Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Jernej, L.
Giant cell tumor of bone (GCT). Efficacy and safety of treatment with denosumab
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 93
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Brcic Iva
- Lohberger Birgit
- Smolle Maria Anna
- Altmetrics:
- Abstract:
- Giant cell tumor of bone (GCT). Efficacy and safety of treatment with denosumab: Introduction Giant cell tumors of bone (GCT) are considered as intermediate neoplasias due to locally aggressive growth and a rare tendency to metastasize. These rare lesions occur mostly in adults aged 20 to 45 years. Histological appearance is dominated by multinucleated osteoclast-like giant cells which are recruited by neoplastic cells and determine the osteolytic character of GCT. Treatment primarily constitutes of surgical therapy, however, systematic therapy with denosumab is recommended in calcitrant cases. This diploma thesis was set out to investigate efficacy and safety of denosumab, a human monoclonal antibody leading to formation of new bone. Subjects Fifty-four patients with GCT treated at the Department of Orthopaedics and Trauma between 1998 and 2020 were included into this retrospective analysis of tumor databank. Histological, immunohistochemical and mutational analyses took place in cooperation with the Institute of Pathology. Statistical analysis of all patients with verified diagnosis was performed using IBM SPSS Statistics, Version 26. Nine detailed case reports of every patient treated with denosumab concluded the analysis. Results Of all patients, 51.9% were female and 48.1% were male. Mean age at diagnosis was 37.9 years. Most common symptom as well as major reason for consultation was pain. Size of the tumors ranged from 1 up to 17 cm. Local recurrence affected approximately a quarter of all patients (25.9%). All patients received surgical therapy, 9 patients were also treated with denosumab. The mean follow-up was 68.9 months. Tumor progression under denosumab therapy was in no case observed, calcification took place in 6 patients. Denosumab improved surgical therapy in 6 cases and rendered amputation redundant in one young patient. On the contrary, reduction of pain could not be achieved in 3 cases. One adverse event was described: The patient developed a calcified soft tissue expansion where denosumab injections were administered. The lesion was surgically removed. No other side effects occurred. Discussion Therapy with denosumab facilitated better surgical therapy and led to increased mobility due to less invasive operations. Radiological and histological response was distinct. However, pain reduction could not be achieved in every case. Regarding safety of denosumab, no concerns derived from our analysis.