title: The dilemma of denosumab: Salvage of a femoral head giant cell tumour.
abstract: BACKGROUND
  Denosumab is a monoclonal RANKL antibody which has been shown to be highly effective in treating giant cell tumour (GCT) of bone. We report on its use as a neo-adjuvant agent to avoid morbid surgery for an adolescent.
  
  
  METHODS
  We report a case of a15-year old female with a Campanacci 3 GCT involving the femoral head and neck.
  
  
  CONCLUSIONS
  To preserve bone stock and avoid an outright hip replacement, the patient was given denosumab pre-operatively to consolidate the tumour. After receiving 6 months of treatment, a rim of cortical bone had developed to allow an extended curettage of the tumour to be performed without fear of collapse of the articular surface.
  
  
  CONCLUSIONS
  This is the first reported case of the use of denosumab in GCT of the femoral head and neck. We describe our experience in the neo-adjuvant use of denosumab and offer suggestions for future use. Further studies will be needed to see if denosumab has a role in conventional GCT and whether it can lead to a lowering of local recurrence rates.
authors.affiliation: Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK. Electronic address: Louie.gaston@nhs.net.
authors.forename: Czar Louie
authors.initials: CL
authors.lastname: Gaston
authors.affiliation: Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK.
authors.forename: Florian
authors.initials: F
authors.lastname: Puls
authors.affiliation: Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK.
authors.forename: Robert John
authors.initials: RJ
authors.lastname: Grimer
keywords: Denosumab; Femoral head; GCT; Giant cell tumour; Hip