探索地诺单抗在动脉瘤性骨囊肿治疗中的潜力:范围综述。

IF 1.6 4区 医学 Journal of Orthopaedic Surgery Pub Date : 2024-09-01 DOI:10.1177/10225536241297105
Vinesh Sandhu, Vivek Ajit Singh, Ajay Puri
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引用次数: 0

摘要

背景地诺单抗通过抑制破骨细胞的活性,有效治疗 RANKL 介导的骨疾病。虽然地诺单抗已被批准用于治疗巨细胞瘤,但其在动脉瘤性骨囊肿(ABC)中的作用仍不明确。本综述探讨了地诺单抗在动脉瘤骨囊肿中的应用,重点关注其作用、疗效和不良反应。方法:按照PRISMA扩展范围综述指南进行了范围综述。从开始到 2023 年 12 月 31 日,共检索了五个数据库。结果从最初的 390 项研究中,筛选出 29 项,涉及 67 名患者。最常见的ABC部位是脊柱(42例)和骨盆(7例)。25名患者(37.3%)接受了地诺单抗作为主要治疗手段,11名患者(16.4%)接受了新辅助治疗,24名患者(35.8%)在初始治疗效果不佳后接受了二线治疗,7名患者接受了辅助治疗。所有患者在接受地诺单抗治疗后均有良好的临床和放射学反应。10例患者(15%)出现肿瘤复发:6例在停用地诺单抗后(停药后3-17个月)复发,3例在新辅助地诺单抗治疗后的手术后复发,1例在持续治疗期间复发。报告的不良反应包括低钙血症(10 例)、高钙血症(14 例)和骨骺硬化带(2 例),均发生在儿童年龄组。低钙血症出现在地诺单抗治疗的早期,而高钙血症则出现在停药后的 2.5-6 个月,主要通过双膦酸盐治疗。只有不到一半的研究随访时间超过 2 年。结论地诺单抗可能是治疗ABC的有效方法,尤其是对于脊柱和盆腔肿瘤等高风险病例。它还可作为复发/初次干预失败的二线治疗或新辅助治疗。肿瘤复发和反弹性高钙血症是令人担忧的问题,因此有必要进行仔细监测、延长随访时间并采取预防措施。需要进行前瞻性临床试验,以获得更深入的见解。
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Exploring Denosumab's potential in aneurysmal bone cyst treatment: A scoping review.

Background: Denosumab effectively treats RANKL-mediated bone disorders by inhibiting osteoclast activity. While approved for giant cell tumours, its role in aneurysmal bone cysts (ABC) remains unclear. This review explores denosumab's application in ABCs, focusing on its role, outcomes, and adverse effects. Methods: A scoping review adhering to PRISMA Extension for Scoping Reviews guidelines was conducted. The search involved five databases from inception until 31 December 2023. Results: From an initial 390 studies, 29 were selected post-screening involving 67 patients. The most common ABC sites were the spine (n = 42) and pelvis (n = 7). Denosumab served as primary treatment in 25 patients (37.3%), neoadjuvant in 11 (16.4%), second-line therapies after inadequate initial therapies in 24 (35.8%), and adjunct therapy in seven cases. All patients demonstrated favourable clinical and radiological responses post-denosumab. 10 patients (15%) experienced tumour recurrences: six after denosumab discontinuation (3-17 months post-cessation), three post-surgery following neoadjuvant denosumab, and one during ongoing treatment. Adverse effects reported were hypocalcaemia (n = 10), hypercalcemia (n = 14), and sclerotic metaphyseal bands (n = 2), all in the paediatric age group. While hypocalcaemia surfaced early in denosumab therapy, hypercalcaemia manifested 2.5-6 months post-discontinuation, mainly managed with bisphosphonates. Fewer than half of the studies had follow-ups that exceeded 2 years. Conclusion: Denosumab may be an effective therapy for ABC, especially for high-risk cases like spinal and pelvic tumours. It can also be utilized as a second-line for recurrence/failed initial intervention or as neoadjuvant therapy. Concerns exist about tumour recurrence and rebound hypercalcemia, necessitating careful monitoring, longer follow-up, and prophylactic measures. Prospective clinical trials are warranted for deeper insights.

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期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
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