Remarkable Regression Of A Giant Cell Tumor Of The Cervical Spinetreated Conservatively With Denosumab: A Case Study

Abstract:

This case study has been conducted to establish the fact that Denosumab can be used as an adjuvant therapy, by which to avoid or reduce the risks and morbidity of surgical treatment in patients with spinal GCTs extending into the nearby tissues, considering the adequate duration, safety, and lack of adverse events of this treatment, even though further evidence with more patients and a longer follow-up is warranted.

Introduction

Wide resection of giant cell tumors at the cervical spine is sometimes extremely chal-lenging, especially in cases where tumors extend into the nearby tissues, such as vertebral arteries, thespinal cord, or spinal nerve roots. Denosumab, a human monoclonal antibody that binds the receptoractivator of nuclear factor  _- _ ligand, is reported to be effective for decreasing resorption of giant celltumor of the bone, but the detailed progress of giant cell tumors in the cervical spine extending into thenearby tissues after such treatment has not been reported.

Presentation of Case

A 41-year-old man presented with neck pain. Computed tomography-guidedneedle biopsy showed numerous giant cells with a large vesicular nucleus, consistent with a giant celltumor. Because of the extension of the tumor with involvement of the vertebral artery and surround-ing tissues, denosumab (120 mg) was administered subcutaneously once per month for 24 months.Six months after denosumab treatment, follow-up computed tomography revealed a dramatic regres-sion and osteosclerosis of the tumor. Two years after starting denosumab treatment, positron emissiontomography showed no tumor recurrence.

Discussion

Although the tumor was extended with involvement of the surrounding tissues and surgeryfollowing denosumab treatment was not performed, at 24 months since initiation of denosumab treat-ment we confirmed complete regression radiographically.CONCLUSIONS: Denosumab may be used as an adjuvant by which to avoid or reduce the risks and mor-bidity of surgical treatment in patients with spinal giant cell tumors extending into nearby tissues.

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