spine Program, Vancouver, Canada (Pacheco) Department of Pathology, Vancouver General Hospital, Vancouver, Canada (Reynolds) Spinal Unit, Oxford University Trust Hospital, Oxford, United Kingdom (Patel) Department of Oncology, MD Anderson Cancer Center, Houston, TX, United States (Rhines) Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX, United States (Mendel, Ramos) Department of Neurosurgery, Ohio State University, Columbus, OH, United States (Mattei) Department of Oncology, Ohio State University, Columbus, OH, United States (Goldschlager) Department of Neurosurgery, Monash Health, Melbourne, Australia (Goldschlager) Department of Surgery, Monash Institute of Medical Research, Monash University, Melbourne, Australia (Dea) Division of Neurosurgery, Department of Surgery, Universite de Sherbrooke, Sherbrooke, QC, Canada | Issue Date: | 29-Jun-2016 | Copyright year: | 2015 | Publisher: | American Association of Neurological Surgeons (E-mail: jnevro@virginia.edu) | Place of publication: | United States | Publication information: | Journal of Neurosurgery: Spine. 22 (5) (pp 526-533), 2015. Date of Publication: May 2015. | Journal: | Journal of Neurosurgery: Spine | Abstract: | OBJECT: Giant cell tumors (GCTs) of the spine are rare and complex to treat. They have a propensity for local recurrence and the potential to metastasize. Treatment is currently surgical and presents unique challenges due to the proximity of neural structures and the need for reconstruction. Denosumab has been shown in clinical trials to be an effective treatment for GCT, but has not yet been studied specifically in GCT of the spine or as a surgical adjunct. To the authors' knowledge this is the first such reported series. METHOD(S): A multicenter, prospective series of 5 patients with GCT of the spine treated with denosumab were included. Patient demographic data, oncological history, neurological status, tumor staging, treatment details and adverse events, surgical procedure, complications, radiological and histological responses, and patient outcome were analyzed. RESULT(S): All patients were women, with a mean age of 38 years, and presented with pain; 2 patients had additional neurological signs and symptoms. The mean duration of symptoms was 62 weeks. No patient had a prior tumor or metastatic disease at presentation. All patients had Enneking Stage III tumors and were treated with monthly cycles of 120 mg of denosumab, with initial additional loading doses on Days 8 and 15. Patients were given daily supplements of calcium (500 mg) and vitamin D (400 IU). There were no denosumab-related adverse events. All patients had a radiological response to denosumab. One patient failed to have a histological response to denosumab, with > 90% of tumor cells found to be viable on histological investigation. CONCLUSION(S): This study reports the early experience of using denosumab in the treatment of spinal GCT. The results demonstrate a clinically beneficial radiological response and an impressive histological response in most but not all patients. Further experience with denosumab and longer patient follow-up is required. Denosumab has the potential to change the treatment paradigm for spinal GCT.Copyright © AANS, 2015. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.3171/2014.10.SPINE13937 | PubMed URL: | 25700239 [http://www.ncbi.nlm.nih.gov/pubmed/?term=25700239] | ISSN: | 1547-5654 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/41042 | Type: | Article | Subjects: | liquorrhea/co [Complication] adult article bladder dysfunction/co [Complication] cancer patient cancer staging cancer surgery clinical article computer assisted tomography disease duration drug withdrawal female follow up human human tissue hypotension/co [Complication] image guided biopsy intestine function disorder/co [Complication] loading drug dose medical history mental health multicenter study multiple cycle treatment muscle weakness/co [Complication] needle biopsy nerve injury/co [Complication] operative blood loss/co [Complication] *osteoclastoma/dt [Drug Therapy] *osteoclastoma/su [Surgery] osteoclastoma/dt [Drug Therapy] peroperative complication/co [Complication] postoperative complication/co [Complication] prospective study *spine tumor/dt [Drug Therapy] *spine tumor/su [Surgery] spine tumor/dt [Drug Therapy] treatment duration treatment response tumor recurrence urinary tract infection/co [Complication] vitamin supplementation calcium *denosumab/dt [Drug Therapy] vitamin D clinical article computer assisted tomography disease duration drug withdrawal female follow up human human tissue hypotension / complication image guided biopsy intestine function disorder / complication liquorrhea / complication loading drug dose medical history mental health multicenter study multiple cycle treatment muscle weakness / complication needle biopsy nerve injury / complication operative blood loss / complication *osteoclastoma / *drug therapy / *surgery spine tumor / drug therapy treatment duration treatment response tumor recurrence vitamin supplementation *spine tumor / *drug therapy / *surgery prospective study postoperative complication / complication urinary tract infection / complication peroperative complication / complication osteoclastoma / drug therapy adult Article bladder dysfunction / complication cancer patient cancer staging cancer surgery |
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