Radiological Evaluation of the Efficacy of Denosumab as a Treatment for Giant-cell Tumour of Bone with Histopathological Correlation
C Lee, ACS Lam, RCH Yau, WH Shek, YL Lam
Hong Kong J Radiol 2018;21:158-65
DOI: 10.12809/hkjr1816801
Objective: To evaluate the efficacy of denosumab as a treatment for giant-cell tumour of bone (GCTB) with
histopathological correlation.
Methods: This was a single-centre retrospective study of patients with histologically proven GCTB. Clinical
data of all patients treated with neoadjuvant and adjuvant denosumab according to a standardised protocol
were reviewed. Duration of follow-up from the time of diagnosis ranged from 4 to 30 months. Clinical response
in terms of pain reduction or functional improvement and major adverse drug effects were documented. Pre- and
post-treatment tumour responses were evaluated using available radiographs, computed tomography (CT)
and magnetic resonance imaging (MRI) images taken at irregular intervals. Concomitant histopathological
evaluations of tissue samples were also conducted to assess the percentage of giant cells and de novo bone matrix.
Results: A total of 12 patients received denosumab treatment for GCTB from 20 July 2012 to 5 June 2015. Among
them, 10 (83.3%) patients had no tumour recurrence before September 2016; and 11 (91.6%) patients reported
reduced pain or functional improvement with no major treatment complications. Excellent treatment response was
achieved for 10 (90.9%) of 11 patients who underwent radiographic assessment and four (100%) of four patients
who underwent CT assessment. Serial MRI assessments demonstrated tumour recurrence in two (18.2%) of 11
patients. Histopathological tumour response was observed in all patients.
Conclusion: Denosumab is an efficacious treatment for GCTB in terms of clinical, radiological, and
histopathological response, with no major complications documented in the present study. Radiography and CT
are useful tools for clinical evaluations of the efficacy of denosumab treatment for GCTB.
Author affiliation(s):
C Lee, ACS Lam, YL Lam: Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
RCH Yau: Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong
WH Shek: Department of Pathology, Queen Mary Hospital, Pokfulam, Hong Kong
中文摘要
以放射學評估Denosumab對骨巨細胞瘤的療效和其組織病理相關性
李雋、林卓司、游正軒、黃雪雲、石維雄、林英利
目的：評估denosumab治療骨巨細胞瘤的療效及其組織病理相關性。
方法：這項單中心回顧研究針對經組織學證實的骨巨細胞瘤（GCTB）患者，回顧根據標準化方案以新輔助和佐劑denosumab治療所有患者的臨床數據。診斷後的隨訪期為4至30個月。本研究記錄患者疼痛減輕或功能改善和主要藥物不良反應，並利用不規則間隔拍攝的X線片、CT和MRI評估治療前後的腫瘤反應，以及進行組織樣本病理評估以評估巨細胞與骨基質的百分比以及新骨生成。
結果：2012年7月20日至2015年6月5日期間共12名患者接受denosumab治療GCTB，其中10例（83.3%）患者在2016年9月前無腫瘤復發；11例（91.6%）患者報告疼痛減輕或功能改善，沒有因治療引發的嚴重併發症。在接受放射學評估的11名患者和接受CT評估的4名患者中，分別有10名（90.9%）和4名（100%）顯示極佳治療反應。連續MRI評估顯示11例患者中有2例（18.2%）腫瘤復發。所有患者皆顯示組織病理學腫瘤療效。
結論：在臨床、放射學和組織病理學反應方面皆顯示denosumab為治療GCTB的有效方法。本研究未有發現重要併發症。X線片和CT是用於臨床評估denosumab對GCTB療效的有用工具。