The clinical approach toward giant cell tumor of bone.
We provide an overview of imaging, histopathology, genetics, and multidisciplinary treatment of giant cell tumor of bone (GCTB), an intermediate, locally aggressive but rarely metastasizing tumor. Overexpression of receptor activator of nuclear factor κB ligand (RANKL) by mononuclear neoplastic stromal cells promotes recruitment of numerous reactive multinucleated giant cells. Conventional radiographs show a typical eccentric lytic lesion, mostly located in the meta-epiphyseal area of long bones. GCTB may also arise in the axial skeleton and very occasionally in the small bones of hands and feet. Magnetic resonance imaging is necessary to evaluate the extent of GCTB within bone and surrounding soft tissues to plan a surgical approach. Curettage with local adjuvants is the preferred treatment. Recurrence rates after curettage with phenol and polymethylmethacrylate (PMMA; 8%-27%) or cryosurgery and PMMA (0%-20%) are comparable. Resection is indicated when joint salvage is not feasible (e.g., intra-articular fracture with soft tissue component). Denosumab (RANKL inhibitor) blocks and bisphosphonates inhibit GCTB-derived osteoclast resorption. With bisphosphonates, stabilization of local and metastatic disease has been reported, although level of evidence was low. Denosumab has been studied to a larger extent and seems to be effective in facilitating intralesional surgery after therapy. Denosumab was recently registered for unresectable disease. Moderate-dose radiotherapy (40-55 Gy) is restricted to rare cases in which surgery would lead to unacceptable morbidity and RANKL inhibitors are contraindicated or unavailable.
Departments of Orthopedic Surgery, Clinical Oncology, Radiology, and Pathology, Leiden University Medical Center, Leiden, The Netherlands.
Lizz
L
van der Heijden
P D Sander
PD
Dijkstra
Michiel A J
MA
van de Sande
Judith R
JR
Kroep
Remi A
RA
Nout
Carla S P
CS
van Rijswijk
Judith V M G
JV
Bovée
Pancras C W
PC
Hogendoorn
Hans
H
Gelderblom
D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D003131:Combined Modality Therapy; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D053245:RANK Ligand / Q000037:antagonists & inhibitors* / Q000096:biosynthesis; D011859:Radiography
D061067:Antibodies, Monoclonal, Humanized; D004164:Diphosphonates; D053245:RANK Ligand; C505688:TNFSF11 protein, human; D000069448:Denosumab
Curettage; Denosumab; GCTB; Giant cell tumor of bone; Histopathology; RANK ligand; Radiotherapy; Review