Clinical outcome of extended curettage with postoperative denosumab administration for the treatment of Campanacci Grade III giant cell tumors of the extremities

doi:10.21203/rs.3.rs-3748602/v1

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Clinical outcome of extended curettage with postoperative denosumab administration for the treatment of Campanacci Grade III giant cell tumors of the extremities

https://doi.org/10.21203/rs.3.rs-3748602/v1

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Background

Management of Campanacci Grade III giant cell tumors of the extremities is controversial because wide resection with reconstruction results in a poor functional outcome for most patients. Denosumab has been used before operation to enable curettage and surgical downstaging in patients with giant cell tumor of bone (GCTB), where joint preservation is difficult. However, owing to osteosclerosis of the lesion and difficulty to curet the lesion thoroughly, preoperative denosumab treatment increases the local recurrence rate. It is unclear whether postoperative treatment with denosumab facilitate the ability of a joint to be salvaged by intralesional surgery instead of resection. Therefore, we performed a retrospective study to investigate the local recurrence rate, joint preservation status, and functional outcomes after extended curettage and postoperative denosumab treatment in Campanacci Grade III giant cell tumors of the extremities.

Methods

We retrospectively reviewed 23 patients with Campanacci Grade III GCTB of the extremities in our hospital from January 2017 to June 2023, who underwent extended curettage and postoperative denosumab administration alone, without preoperative denosumab treatment. Patients were followed for adverse events of denosumab, surgical outcome, limb function of lesions, and local recurrence following extended curettage with postoperative denosumab .

Results

All incisions were healed without deep infection and internal fixation failure. The mean age of the patients at surgery was 36.6 years, and the mean followup was 35.8 months ( range, 6–72 months). There of the 23 patients had local recurrence years postoperatively. The recurrence rate is 13.0%. Two was treated with repeat intralesional surgery with no additional recurrence 2 years later, and another was treated with en bloc resection and reconstruction with vascularised fibular graft. One patient had progression to knee osteoarthritis without oral analgesics. No patient had pulmonary metastases develop and malignant transformation of GCTB. The mean Musculoskeletal Tumor Society functional scores at last followup were 27.3 of 30 (range,25–29). No serious adverse events were detected due to denosumab.

Conclusion

Our observations suggest extended curettage with postoperative denosumab administration is a reasonable option for Campanacci Grade III giant cell tumors of the extremities. Extended curettage with adjuvant denosumab therapy resulted in beneficial surgical downstaging, including either a less morbid surgical procedure or delayed en bloc resection. Maybe, resection should be considered when structural integrity cannot be regained after bone grafting or bone cement filling combined with intemal fixation.

Giant cell tumor of bone

Curettage

Denosumab

Outcome

Giant cell tumor of bone(GCTB) is an intermediate primary bone tumor that is known to be locally aggressive, but rarely metastasizing. It is most commonly found in the metaphyseal-epiphyseal region of the long bones, espacially in the region around knee[1]. The main treatment is surgery, which include curettage with adjuvants and en bloc resection. Currently, Campanacci Grades I and II GCTB, which are defined as having no extraosseous extension [2], routinely are treated with curettage with adjuvants. Grade III lesions often are treated with en bloc resection owing to obliteration of the cortical bone and extension into the soft tissue to prevent local recurrence [3, 4, 5].The use of curettage with adjuvants reportedly is associated with relatively high local recurrence rates but with joint preservation and good postoperative function [6, 7]. En bloc resection reduces the local recurrence rate but results in poor functional outcomes in the anatomic location [6, 7].

In GCTB, the stromal cells and osteoclast-like giant cells express receptor activation of nuclear factor-kappa ß(RANK) ligand and induce receptor activation of RANK positive osteoclast-like giant cells and their precursors [8]. Denosumab is a fully human monoclonal antibody that inhibits the RANK ligand (RANKL), then interrupts RANK-RANKL interactions, and thereby prevents the giant cell tumor of bone-induced bone destruction [9]. Early evidence suggests that preoperative denosumab treatment was associated with a reduction in local recurrence and resulted in beneficial surgical downstaging, but some studies found an increase in the proportion of patients experiencing local recurrence, and thereby have questioned that premise [9–15]. Therefore, we did not use preoperative denosumab therapy for most of patients with giant cell tumor of the extremities. For Campanacci Grade III giant cell tumors of the extremities, although the the local recurrence rate is generally low after en bloc resection, it is not necessarily the most favorable primary treatment. Considering the benign nature of GCTB, the complications, the survival for a long time, and the need for multiple revision surgery,

the aim for joint preservation is generally justified. The preferred surgical treatment for Campanacci Grade III GCTB of the extremities remains controversial.

Therefore, we performed a retrospective study to investigate the local recurrence rate, joint preservation status, and functional outcomes after extended curettage and postoperative denosumab treatment in Campanacci Grade III giant cell tumors of the extremities. We attempt to answer the questions,:(1): Is the use of extended curettage with adjuvants and postoperative denosumab treatment would provide adequate local control?(2) Is the use of extended curettage with adjuvants and postoperative denosumab treatment would obtain good postoperative function? (3) Is the use of extended curettage with adjuvants and postoperative denosumab treatment would resulted in beneficial surgical downstaging for patients with Campanacci Grade III giant cell tumors of the extremities?

We retrospectively reviewed 23 patients with Campanacci Grade III GCTB of the extremities in our hospital from January 2017 to June 2023, who underwent extended curettage surgery with adjuvants and postoperative denosumab administration alone. Patients who received denosumab preoperatively were excluded. Patients without sufficient clinical information and those diagnosed with malignant GCTB also were excluded in the study. This study was approved by the ethics committee of Southwest Hospital, Army Military Medical University.

We collected data from medical records and included patient demographics, radiographic evaluation, histopathological evaluation,

tumor localization, soft tissue extension, date and type of surgical intervention, method of reconstruction, surgery-related complications, revisions, reasons for revisions, local recurrence and metastasis. Functional outcomes (evaluated by Musculoskeletal Tumor Society (MSTS) score[16]) and the denosumab-related adverse events((evaluated by the Common Terminology Criteria for Adverse Events, volume 4.03 [17]) were assessed at the latest follow up.

All patients were surgically treated by oncological orthopaedic senior surgeon (Shuai Zhang). Soft tissue extension and extent of bone involvement were assessed on preoperative plain X-rays and Magnetic resonance imaging (MRI), occasionally with computed tomography (CT) scan or emission computed tomography (ECT) bone scan of the lesion, depending on presentation. The tumor mass in the surrounding soft tissues was resected with a safe margin of 0.5-1 cm, except for areas connected to the cortical destruction. The fracture hematoma was also considered soft tissue extension. Important blood vessels and nerves must be protected during the resection of soft tissue mass, to avoid causing limb ischemic necrosis or severe neurological dysfunction of the extremities. Then a large bone window was made to facilitate observation and evacuation of the tumor under direct view. The curettage was performed through the large cortical bone window using curettes of different sizes and bending angles and all visible regions of the tumor were removed. Subsequently, the cavity was cauterized by high-frequency electric knife (Fig. 1), and alcohol was used in the remaining cavity for more than 15 minutes, followed by saline washout to remove all tumor tissues. The subchondral region was filled with autologous or allogeneic cancellous bone graft when the remaining subchondral bone was thin after tumor curettage, to ensure that the thickness of subchondral bone exceeds 1 centimeter(cm) (Fig. 2). The tumor cavity was then filled with polymethylmethacrylate (PMMA) bone cement. Subsequently, internal fixation was performed after curettage to maintain structural integrity and allow early functional exercises despite the size of the bone defects. The wound was closed with deep drains in place.

Each patient was managed with the standard perioperative protocol, including intravenous antibiotics until all drains were removed, prophylaxis against venous thrombosis and pain control. Some patients were immobilized in a brace for the first 4–6 weeks to maintain joint stability and protect the implants. Post-operatively, patients received subcutaneous denosumab (120 mg) monthly within half a year. Then all patinets were advised receiving denosumab every six months until either disease progression, serious adverse drug reactions, withdrawal of patient consent, pregnancy, or absence of clinical benefit according to the doctor’s judgment. All patients were strongly advised to take daily supplements of ≥ 500 mg calcium and ≥ 400 IU vitamin D during the period with denosumab therapy.

Our follow up protocol consisted of radiography at 1, 3, and 6 months postoperatively followed by half yearly radiographs until 2 years postoperatively and annually thereafter until last follow-up. We performed computed tomography of the chest and ECT at 1, 2, 3, and 5 years postoperatively. MRI of the tumor area was performed if tumor recurrence is suspected. Local recurrence, lung metastasis, surgical and denosumab- related complications, graft union and final joint preservation were recorded. At the final followup, functional results and pain in the affected extremity were evaluated by the Musculoskeletal Tumor Society (MSTS) system, which is based on six parameters, including walking ability, pain, emotional acceptance, functional activities, the use of external support and gait. Results were established as excellent for MSTS score ≥ 90%, good for 80–90%, satisfactory for 60–80%, and poor for ≤ 60%.

The details and functional outcome of patients in the present study are shown in Table 1, which includes the notable incidence of complications and problems. There were fifteen men and eight women, with a mean age of 36.6 years (range 20–63 years). The involved bone was the distal femur in 8 patients, proximal tibia in 4 patients, proximal humerus in 3 patient, distal radius in 7 patients and the Scapula in 1 patient. Four patients have a pathologic fracture and six patients have recurrence before extended curettage surgery. At the final followup, all patients were alive, and had a mean followup time of 35.8 months ( range, 6–72 months), measured from the date of surgery. Of the 23 patients included in the present study, no patient had tumor metastasis. However, one (patient 20) experienced recurrence in soft tissue and the bone 14 months postoperatively, which was subsequently treated with en bloc resection and reconstruction with vascularised fibular graft. Two patients (Patient 9 and 12) had local recurrence in the bone 12 and 18 months later respectively that was treated with repeat intralesional surgery with adjuvants. These two patients had no additional recurrence at follow-up. The local recurrence rate was 13.0% after extended curettage with adjuvants (three of 23).

The joint preservation rate was 95.7%. Only one patient recieved en bloc resection and reconstruction with vascularised fibular graft due to recurrence. The mean overall MSTS score was 27.3 of 30 (range,25–29)., with 17 being excellent and 6 good. Joint function can meet the needs of daily life, with the exception of heavy labor. Detailed data on clinical results are reported in Table 1. One patient had radiographic evidence of osteoarthritis, with experienced pain (especially upon physical activity.), but the pain could be endured without the need for analgesics. X ray showed the healing of bone graft were satisfactory, no signs of subchondral collapse. Perioperative and 24-months’ follow-up images of patient 22 are given in Fig. 3, Fig. 4, Figs. 5 and 6.

Figure 4

(A) A CT image and (B) a MR image of patient 22 show cortical destruction and soft tissue extension of the GCT.

Figure 6

Postoperative X-ray (anteroposterior and lateral views) of patient 22 after 24 months follow-up.

There were no major surgical related complications: One patient developed superficial wound infection, which resolved after a 4-week course of antibiotics. The neuropraxia of the peroneal nerve was observed in one patient, potentially caused by stretching during the surgery, and the function of the affected extremity recovered within six months. No patient had immune rejection, fracture, failure of internal fixation, and significant graft bone resorption. No serious adverse events, malignant progression, or positively adjudicated osteo-necrosis of the jaw were detected due to denosumab. 5 patients had least one denosumab-related adverse event, most frequently headache, nausea, fatigue, back pain, or musculoskeletal pain. No patients discontinued denosumab treatment because of adverse events. Only one paitent discontinued denosumab treatment for twelve monthes due to cost constraints.

Campanacci Grade III GCTB of the extremities is also considered an intermediate primary bone tumor, despite more aggressive, and easier to recur and metastasize. The rate of metastasis is approximately 1% in patients without recurrence and 6% in patients with recurrence[18]. This

unique behavior of GCTB has led to controversy regarding optimal surgical treatment. Grade III lesions often are treated with en bloc resection owing to obliteration of the cortical bone and extension into the soft tissue to prevent local recurrence [3, 4, 5]. But wide resection results in poor functional outcomes in the anatomic location [6, 7], especially in the context of the proximal humerus and the distal radius. Intralesional surgery with adjuvants tends to have better functional results with joint preservation but has been associated with relatively higher local recurrence rates[6, 7]. A retrospective study involving 408 patients with GCTB of the extremity reported the local recurrence rate was 16% in those treated with curettage alone compared with 60% treated with curettage after preoperative deno-sumab therapy[12]. Naofumi Asano et al.[15] performed a retrospective study, and they found that of the patients with Campanacci grade 3 tumours, 53 patients underwent curettage, and 21 (39.6%) had local recurrence. However, the recurrence rate in our study was only 13.0%, significantly lower than that reported in the previous literature, in those treated with curettage of the patients with Campanacci Grade III tumors. We consider this lower recurrence rate are due to the following reasons: (1) The tumor mass in the surrounding soft tissues was resected with a safe margin of 0.5-1 cm, a large bone window was made to facilitate observation and evacuation of the tumor under direct view, and then the curettage with adjuvants was performed through the large cortical bone window. All patients had received extended curettage to get safe surgical margin through the above methods. (2) When structural integrity cannot be regained after bone grafting or bone cement filling combined with intemal fixation, resection was choosen. We excluded these patients whose recurrence rate was more higher, if curettage was performed. Maybe, this is another reason. (3) The application of postoperative denosumab therapy maybe delay the local recurrence, then reduce the recurrence rate at the last follow up.

Due to the tumor destruction and extended curettage, the subchondral bone at the joint is obviously destroyed. This leads to irregularity of the articular surface and instability of the lower limbs, which in turn leads to further wear of the articular surface. In addition, the filled bone cement can not be integrated into the host bone, and the elastic modulus of the two materials is different. When the paitent is walking, the bone cement rolls slightly, causing damage to the subchondral and articular cartilage, which in turn results in mechanical wear of the jiont. Abdelrahman et al.[19] reported that when the tumor is less than 1 cm from the articular surface, the incidence of degenerative changes in articular cartilage after the use of cement alone is more than 2.5 times greater than that when the tumor is more than 1 cm away. Studies also have shown that cement constructs are less rigid than normal subchondral bone or successful bone graft [20]. Therefore, we think that more attention should be paid to the preservation of subchondral bone, and the thickness of subchondral bone should be greater than 1cm. At the last follow-up, most of our patients showed bone graft fusion, normal contour of the articular surface, and no stenosis of the articular space. Only one patient with radiographic evidence of osteoarthritis showed the resultant early degenerative changes of the joint.

The joint preservation rate was 95.6%, and the joint function, evaluated by the American Musculoskeletal Tumor Society system, was well preserved in all of the patients in the current series. Functional outcomes in our patients were improved compared with reported outcomes of en bloc resection, especially in studies of proximal humerus and distal radius resections and reconstructions for GCTB[21, 22]. Except the excellent function, there were no major surgical related complications in our patients. Only one patient developed superficial wound infection, and the neuropraxia of the peroneal nerve was observed in one patient. The surgical related complications were resolved easily. Fewer surgical related complications and better functional results support the use of extended curettage with adjuvants and postoperative denosumab treatment to defer or downstage the planned surgical procedure in patients with Campanacci Grade III giant cell tumors of the extremities.

Denosumab, showing to be highly effective at suppressing the progression of GCTB, has been applied in many conturies for the treatment of GCTB for more than a decade. However, the role of denosumab in patients with GCTB who can be treated by curettage has not been well defined. More and more studies [13, 15, 23] have observed a

potential increased risk of local recurrence after surgery following the preoperative application of denosumab, raising concerns on the use of this agent against GCTB in combination with surgery. Chawla S et al. [23] found that preoperative denosumab therapy in combination with curettage surgery was significantly associated with an increased risk of local recurrence in Campanacci Grade 3 tumors in a multi-institutional, retrospective study involving 234 patients. Chinder et al. reported that the

use of preoperative denosumab for GCTB was the only significant risk factor for local recurrence [24]. Both the previous reports and our patients have found that preoperative denosumab treatment caused irregular ossification within the GCTB and new bone on the periphery of the tumor. New bone formation caused difficulty in recognizing the true margins to be removed during curettage, and neoplastic cells may remained. This may be the main reason of tumor recurrence. Therefore, we give up the preoperative use of denosumab, and choose only postoperative application after extended curettage in Campanacci Grade III tumors.

Furthermore, there is no consensus on the management of postoperative denosumab use after curettage. Further investigation should be required to determine the optimal interval and duration of postoperative denosumab treatment. Post-operatively, our patients received subcutaneous denosumab monthly within half a year. Then all patients were advised receiving denosumab every six months until either disease progression, serious adverse drug reactions, withdrawal of patient consent, pregnancy, or absence of clinical benefit according to the doctor’s judgment. The reasons for choosing this strategy are as follows: first, some patients can not bear high financial pressures brought by the long- term application of denosumab after undergoing surgery, especially in the underdeveloped areas of western China. Second, all patients had received extended curettage to get safe surgical margin. Maybe, this could reduce the frequency of denosumab use. Third, we worried the side effects and resistance of denosumab making the patient unable to benefit from the treatment with denosumab. Fourth, potential malignant transformation after denosumab use, which was reported in previous studies [16, 25], was concerning, especially for long-term use.

We recognize the following significant limitations of our results: the number of patients is small, the follow-up is not yet sufficient to report on long-term results, lack of a control group, and it is retrospective. However, this is a relatively uncommon tumor and large numbers cannot be readily accumulated from one institution. By reporting the results of this initial study, we hope to encourage appropriate use of this promising strategy for Campanacci Grade III GCTB to get better clinical result. Of course, larger series, a multicenter study and a longer follow-up are needed to further verify the long-term efficacy.

Based on the current follow-up results, except for some limitations, in our opinion, extended curettage with postoperative denosumab administration can get adequate local control, obtain good postoperative function, and resulted in beneficial surgical downstaging including either a less morbid surgical procedure or delayed en bloc resection for patients with Campanacci Grade III giant cell tumours of the extremities. Maybe, resection should be considered when structural integrity cannot be regained after bone grafting or bone cement filling combined with intemal fixation.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Contribution

S.Z. and JQ.Z. conceived and designed the study. L.S. acquired the clinical data. S.Z. and JQ.Z. analyzed the data and drafted the manuscript. S.Z. supervised the study. All authors critically reviewed, edited and approved the manuscript.

Funding

None.

Ethics declarations

Ethical approval and consent to participate

This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Army Medical University in accordance with the Declaration of Helsinki and relevant policies in China. The written informed consent was waived by the Ethics Committee of The First Affiliated Hospital of Army Medical University for the retrospective nature of this study.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Futamura, N, Urakawa, H, Tsukushi, S, et al. Giant cell tumor of bone arising in long bones possibly originates from the metaphyseal region. ONCOL LETT. 2016; 11 (4): 2629-2634. doi: 10.3892/ol.2016.4264
Campanacci, M, Giunti, A, Olmi, R. [Metaphyseal and diaphyseal localization of giant cell tumors]. Chir Organi Mov. 1975; 62 (1): 29-34. PMID: 1095318
Tsukamoto, S, Mavrogenis, AF, Kido, A, et al. Current Concepts in the Treatment of Giant Cell Tumors of Bone. Cancers (Basel). 2021; 13 (15): doi: 10.3390/cancers13153647
Turcotte, RE, Wunder, JS, Isler, MH, et al. Giant cell tumor of long bone: a Canadian Sarcoma Group study. CLIN ORTHOP RELAT R. 2002; (397): 248-58. doi: 10.1097/00003086-200204000-00029
Tsukamoto, S, Mavrogenis, AF, Tanzi, P, et al. Curettage as first surgery for bone giant cell tumor : adequate surgery is more important than oncology training or surgical management by high volume specialized teams. EUR J ORTHOP SURG TR. 2019; 30 (1): 3-9. doi: 10.1007/s00590-019-02535-y
Tsukamoto, S, Mavrogenis, AF, Kido, A, et al. Current Concepts in the Treatment of Giant Cell Tumors of Bone. Cancers (Basel). 2021; 13 (15): doi: 10.3390/cancers13153647
Errani, C, Tsukamoto, S, Ciani, G, et al. Present day controversies and consensus in curettage for giant cell tumor of bone. J Clin Orthop Trauma. 2019; 10 (6): 1015-1020. doi: 10.1016/j.jcot.2019.09.017
Thomas DM, Skubitz KM. Giant cell tumour of bone. Curr Opin Oncol. 2009;21:338–344.
Branstetter, DG, Nelson, SD, Manivel, JC, et al. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. CLIN CANCER RES. 2012; 18 (16): 4415-24. doi: 10.1158/1078-0432.CCR-12-0578
Rutkowski, P, Ferrari, S, Grimer, RJ, et al. Surgical downstaging in an open-label phase II trial of denosumab in patients with giant cell tumor of bone. ANN SURG ONCOL. 2015; 22 (9): 2860-8. doi: 10.1245/s10434-015-4634-9
Chawla, S, Henshaw, R, Seeger, L, et al. Safety and efficacy of denosumab for adults and skeletally mature adolescents with giant cell tumour of bone: interim analysis of an open-label, parallel-group, phase 2 study. LANCET ONCOL. 2013; 14 (9): 901-8. doi: 10.1016/S1470-2045(13)70277-8
Errani, C, Tsukamoto, S, Leone, G, et al. Denosumab May Increase the Risk of Local Recurrence in Patients with Giant-Cell Tumor of Bone Treated with Curettage. J BONE JOINT SURG AM. 2018; 100 (6): 496-504. doi: 10.2106/JBJS.17.00057
Rutkowski, P, Gaston, L, Borkowska, A, et al. Denosumab treatment of inoperable or locally advanced giant cell tumor of bone - Multicenter analysis outside clinical trial. EJSO-EUR J SURG ONC. 2018; 44 (9): 1384-1390. doi: 10.1016/j.ejso.2018.03.020
Jamshidi, K, Gharehdaghi, M, Hajialiloo, SS, et al. Denosumab in Patients with Giant Cell Tumor and Its Recurrence: A Systematic Review. ARCH BONE JT SURG-AB. 2018; 6 (4): 260-268. PMID: 30175172
Asano, N, Saito, M, Kobayashi, E, et al. Preoperative Denosumab Therapy Against Giant Cell Tumor of Bone is Associated with an Increased Risk of Local Recurrence After Curettage Surgery. ANN SURG ONCOL. 2022; 29 (6): 3992-4000. doi: 10.1245/s10434-022-11411-9
Enneking, WF, Dunham, W, Gebhardt, MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. CLIN ORTHOP RELAT R. 1993; (286): 241-6. PMID: 8425352
Basch, E, Reeve, BB, Mitchell, SA, et al. Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). JNCI-J NATL CANCER I. 2014; 106 (9): doi: 10.1093/jnci/dju244
Rock, M. Curettage of giant cell tumor of bone. Factors influencing local recurrences and metastasis. Chir Organi Mov. 1990; 75 (1 Suppl): 204-5. PMID: 2249533
Abdelrahman, M, Bassiony, AA, Shalaby, H, et al. Cryosurgery and impaction subchondral bone graft for the treatment of giant cell tumor around the knee. HSS J. 2009; 5 (2): 123-8. doi: 10.1007/s11420-009-9125-8
Campanacci, M, Capanna, R, Fabbri, N, et al. Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov. 1990; 75 (1 Suppl): 212-3. PMID: 2249537
Zhang, S, Xu, MT, Wang, XQ, et al. Functional outcome of en bloc excision and custom prosthetic replacement for giant cell tumor of the distal radius. J ORTHOP SCI. 2015; 20 (6): 1090-7. doi: 10.1007/s00776-015-0763-z
Mayilvahanan, N, Paraskumar, M, Sivaseelam, A, et al. Custom mega-prosthetic replacement for proximal humeral tumours. INT ORTHOP. 2006; 30 (3): 158-62. doi: 10.1007/s00264-005-0029-z
Chawla, S, Blay, JY, Rutkowski, P, et al. Denosumab in patients with giant-cell tumour of bone: a multicentre, open-label, phase 2 study. LANCET ONCOL. 2019; 20 (12): 1719-1729. doi: 10.1016/S1470-2045(19)30663-1
Chinder, PS, Hindiskere, S, Doddarangappa, S, et al. Evaluation of Local Recurrence in Giant-Cell Tumor of Bone Treated by Neoadjuvant Denosumab. CLIN ORTHOP SURG. 2019; 11 (3): 352-360. doi: 10.4055/cios.2019.11.3.352
Park, A, Cipriano, CA, Hill, K, et al. Malignant Transformation of a Giant Cell Tumor of Bone Treated with Denosumab: A Case Report. JBJS Case Connect. 2016; 6 (3): e78. doi: 10.2106/JBJS.CC.16.00024

Table I. Characteristics and results of the 23 patients.

Case	Sex	Age	Site	Pathological fracture at presentation	Local recurrence at extended curettage surgery	Follow-up, months	Duration of postoperative denosumab therapy (months)	Surgery-related complication	Denosumab-related complication	Recurrence and treatment	MSTS score^*
1	Male	33	Proximal humerus	No	Yes	66	60	None	fatigue, musculoskeletal pain	None	93.3 (28)
2	Female	28	Distal tibia	No	No	67	66	None	None	None	96.7(29)
3	Male	51	Scapula	No	No	60	60	None	nausea, fatigue	None	86.7 (26)
4	Male	36	Distal radius	No	No	26	24	None	None	None	86.7 (26)
5	Male	20	Proximal humerus	Yes	No	32	30	None	None	None	83.3 (25)
6	Female	49	Distal femur	No	Yes	26	24	neuropraxia of the peroneal nerve	None	None	90.0 (27)
7	Male	26	Distal radius	No	No	35	30	None	None	None	93.3 (28)
8	Male	41	Proximal tibia	No	No	39	36	superficial wound infection	None	None	96.7(29)
9	Male	29	Distal radius	Yes	No	62	60	None	Back pain, headache	Once (12 months), repeat extended curettage and bone cement	86.7 (26)
10	Female	33	Distal radius	Yes	No	45	42	None	None	None	93.3 (28)
11	Male	31	Distal femur	No	No	48	48	None	None	None	96.7(29)
12	Male	63	Distal femur	No	No	50	48	None	None	Once (18 months), repeat extended curettage and bone cement	90.0 (27)
13	Male	23	Distal radius	No	No	52	48	None	Fatigue	None	93.3 (28)
14	Male	35	Proximal humerus	No	No	8	6	None	None	None	96.7(29)
15	Male	23	Distal femur	No	No	12	12	None	None	None	96.7(29)
16	Female	47	Distal femur	No	Yes	6	6	None	None	None	90.0 (27)
17	Male	51	Distal femur	Yes	Yes	9	6	None	None	None	83.3 (25)
18	Male	37	Distal femur	No	No	18	18	None	None	None	90.0 (27)
19	Female	29	Proximal tibia	No	Yes	12	12	None	None	None	93.3 (28)
20	Female	34	Distal radius	No	No	39	36	None	None	Once (14 months), enbloc resection and reconstruction with vascularised fibular graft	83.3 (25)
21	Male	40	Proximal tibia	No	No	16	12	None	None	None	96.7(29)
22	Female	54	Distal radius	No	No	24	24	None	None	None	90.0 (27)
23	Female	29	Distal femur	No	Yes	72	60	None	Musculoskeletal pain, fatigue, back pain	None	90.0 (27)

^* Musculoskeletal Tumor Society (MSTS) score calculated as percentage of maximum possible score of 30

No competing interests reported.

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Clinical outcome of extended curettage with postoperative denosumab administration for the treatment of Campanacci Grade III giant cell tumors of the extremities

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