The role of denosumab in the complex treatment of giant cell tumor of the spine: reducing of local recurrence rate, surgery time and blood loss

Objective. To assess the effect of the combined treatment method including preoperative denosumab therapy on the results of treatment of patients with giant cell tumors of the spine.Material and Methods. A single-center retrospective-prospective study of a series of clinical cases included 15 patients with giant cell tumors of vertebrae. The average follow-up period was 56 months. A total of 11 patients received denosumab therapy according to the following scheme: 120 mg subcutaneously on the 1st, 8th, 15th and 28th days of the first month and then once every 28 days. Surgical options included marginal resection, segmental resection, or en-bloc resection with or without spinal reconstruction/stabilization. In the case of locally advanced and inoperable disease, long-term therapy with denosumab was carried out until the disease progressed or serious adverse events appeared.Results. Thoracic vertebrae were involved in 7 (46.6 %) of 15 cases, lumbar in 4 (26.7 %) and cervical in 4 (26.7 %). Local recurrence rate after surgery alone was 40 % (2/5), average time to recurrence onset was 4.5 months. No relapses were observed after combined treatment performed in four patients. Disease progression during long-term denosumab therapy for inoperable disease recurrence was not recorded (0/7). The average number of denosumab injections before surgery and during long-term therapy was 15 and 24 injections, respectively. Denosumab therapy allows reducing the duration of surgery and the volume of blood loss.Conclusion. Combined therapy of giant cell vertebral tumor allows to reduce the risk of recurrence of the disease, as well as to reduce surgery duration and blood loss. Long-term continuous therapy for inoperable cases allows achieving long-term stabilization of the effect. Due to the rarity of giant cell tumors of the spine, a further prospective recruitment of patients is required to study the efficacy and safety of combined therapies.

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Staged sacrectomy—an adaptive approach

Journal of Neurosurgery Spine ◽

10.3171/2009.3.spine08824 ◽

2009 ◽

Vol 11 (3) ◽

pp. 285-294 ◽

Cited By ~ 26

Author(s):

Rajaraman Ramamurthy ◽

Jagadish Chandra Bose ◽

Vimalakannan Muthusamy ◽

Mayilvahanan Natarajan ◽

Deiveegan Kunjithapatham

Keyword(s):

Survival Rate ◽

Local Recurrence ◽

Blood Loss ◽

Giant Cell Tumor ◽

Giant Cell ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Cell Tumor ◽

Wound Complications ◽

Kaplan Meier

Object Sacral tumors are commonly diagnosed late and therefore present at an advanced stage. The late presentation makes curative surgery technically demanding. Sacrectomy is fraught with a high local recurrence rate and potential complications: deep infection; substantial blood loss; large-bone and soft-tissue defects; bladder, bowel, and sexual dysfunction; spinopelvic nonunion; and gait disturbance. The aim of this study was to analyze the complications and morbidity of sacrectomy and the modifications meant to reduce the morbidity. Methods This is a retrospective study of the patients who underwent sacrectomy between February 1997 and September 2008 in the Department of Surgical Oncology, Government Royapettah Hospital, Kilpauk Medical College, in Chennai, Tamilnadu, India. Sacrectomy was performed using 1 of the following approaches: posterior approach, abdominolateral approach, or abdominosacral approach, either as sequential or staged operations. The morbidity rate after the sequential and staged abdominosacral approaches was analyzed. Functional assessment was made based on the Enneking functional scoring system. The results were analyzed and survival analysis was done using the Kaplan-Meier method (with SPSS software). Results Nineteen patients underwent sacrectomy, of which 12 operations were partial, 3 were subtotal, and 4 were total sacrectomy. Histological diagnosis included giant cell tumor, chordoma, chondroblastoma, adenocarcinoma of rectum, and retroperitoneal sarcoma. The giant cell tumor was the most common tumor in this series, followed by chordoma. The patients' mean age at diagnosis was 32 years. There were 10 male and 9 female patients. Fortyseven percent of patients had bowel and bladder disturbances postoperatively, and 57.89% of patients had wound complications. The median follow-up duration was 24 months (range 2–140 months). The 5-year overall survival rate was 70.4%, and the 5-year disease-free survival rate was 65% (based on the Kaplan-Meier method). The local recurrence rate (5 cases) was 26.32%. The median duration for first recurrence was 12 months (range 3–17 months). Distant metastasis occurred in 1 patient (5.26%), and 4 patients died, 1 of them due to pulmonary thromboembolism, in the postoperative period. Based on the Enneking system of functional evaluation, 5 patients (26.32%) had excellent outcome, 6 (31.57%) had good outcome, 5 (26.32%) had fair outcome, and 3 (15.78%) had poor outcome. Spinopelvic reconstruction was not performed in any of the patients, and all were ambulatory postoperatively. The staged abdominosacral approach has markedly reduced patient morbidity in terms of reduction of operating time, blood loss, anesthesia complications, and wound complications. Conclusions Sacrectomy, a dreaded operation that often results in morbidity, is now feasible with modifications and improvement in surgical technique. The staged abdominosacral approach reduces the immediate postoperative morbidity. Use of a gluteal advancement flap reduces the incidence of wound complications. With modern surgical facilities and postoperative care, sacrectomy is feasible via the staged abdominosacral approach.

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What’s new in musculoskeletal oncology

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04590-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Costantino Errani ◽

Andreas F. Mavrogenis ◽

Shinji Tsukamoto

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Giant Cell ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Bone Tumors ◽

Long Bone ◽

Giant Cell Tumors ◽

Poor Prognostic Factor ◽

New Treatment

AbstractWe reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems and three-dimensional-printed prostheses seem to be new treatment options, especially in challenging anatomical locations, such as the sacrum and pelvis. Regarding the treatment of giant cell tumor of bone, recent studies have suggested that denosumab administration is related to a higher local recurrence rate following curettage, but a lower local recurrence rate following en bloc resection. In addition, there was no difference in the local recurrence rate at five years after surgery between short-term and long-term denosumab therapy. With regard to soft tissue tumors, percutaneous cryoablation appears to be a new treatment option for extra-abdominal desmoid tumors, with encouraging results. Regarding soft tissue sarcomas, a negative surgical margin of < 1 mm is sufficient to control local recurrence. Pexidartinib seems to be a promising systemic therapy for the treatment of tenosynovial giant cell tumors for which surgery is not expected to improve the function of the affected limb. Finally, the life expectancy of patients is the most important factor in determining the optimal surgical procedure for patients with impending or pathological fractures of the long bone due to metastatic bone tumors. Elevated C-reactive protein level was found to be an independent poor prognostic factor at 1 year after surgery for long bone metastases.

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Modified Kraske Procedure with Mid-Sacrectomy and Coccygectomy forEn BlocExcision of Sacral Giant Cell Tumors

Case Reports in Surgery ◽

10.1155/2014/834537 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Vítor M. Gonçalves ◽

Álvaro Lima ◽

João Gíria ◽

Nuno Carvalho ◽

José Parreira ◽

...

Keyword(s):

Local Recurrence ◽

Giant Cell ◽

Treatment Options ◽

Complete Resection ◽

Tumor Control ◽

High Recurrence Rate ◽

Giant Cell Tumors ◽

En Bloc ◽

Sacral Tumors

Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed,en blocexcision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique foren blocexcision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.

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MP80-01 THE USE OF INTRA-OPERATIVE FROZEN SECTION DURING ORGAN SPARING SURGERY FOR PENILE CANCER GREATLY REDUCES THE LOCAL RECURRENCE RATE. LONG TERM FOLLOW UP DATA

The Journal of Urology ◽

10.1016/j.juro.2017.02.2506 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Ayman Younis ◽

Dawn Cave ◽

John Dormer ◽

Timothy Terry ◽

Jonathan Goddard ◽

...

Keyword(s):

Local Recurrence ◽

Recurrence Rate ◽

Penile Cancer ◽

Local Recurrence Rate ◽

Frozen Section ◽

Long Term Follow Up ◽

Organ Sparing

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P1.14-015 Local Recurrence Rate and Timing after Stereotactic Body Radiotherapy for Lung Cancer: Need for Long-term Follow-up

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2017.09.1033 ◽

2017 ◽

Vol 12 (11) ◽

pp. S2041-S2042

Author(s):

T. Shintani ◽

Y. Matsuo ◽

T. Mitsuyoshi ◽

Y. Iizuka ◽

T. Mizowaki

Keyword(s):

Lung Cancer ◽

Local Recurrence ◽

Recurrence Rate ◽

Stereotactic Body Radiotherapy ◽

Local Recurrence Rate ◽

Long Term Follow Up

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Outcomes of surgery for giant cell tumors of the tendon sheath within the hand.

Polish Journal of Surgery ◽

10.5604/01.3001.0014.4136 ◽

2020 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

Andrzej Żyluk ◽

Ada Owczarska

Keyword(s):

Giant Cell ◽

Recurrence Rate ◽

Surgical Margin ◽

Tendon Sheath ◽

High Rate ◽

High Recurrence Rate ◽

Giant Cell Tumors ◽

Proliferative Lesion

Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterised by relatively high recurrence rate after surgery. The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumours, in a long-term (a mean of 4,2 year) follow-up. Patients and methods. Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated on), at a mean of 4,2 year follow-up. The final assessment was performed in a form of phone interview. Results. The tumours most frequently were located in fingers - 42 cases (72%). In 31 patients (53%) the lesion had well-defined capsule, and in 11 (19%) a satellite nodules were found around the main tumour. A total of 9 relapses (21%) occurred, all within first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with the recurrence, the primary lesion had not well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained from mild pain of the scar and/or numbness of the part of the involved finger. Conclusions. The main factor influencing the high rate of recurrence was incomplete tumour excision, what resulted from inadequately accurate surgery and the tumour morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping greater surgical margin at resection of the non-capsulated lesions was emphasised, what may translate into reducing of the recurrence rate.

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The Impact of the Introduction of Total Mesorectal Excision on Local Recurrence Rate and Survival in Rectal Cancer: Long-Term Results

Annals of Surgical Oncology ◽

10.1245/s10434-011-1571-0 ◽

2011 ◽

Vol 18 (7) ◽

pp. 1899-1906 ◽

Cited By ~ 54

Author(s):

C. A. Maurer ◽

P. Renzulli ◽

C. Kull ◽

S. A. Käser ◽

L. Mazzucchelli ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Total Mesorectal Excision ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Long Term Results ◽

Mesorectal Excision ◽

The Impact

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The role and place of azelaic acid in the routes of patients with acne vulgaris

Vestnik dermatologii i venerologii ◽

10.25208/vdv1175-2020-96-5-65-70 ◽

2020 ◽

Vol 96 (5) ◽

pp. 65-70

Author(s):

E. S. Snarskaya

Keyword(s):

Systematic Reviews ◽

Azelaic Acid ◽

Acne Vulgaris ◽

Combined Treatment ◽

Term Therapy ◽

Topical Retinoids ◽

Symptom Complex ◽

Long Term Therapy ◽

Topical Medications

The review presents data from foreign and domestic clinical studies on the efficacy and safety of azelaic acid (Skinoren) in the treatment of acne vulgaris. New aspects of pathogenesis are presented, an analysis of the database of systematic reviews of Russian, European, American researchers is presented, including an analysis of the database of systematic reviews of the Cochrane Systematic Review Intervention Version of the Cochrane Skin Group (2020) comparative studies on the effectiveness of azelaic acid, Skinoren and other topical topical medications for the treatment of acne vulgaris. Possibilities of monotherapy with the preparation of azaelaic acid Skinoren and variants of combined treatment, in particular, a combination of azelaic acid with topical retinoids, benzoyl peroxide, systemic and topical antibiotics for the treatment of acne of varying severity, are shown. Reliable efficacy, safety, the possibility of long-term therapy, high compliance allow us to conclude that Skinoren is highly effective in treating acne, and a number of priority complex advantages, such as the presence of anti-inflammatory, antibacterial, anti-keratinizing, antiandrogenic and anti-tyrosinase action, allow Skinoren to be considered as optimal. topical agent for long-term and safe treatment of acne and prevention of the development of post-acne symptom complex.

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