1
|
Trovarelli G, Rizzo A, Cerchiaro M, Pala E, Angelini A, Ruggieri P. The Evaluation and Management of Lung Metastases in Patients with Giant Cell Tumors of Bone in the Denosumab Era. Curr Oncol 2024; 31:2158-2171. [PMID: 38668063 PMCID: PMC11049429 DOI: 10.3390/curroncol31040160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Giant cell tumor of bone (GCTB) is characterized by uncertain biological behavior due to its local aggressiveness and metastasizing potential. In this study, we conducted a meta-analysis of the contemporary literature to evaluate all management strategies for GCTB metastases. A combination of the terms "lung metastases", "giant cell tumor", "bone", "treatment", and "oncologic outcomes" returned 133 patients meeting our inclusion criteria: 64 males and 69 females, with a median age of 28 years (7-63), at the onset of primary GCTB. Lung metastases typically occur at a mean interval of 26 months (range: 0-143 months) after treatment of the primary site, commonly presenting as multiple and bilateral lesions. Various treatment approaches, including surgery, chemotherapy, radiotherapy, and drug administration, were employed, while 35 patients underwent routine monitoring only. Upon a mean follow-up of about 7 years (range: 1-32 years), 90% of patients were found to be alive, while 10% had died. Death occurred in 25% of patients who had chemotherapy, whereas 96% of those not treated or treated with Denosumab alone were alive at a mean follow-up of 6 years (range: 1-19 years). Given the typically favorable prognosis of lung metastases in patients with GCTB, additional interventions beyond a histological diagnosis confirmation may not be needed. Denosumab, by reducing the progression of the disease, can play a pivotal role in averting or delaying lung failure.
Collapse
Affiliation(s)
- Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Arianna Rizzo
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, 35128 Padua, Italy; (G.T.); (A.R.); (M.C.); (E.P.); (A.A.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padua, Italy
| |
Collapse
|
2
|
Tsukamoto S, Mavrogenis AF, Tanaka Y, Kido A, Honoki K, Tanaka Y, Errani C. Metastasectomy Versus Non-Metastasectomy for Giant Cell Tumor of Bone Lung Metastases. Orthopedics 2021; 44:e707-e712. [PMID: 34618641 DOI: 10.3928/01477447-20211001-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Approximately 2% to 9% of giant cell tumor of bone (GCTB) metastasizes systemically, mainly to the lungs. The biological behaviors and clinical courses of lung metastases are difficult to predict, and their treatment recommendations vary, including metastasectomy and non-metastasectomy with chemotherapy (denosumab, interferon-alfa, bisphosphonates), with radiation therapy, or with observation alone. However, it is unclear whether metastasectomy for GCTB lung metastases decreases the mortality rate of these patients. Therefore, the authors performed this systematic review to compare metastasectomy and non-metastasectomy for GCTB patients with operable lung metastasis. Of the 919 relevant studies, 16 studies (138 patients) were included for analysis; 61.6% of patients had metastasectomy and 38.4% had non-metastasectomy. Analysis showed that mortality rates were similar for the patients who had metastasectomy compared with those who did not; the proportion of patients who died of disease was 7.1% in the metastasectomy group and 17.0% in the non-metastasectomy group, with an overall pooled odds ratio of 0.64 (P=.36). Therefore, physicians should reconsider the potential risks and benefits of metastasectomy for patients with GCTB and lung metastasis, because metastasectomy does not reduce the mortality rate in these patients. [Orthopedics. 2021;44(6):e707-e712.].
Collapse
|
3
|
Tsukamoto S, Ciani G, Mavrogenis AF, Ferrari C, Akahane M, Tanaka Y, Rocca M, Longhi A, Errani C. Outcome of lung metastases due to bone giant cell tumor initially managed with observation. J Orthop Surg Res 2020; 15:510. [PMID: 33160367 PMCID: PMC7648999 DOI: 10.1186/s13018-020-02038-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background The outcomes of patients with lung metastases from giant cell tumor of bone (GCTB) vary from spontaneous regression to uncontrolled growth. To investigate whether observation is an appropriate first-line management approach for patients with lung metastases from GCTB, we evaluated the outcomes of patients who were initially managed by observation. Methods We retrospectively reviewed the data of 22 patients with lung metastases from histologically confirmed GCTB who received observation as a first-line treatment approach. The median follow-up period was 116 months. Results Disease progression occurred in 12 patients (54.5%). The median interval between the discovery of lung metastases and progression was 8 months. Eight patients underwent metastasectomy following initial observation. The median interval between the discovery of lung metastases and treatment by metastasectomy was 13.5 months. None of the patients experienced spontaneous regression. Of the 22 patients, 36.4% needed a metastasectomy, and 9.1% required denosumab treatment during the course of the follow-up period. Disease progression occurred in 45.5% of the 11 patients with lung nodules ≤ 5 mm, while all five of the patients with lung nodules > 5 mm experienced disease progression. Progression-free survival was significantly worse in the group with lung nodules > 5 mm compared to the group with lung nodules ≤ 5 mm (p = 0.022). Conclusions Observation is a safe first-line method of managing patients with lung metastases from GCTB. According to radiological imaging, approximately half of the patients progressed, and approximately half required a metastasectomy or denosumab treatment. However, patients with lung nodules > 5 mm should receive careful observation because of the high rate of disease progression in this group.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
| | - Giovanni Ciani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Holargos, Athens, Greece
| | - Cristina Ferrari
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Michele Rocca
- Thoracic Surgery Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alessandra Longhi
- Oncology Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Costantino Errani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
4
|
Sachan DK, Bansal N, Gupta S, Kumar S. A rare case of giant cell tumour (GCT) of bone with lung metastases. BMJ Case Rep 2018; 2018:bcr-2017-221667. [PMID: 29326370 DOI: 10.1136/bcr-2017-221667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case of 16-year-old girl with giant cell tumour of right fibula is presented to us with bilateral lung metastases. In view of widespread bilateral lung metastatic lesions, the patient was given multimodality treatment. Chemotherapy followed by radiotherapy to the local site as well as lung bath has been given and has shown good response.
Collapse
Affiliation(s)
| | - Nupur Bansal
- Department of Radiotherapy, King George's Medical University, Lucknow, UP, India
| | | | - Sanjeev Kumar
- Department of Radiotherapy, King George's Medical University, Lucknow, UP, India
| |
Collapse
|
5
|
Balasubramanian N, Gnanasundaram R, Prakasam S. Endoprosthetic Reconstruction of distal Humerus following Resection of distal Humeral Giant Cell Tumours in Six Patients in Rural India. Malays Orthop J 2017; 11:25-29. [PMID: 29021875 PMCID: PMC5630047 DOI: 10.5704/moj.1707.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4) who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.
Collapse
Affiliation(s)
- N Balasubramanian
- Department of Orthopaedics, Saveetha Medical College & University, Chennai, India
| | - R Gnanasundaram
- Department of Orthopaedics, Saveetha Medical College & University, Chennai, India
| | - S Prakasam
- Department of Orthopaedics, Saveetha Medical College & University, Chennai, India
| |
Collapse
|
6
|
Sakanoue I, Hamakawa H, Onishi E, Imai Y, Takahashi Y. Giant cell tumor of the rib with direct invasion into the thoracic spine. Gen Thorac Cardiovasc Surg 2016; 65:293-296. [PMID: 27169847 DOI: 10.1007/s11748-016-0656-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Abstract
Giant cell tumors of bone are relatively rare, benign, but locally aggressive osteolytic skeletal neoplasms of young adults. They usually affect the epiphyses of long bones, especially around the knee joint, and are rarely seen in the ribs. The mainstay of therapy is surgical resection. Herein, we report a case of successful resection in a patient who presented with primary giant cell tumor of the rib, directly invading the thoracic spine. Computed tomography and magnetic resonance imaging were helpful for assessing the depth of tumor invasion. Radical resection of the tumor and reconstruction of the vertebrae with preserved allograft bone were performed. No respiratory or neurological problems occurred, and the patient remained well 2 years after surgery.
Collapse
Affiliation(s)
- Ichiro Sakanoue
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Hiroshi Hamakawa
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Eijiro Onishi
- Department of Orthopedics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Takahashi
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| |
Collapse
|