Abstract
Simple SummaryAccording to the 2020 World Health Organization classification, a giant cell tumor of bone is an intermediate malignant bone tumor. Denosumab treatment before curettage should be avoided due to the increased risk of local recurrence. Administration of denosumab before en bloc resection of the giant cell tumors of the pelvis and spine facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for giant cell tumors of the sacrum. Denosumab therapy with or without embolization is indicated for inoperable giant cell tumors of the pelvis, spine, and sacrum. A wait-and-see approach is recommended for lung metastases at first, then denosumab should be administered to the growing lesions. Radiotherapy is not recommended owing to the risk of malignant transformation. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant giant cell tumors of bone.The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.
Highlights
Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available
Giant cell tumors of bone (GCTBs) are intermediate malignant bone tumors with h2igohf 17 local infiltration ability, which accounts for approximately 5% of all primary bone tumors
En bloc resection may be a reasonable option for patients with acetabular GCTB with a low local recurrence rate, it has a high incidence of complications [84]; if en bloc resection is planned, short-term denosumab treatment should be recommended prior to surgery to reduce the risk of intraoperative bleeding and the local recurrence rate
Summary
Giant cell tumors of bone (GCTBs) are intermediate malignant bone tumors with h2igohf 17 local infiltration ability, which accounts for approximately 5% of all primary bone tumors [1]. A recent systematic review reported that the use of one or two high-speed burrs, PMMA, or phenol could reduce the local recurrence rate by 50% compared to the use of simple curettage [33]. A recent systematic review reported that the recurrence rate was 20–100% in a group that received preoperative denosumab therapy and underwent curettage and that it was 0–50% in a group that underwent curettage alone [15] This may be because preoperative administration of denosumab causes osteosclerosis, which makes it difficult to identify the tumor area intraoperatively, leaving the tumor behind, while the tumor cells hidden in the osteosclerotic lesion are reactivated after denosumab treatment is discontinued [14,15,49,50]. Preoperative denosumab administration (1–3 doses) is recommended; the local recurrence rates were similar between patients receiving 1–3 doses and those receiving ≥3 doses of denosumab preoperatively (27% (13 of 48 patients) vs. 36% (13 of 36 patients)), reducing the costs and the incidence of denosumab-related complications [59]
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