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Bisphosphonate-loaded Bone Cement as a Local Adjuvant Therapy for Giant Cell Tumor of Bone

A 1 to 12-Year Follow-up Study

Greenberg, David D., MD*; Lee, Francis Y., MD, PhD

American Journal of Clinical Oncology: March 2019 - Volume 42 - Issue 3 - p 231–237
doi: 10.1097/COC.0000000000000504
Original Articles: Sarcoma
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Background: Historically, nontargeted adjuvant therapies such as liquid nitrogen, phenol, argon beam, and alcohol have been applied locally after curettage of giant cell tumors (GCT) in the extremities. Systemic bisphosphonates (BP) and denosumab have emerged as osteoclast-targeting therapies because osteoclast-like giant cells, responsible for aggressive bone resorption, are susceptible to BP or denosumab. However, such drugs may cause systemic side effects. We examined the effects of an alternative intraoperative local delivery of BP on GCTs.

Materials and Methods: In total, 17 patients with GCTs underwent extended surgical curettage procedures consisting of high-speed burring, traditional adjuvant therapy, and application of BP-loaded polymethylmethacrylate bone cement. Clinical data and follow-up radiographs were reviewed to investigate local recurrence (LR) rate and complications in a retrospective manner.

Results: There were 6 males and 11 females (mean age, 33.7 y). There were no cases of pulmonary metastases. Patient follow-up ranged from 1 to 12 years. There was 1 LR during the follow-up period for an LR rate of 5.9%. The mean final Musculoskeletal Tumor Society (MSTS) score was 29. There were no systemic or localized avascular necrosis or atypical fractures related to BPs noted.

Conclusions: BP-loaded polymethylmethacrylate is a targeted local adjuvant therapy that is feasible, safe, and may reduce LRs while alleviating the risk of systemic side effects of BPs such as avascular necrosis of jaw and atypical femur fractures. Future prospective randomized clinical trials will strengthen the level of evidence of this proposed targeted therapy.

Level of Evidence: Therapeutic level IV—see instructions for authors for a complete description of evidence.

*Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO

Department of Orthopaedic Surgery, Yale University, New Haven, CT

The authors declare no conflicts of interest.

Reprints: David D. Greenberg, MD, Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO 63110. E-mail: david.greenberg@health.slu.edu.

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