Preoperative denosumab combined with microwave ablation for joint preservation in advanced giant cell tumor of bone: a retrospective study.

IF 2.8 3区医学 Q1 ORTHOPEDICS Journal of Orthopaedic Surgery and Research Pub Date : 2025-02-18 DOI:10.1186/s13018-025-05589-3

Chuanxi Zheng, Xiayi Zhou, Gang Xu, Jin Qiu, Tao Lan, Wei Li, Shiquan Zhang

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Abstract

Background: Preoperative denosumab has been an essential part of the management of giant cell tumor of bone (GCTB) which enhanced subchondral bone integrity and facilitated joint preservation surgery. However, evidence suggests that denosumab-induced sclerotic changes may potentially increase the risk of postoperative recurrence. This study evaluates the efficacy of microwave ablation (MWA) as an adjuvant to intralesional curettage following denosumab treatment in advanced GCTB.

Methods: A retrospective review was conducted on 54 patients with extremity GCTB treated with preoperative denosumab between 2019 and 2024. 33 patients underwent curettage, while 21 patients underwent combined microwave ablation with curettage. The recurrence rates and joint preservation rates were analyzed. Functional outcomes were assessed by the Musculoskeletal Tumor Society (MSTS) score.

Results: Local recurrence occurred in 14 patients, including 3 in the MWA group and 11 in the curettage-only group. In the MWA group, all recurrences were managed with repeat curettage, whereas 6 patients in the curettage-only group required extensive resection. The joint preservation rate was significantly higher in the MWA group (100%) compared to the curettage-only group (81.8%). The local recurrence rate was lower in the MWA group (14.3%) than in the curettage-only group (33.3%), with two-year local recurrence-free survival rates of 95.2% and 68.2%, respectively; however, the difference was not statistically significant (P = 0.12). Functional outcomes were comparable, with a mean MSTS score of 24.9 ± 1.33.

Conclusion: The preoperative denosumab combined with adjuvant MWA offers an alternative approach to enhance joint preservation in advanced GCTB, emphasizing its potential as an effective adjuvant strategy. Further large-scale studies are warranted to validate these findings and refine treatment strategies.

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术前地诺单抗联合微波消融用于晚期骨巨细胞瘤的关节保存：回顾性研究。

背景：术前denosumab已成为骨巨细胞瘤（GCTB）治疗的重要组成部分，可增强软骨下骨完整性并促进关节保留手术。然而，有证据表明，denosumab诱导的硬化改变可能会增加术后复发的风险。本研究评估了微波消融（MWA）作为地诺单抗治疗晚期GCTB后病灶内刮除的辅助治疗的效果。方法：对2019 - 2024年54例术前应用denosumab治疗的肢体GCTB患者进行回顾性分析。33例行刮除术，21例行微波消融联合刮除术。分析复发率和关节保存率。功能结果由肌肉骨骼肿瘤协会（MSTS）评分评估。结果：局部复发14例，其中MWA组3例，单纯刮刮组11例。在MWA组中，所有复发患者均通过重复刮除进行治疗，而仅刮除组中有6例患者需要广泛切除。MWA组关节保存率（100%）明显高于单纯刮痧组（81.8%）。MWA组局部复发率（14.3%）低于单纯刮宫组（33.3%），2年局部无复发生存率分别为95.2%和68.2%；但差异无统计学意义（P = 0.12）。功能结果具有可比性，平均MSTS评分为24.9±1.33。结论：术前denosumab联合辅助MWA为晚期GCTB提供了一种增强关节保护的替代方法，强调了其作为有效辅助策略的潜力。需要进一步的大规模研究来验证这些发现并完善治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.