Clinical outcome of extended curettage with postoperative denosumab administration for the treatment of Campanacci Grade III giant cell tumors of the extremities

Abstract

Abstract Background Management of Campanacci Grade III giant cell tumors of the extremities is controversial because wide resection with reconstruction results in a poor functional outcome for most patients. Denosumab has been used before operation to enable curettage and surgical downstaging in patients with giant cell tumor of bone (GCTB), where joint preservation is difficult. However, owing to osteosclerosis of the lesion and difficulty to curet the lesion thoroughly, preoperative denosumab treatment increases the local recurrence rate. It is unclear whether postoperative treatment with denosumab facilitate the ability of a joint to be salvaged by intralesional surgery instead of resection. Therefore, we performed a retrospective study to investigate the local recurrence rate, joint preservation status, and functional outcomes after extended curettage and postoperative denosumab treatment in Campanacci Grade III giant cell tumors of the extremities. Methods We retrospectively reviewed 23 patients with Campanacci Grade III GCTB of the extremities in our hospital from January 2017 to June 2023, who underwent extended curettage and postoperative denosumab administration alone, without preoperative denosumab treatment. Patients were followed for adverse events of denosumab, surgical outcome, limb function of lesions, and local recurrence following extended curettage with postoperative denosumab . Results All incisions were healed without deep infection and internal fixation failure. The mean age of the patients at surgery was 36.6 years, and the mean followup was 35.8 months ( range, 6–72 months). There of the 23 patients had local recurrence years postoperatively. The recurrence rate is 13.0%. Two was treated with repeat intralesional surgery with no additional recurrence 2 years later, and another was treated with en bloc resection and reconstruction with vascularised fibular graft. One patient had progression to knee osteoarthritis without oral analgesics. No patient had pulmonary metastases develop and malignant transformation of GCTB. The mean Musculoskeletal Tumor Society functional scores at last followup were 27.3 of 30 (range,25–29). No serious adverse events were detected due to denosumab. Conclusion Our observations suggest extended curettage with postoperative denosumab administration is a reasonable option for Campanacci Grade III giant cell tumors of the extremities. Extended curettage with adjuvant denosumab therapy resulted in beneficial surgical downstaging, including either a less morbid surgical procedure or delayed en bloc resection. Maybe, resection should be considered when structural integrity cannot be regained after bone grafting or bone cement filling combined with intemal fixation.