Radiological Evaluation of the Efficacy of Denosumab as a Treatment for Giant-cell Tumour of Bone with Histopathological Correlation

Full Article

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