Preoperative administration of denosumab is a feasible adjuvant option for the treatment of resectable giant cell tumor of bone in the spine: A multi-institutional study by the Japanese Musculoskeletal Oncology group.

Abstract

Although the significance of preoperative denosumab administration for giant cell tumor of bone (GCTB) is still controversial, sporadic reports have suggested a clinical benefit of administration prior to surgery for spinal GCTB. In this retrospective, multi-institutional study, we assessed the effects of preoperative denosumab administration for spinal GCTB. Ten cases of GCTB in the spine with preoperative denosumab administration (the denosumab group) and 19 cases without preoperative denosumab administration (the control group) were included. Oncological outcomes (local recurrence, distant metastasis, and overall survival), duration of the surgery, intraoperative blood loss, functional outcomes as evaluated by the Frankel classification, perioperative complications, adverse events associated with denosumab administration, and margin status in resection cases were surveyed. The median frequency of preoperative denosumab administration was four times in the denosumab group. Curettage against resection and no preoperative denosumab administration were revealed as independent risks for local recurrence. Preoperative denosumab administration significantly reduced intraoperative blood loss. It also resulted in significantly better postoperative function. Periodontitis as an adverse effect of denosumab administration was found only in two cases in the control group, where it was applied for controlling local recurrence. Cases with local recurrence showed worse function at the final follow-up, suggesting the significant impact of local recurrence on function. The negative margin rate was significantly higher in the denosumab group. No significant difference was noted in the risk for metastasis and lethal events, duration of surgery, and incidence of postoperative complications between the two groups. Preoperative denosumab administration resulted in better local control, reduced intraoperative blood loss, and better function. The present data suggest that it has a clinical benefit in the treatment of spinal GCTB.