European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Indication-specific use of Denosumab in Giant Cell Tumour of Bone: A retrospective cohort study.
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Duivenvoorden Mylene Jc, Kurisunkal Vineet, Hannink Gerjon, Parry Michael, Jeys Lee, Verspoor Floortje Gm
Аннотация
INTRODUCTION: Giant Cell Tumours of Bone (GCTB) are locally aggressive, benign bone tumours. Denosumab was initially introduced as a neoadjuvant therapy to facilitate curettage but is now also used prior to en-bloc resection, as definitive treatment for unresectable disease, and as long-term treatment for recurrent or metastatic disease. Evidence regarding indication-specific outcomes remains limited. This study evaluated contemporary Denosumab use according to treatment intent, focusing on treatment duration, recurrence patterns, and long-term administration.
MATERIALS AND METHODS: A retrospective review was conducted of all GCTB patients treated with Denosumab at the Royal Orthopaedic Hospital, Birmingham, between 2010 and 2023. Patients were categorized according to treatment intent: 1) Short-course Neoadjuvant Denosumab (SCND), 2) Long-course Neoadjuvant Denosumab (LCND), 3) Definitive Denosumab for unresectable disease, and 4) Long-term Denosumab following local or distant recurrence.
RESULTS: The study included 155 patients. Twenty-eight patients (18%) received SCND for median 15 weeks (IQR 11-20), local recurrence occurring in 13 patients (46%). Fifty-two patients (34%) received LCND for median 22 weeks (IQR 13-54), local recurrence occurring in 6 patients (12%). Forty-two patients (27%) received definitive Denosumab for median 123 weeks (IQR 83-182), while 33 patients (21%) received long-term Denosumab following recurrence for median 123 weeks (IQR 29-247). Dose de-escalation was frequently feasible in patients with sustained disease control, whereas adverse events were primarily associated with prolonged treatment exposure.
CONCLUSION: This study demonstrates that Denosumab is used across several distinct clinical indications in GCTB. High recurrence rates were observed following short-course neoadjuvant treatment prior to curettage, whereas prolonged disease control was frequently achieved in selected patients receiving definitive or long-term Denosumab. A preliminary clinical framework for indication-specific Denosumab use is proposed and warrants prospective validation.
MATERIALS AND METHODS: A retrospective review was conducted of all GCTB patients treated with Denosumab at the Royal Orthopaedic Hospital, Birmingham, between 2010 and 2023. Patients were categorized according to treatment intent: 1) Short-course Neoadjuvant Denosumab (SCND), 2) Long-course Neoadjuvant Denosumab (LCND), 3) Definitive Denosumab for unresectable disease, and 4) Long-term Denosumab following local or distant recurrence.
RESULTS: The study included 155 patients. Twenty-eight patients (18%) received SCND for median 15 weeks (IQR 11-20), local recurrence occurring in 13 patients (46%). Fifty-two patients (34%) received LCND for median 22 weeks (IQR 13-54), local recurrence occurring in 6 patients (12%). Forty-two patients (27%) received definitive Denosumab for median 123 weeks (IQR 83-182), while 33 patients (21%) received long-term Denosumab following recurrence for median 123 weeks (IQR 29-247). Dose de-escalation was frequently feasible in patients with sustained disease control, whereas adverse events were primarily associated with prolonged treatment exposure.
CONCLUSION: This study demonstrates that Denosumab is used across several distinct clinical indications in GCTB. High recurrence rates were observed following short-course neoadjuvant treatment prior to curettage, whereas prolonged disease control was frequently achieved in selected patients receiving definitive or long-term Denosumab. A preliminary clinical framework for indication-specific Denosumab use is proposed and warrants prospective validation.