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Review
. 2021 Jul 21;13(15):3647.
doi: 10.3390/cancers13153647.

Current Concepts in the Treatment of Giant Cell Tumors of Bone

Shinji Tsukamoto  1 , Andreas F Mavrogenis  2 , Akira Kido  3 , Costantino Errani  4
Affiliations
Review

Current Concepts in the Treatment of Giant Cell Tumors of Bone

Shinji Tsukamoto et al. Cancers (Basel). .

Abstract

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.

Keywords: bisphosphonate; denosumab; giant cell tumor of bone; malignant transformation; metastasis; recurrence; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Treatment algorithm for giant cell tumors of the bone. GCTB: giant cell tumor of bone.
Figure 2
Figure 2
A case of sacral giant cell tumor of the bone treated with denosumab and embolization: (a) contrast-enhanced computed tomography at presentation showing osteolytic lesions of the sacrum and contrast-enhanced effects; (b) contrast-enhanced computed tomography showing bone sclerosis and loss of contrast effect 16 months after diagnosis, after 16 doses of denosumab and two sessions of embolization. The pain observed at presentation also improved. The patient experienced no complications related to denosumab therapy or embolization.
Figure 3
Figure 3
A patient with secondary malignant giant cell tumor of the proximal tibia who experienced malignant transformation after the third episode of local recurrence 6 years after the initial inversion recovery. (a) Radiograph shows a lytic lesion at lateral side of the proximal tibia (arrow). (b) The coronal fat-suppressed T2 W magnetic resonance image shows a high-intensity extraosseous lesion corresponding to a Campanacci stage 3 tumor (arrow).
See this image and copyright information in PMC

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