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European Spine Journal

, Volume 26, Supplement 1, pp 236–242 | Cite as

Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy

  • Noritaka Yonezawa
  • Hideki MurakamiEmail author
  • Satoshi Kato
  • Akihiko Takeuchi
  • Hiroyuki Tsuchiya
Case Report

Abstract

Purpose

Denosumab, a novel monoclonal antibody that targets the receptor activator of nuclear factor-κB (RANK) ligand (RANKL), has recently been used to treat patients with giant cell tumor of bone (GCTB). However, few reports have described the clinical results of denosumab therapy for spinal GCTB and evaluated treatment efficacy with respect to the entirety of the resected vertebra after denosumab therapy.

Methods

We present the case of a 51-year-old man with T12 GCTB that was completely removed by a total spondylectomy following 10 courses of neoadjuvant denosumab therapy. Post-therapy radiological findings indicated epidural tumor reduction in the spinal canal and sclerotic rim formation. However, the affected vertebra collapsed despite denosumab therapy and a massive bridging callus formation was present between the spinal GCTB and adjacent vertebra.

Results

These morphological changes made the tumor margins unclear and increased the difficulty of dissection of the segmental arteries from the vertebral body and en bloc corpectomy by a posterior-approach. Pathological findings indicated increased woven bone at the peripheral lesion of the resected vertebra and RANKL-positive stromal cells remained around the woven bone.

Conclusions

These findings support that GCTB stromal cells survived around the newly formed woven bone after long-term denosumab treatment and total surgical resection of such primary spinal lesions as the gold-standard treatment, even following administration of denosumab. Surgeons should note that prolonged adjuvant denosumab therapy may increase the difficulty of performing a posterior-approach total en bloc spondylectomy.

Keywords

Giant cell tumor Denosumab Total spondylectomy Spine RANKL 

Notes

Acknowledgements

The authors thank Yoshikazu Tanzawa for the patient referral and provision biopsy specimen.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in the study or the findings specified in this paper.

Supplementary material

Supplementary material 1 (MP4 456086 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Noritaka Yonezawa
    • 1
  • Hideki Murakami
    • 1
    Email author
  • Satoshi Kato
    • 1
  • Akihiko Takeuchi
    • 1
  • Hiroyuki Tsuchiya
    • 1
  1. 1.Department of Orthopedic SurgeryKanazawa University School of MedicineKanazawaJapan

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