Denosumab como tratamiento neoadyuvante del tumor de células gigantes del hueso. Indicaciones, resultados y efectos adversos / Denosumab as a neoadjuvant treatment for giant cell tumor of bone. Indications, results and side effects

Resumen El tumor de células gigantes óseo es una neoplasia de agresividad local intermedia, que raramente metastatiza. En los últimos años el denosumab, anticuerpo monoclonal humano, surgió como una alternativa de tratamiento para esta enfermedad, al bloquear el comportamiento lítico tumoral. El objetivo de este trabajo fue determinar sus indicaciones y efectos adversos, analizando también los resultados oncológicos, y las tasas de recurrencia local en pacientes con diagnóstico de tumor de células gigantes óseo que recibieron denosumab como tratamiento neoadyuvante. Entre 2010 y 2018 se analizaron 80 pacientes con tumor de células gigantes, de los cuales 14 recibieron denosumab como tratamiento neoadyuvante. El seguimiento mínimo fue 12 meses. En 8 pacientes se trató de un tumor primario, mientras que 6 fueron pacientes con recidiva tumoral. En todos los casos se evidenció una mejoría clínica. Trece presentaron cambios radiográficos, y 11 respuesta histológica completa. En 6 de 14 pacientes se evidenció una recurrencia local y en 7 se identificó al menos un efecto adverso relacionado con el denosumab (incluyendo una malignización tumoral). A pesar de ser una herramienta útil para el tratamiento del tumor de células gigantes, el uso de denosumab está asociado a mayor tasa de recurrencias locales y no está exento de efectos adversos.

Abstract Giant cell tumor of bone is an intermediate, locally aggressive and rarely metastasiz ing, primary bone neoplasia. In recent years denosumab emerged as a treatment alternative for this pathology. The objective of this work was to analyze its indications as well as the clinical outcomes, side effects and local recurrence rates in patients diagnosed with giant cell tumor of bone, who received denosumab as neoadjuvant treatment. Between 2010 and 2018, 80 patients with giant cell tumor were analyzed, of whom 14 received deno sumab as a neoadjuvant treatment. The minimum follow-up was 12 months. In 8 patients it was a primary tumor, while 6 showed tumor recurrence. In all cases, clinical improvement was evident. Thirteen patients presented radiographic changes, and 11 showed complete histological response. A local recurrence was evidenced in 6 of 14 patients, and at least one adverse effect related to denosumab (including tumor malignancy) was identified in 7. Despite being a useful tool for treating giant cell tumor, the use of denosumab is associated with a higher rate of local recurrences and is not free of adverse effects.

Tumor de células gigantes del fémur / Tumor of giant cells of the femur

El tumor de células gigantes de hueso es un tumor raro de características benignas con un comportamiento agresivo localmente. Predomina en mujeres y por lo general se presenta en la epífisis y metáfisis de los huesos largos. El propósito de este estudio es presentar el caso de un paciente con una lesión tumoral de rodilla y muslo izquierdos de 2 años de evolución y señalar las características diagnósticas de este tumor al mismo tiempo que se revisan los métodos imagenológicos recientes para su confirmación. Se presenta a un paciente masculino de 19 años de edad, que comenzó con dolor, aumento de volumen de la rodilla y muslo izquierdos, acompañado de impotencia funcional. Se reportaron los hallazgos clínicos, radiográficos e histológicos. Debido a la demora entre el inicio de los síntomas y el diagnóstico se practicó el tratamiento quirúrgico del miembro afectado (amputación). Tras 10 meses de observación no se han presentado recidivas o metástasis. Se envió al Servicio de Oncología para valorar e tratamiento con radioterapia. El tumor de células gigantes del hueso es un tumor raro, de buen pronóstico, pero que puede recidivar y causar metástasis cuando se maligniza. Por la posibilidad de transformación en sarcoma requiere estudio y observación periódica. El tiempo para realizar el diagnóstico es fundamental y debe pensarse en este tumor en caso de lesiones líticas de hueso reportadas por imagenología(AU)

The giant cell tumor of bone is a rare benign tumor with a locally aggressive behavior. It predominates in women and usually occurs in the epiphysis and metaphysis of long bones. To present a patient with a tumor lesion left knee and thigh two years of evolution, also noted the diagnostic characteristics of this tumor while recent imaging methods are reviewed for confirmation. 19-year-old male who began with pain, increased volume of the knee and left thigh, accompanied by functional impotensia. clinical, radiological and histological findings were reported. Because of the delay between the onset of symptoms and diagnosis surgical treatment of the affected limb (amputation) was performed. After ten months of observation there have been no recurrences or metastases. The giant cell tumor of bone is a rare tumor with good prognosis but can recur and metastasize when it becomes malignant. The possibility of transformation in sarcoma requires periodic study and observation. The time for diagnosis is essential and should think of this tumor in case of lytic bone lesions reported by imaging(AU)

The Sandwich Technique in the Management of a Peri-articular Giant Cell Tumour of the Knee / La técnica del sándwich en el tratamiento de un tumor de células gigantes periarticulares de la rodilla

ABSTRACT Peri-articular giant cell tumours present a unique challenge to the orthopaedic surgeon due to their locally aggressive nature. Native joint-preserving options confer less morbidity in comparison to radical excision and reconstruction; however, recurrence rates tend to be higher. The use of polymethyl methacryllate (PMMA) decreases the recurrence rate, but it has potentially devastating effects on the articular cartilage. To safeguard against this, the use of an insulating layer between the PMMA and the articular cartilage may be utilized with the goal of protecting the latter and is referred to as the Sandwich technique.

RESUMEN Los tumores de células gigantes periarticulares representan un desafío único al cirujano ortopédico debido a su naturaleza localmente agresiva. Las opciones de conservación de las articulaciones nativas confieren menos morbilidad en comparación con la supresión y reconstrucción radicales. Sin embargo, las tasas de recurrencia tienden a ser más altas. El uso de polimetilmetacrilato (PMMA) disminuye la tasa de recurrencia, pero tiene efectos potencialmente devastadores sobre el cartílago articular. Para protegerlo, el uso de una capa aislante entre el PMMA y el cartílago articular puede ser utilizarse con el objetivo de proteger este último, lo que se conoce como la técnica del sándwich.

Giant cell tumour of the proximal ulna

The report describes a rare case of giant cell tumour of proximal end of ulna occurring in 22 years old lady. Pain and gradual increase in swelling was noticed for last 7 months. X-ray showing complete absorption of proximal ulna. The tumour was excised en-bloc; reconstruction by fibular graft and fusion of elbow in functional position was performed. Postoperatively neurovascular status was normal. Patient is tumour-free and having stable elbow after 5 years of resection and reconstruction

Giant cell tumor of the lower end of the radius

Five cases of giant cell tumor of the lower end of radius are reported. Three of the patients were women and two were men, the youngest of the patients was 18 years old and oldest 37 years. En bloc resection followed by reconstructive procedures were performed in three of the cases with good results

Metachronous multicentric giant-cell tumour: a case report.

Giant-cell Tumours (GCT) of bone are not uncommon but a primary multicentric giant-cell tumour is very rare. This reported case represents a true multicentric giant-cell tumour with four lesions. These lesions had only curettage with no recurrence.

Giant cell tumour of the lower end of the radius--a new treatment modality.

Excision of the lower end of the radius with centralisation of ulna was done in 3 patients with histology proved diagnosis of giant cell tumour, as secondary procedure in 2 cases following recurrence of tumour in the fibular graft, and as a primary procedure in one, where the segment of fibula required was more than 15.2 cm. After an average follow-up of 2.3 years, the results were assessed both subjectively and objectively. The patients were happy with their hand functions and were able to have more than 80% of the grip strength. They could return to their former occupation. There was no recurrence of tumour and no pain at the wrist.