Outcome of lung metastases due to bone giant cell tumor initially managed with observation

Journal of Orthopaedic Surgery and Research

Manabu Akahane¹  Shinji Tsukamoto²  Yasuhito Tanaka²  Andreas F. Mavrogenis³  Alessandra Longhi⁴  Cristina Ferrari⁵  Costantino Errani⁵  Giovanni Ciani⁵  Michele Rocca⁶ 

[1] Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi, 351-0197, Saitama, Japan;Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, 634-8521, Nara, Japan;First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Holargos, Athens, Greece;Oncology Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy;Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy;Thoracic Surgery Service, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy;

关键词: Giant cell tumor of bone;    Observation;    Metastasectomy;    Denosumab;    Metastasis;    Lungs;   

DOI  :  10.1186/s13018-020-02038-1

来源: Springer

【 摘 要 】

BackgroundThe outcomes of patients with lung metastases from giant cell tumor of bone (GCTB) vary from spontaneous regression to uncontrolled growth. To investigate whether observation is an appropriate first-line management approach for patients with lung metastases from GCTB, we evaluated the outcomes of patients who were initially managed by observation.MethodsWe retrospectively reviewed the data of 22 patients with lung metastases from histologically confirmed GCTB who received observation as a first-line treatment approach. The median follow-up period was 116 months.ResultsDisease progression occurred in 12 patients (54.5%). The median interval between the discovery of lung metastases and progression was 8 months. Eight patients underwent metastasectomy following initial observation. The median interval between the discovery of lung metastases and treatment by metastasectomy was 13.5 months. None of the patients experienced spontaneous regression. Of the 22 patients, 36.4% needed a metastasectomy, and 9.1% required denosumab treatment during the course of the follow-up period. Disease progression occurred in 45.5% of the 11 patients with lung nodules ≤ 5 mm, while all five of the patients with lung nodules > 5 mm experienced disease progression. Progression-free survival was significantly worse in the group with lung nodules > 5 mm compared to the group with lung nodules ≤ 5 mm (p = 0.022).ConclusionsObservation is a safe first-line method of managing patients with lung metastases from GCTB. According to radiological imaging, approximately half of the patients progressed, and approximately half required a metastasectomy or denosumab treatment. However, patients with lung nodules > 5 mm should receive careful observation because of the high rate of disease progression in this group.

【 授权许可】

CC BY