【摘要】 目的观察地舒单抗在治疗骨巨细胞瘤(giant cell tumor of bone,GCTB)中发挥的作用。方法 2016年1月至2018年12月,14例难治性GCTB应用地舒单抗,包括脊柱6例、骨盆2例、骶骨3例、四肢复发性GCT 3例。6例脊柱GCTB中5例为手术前应用(胸椎、腰椎),1例为两次手术后复发性难以切除同时发生肺转移病例;2例骨盆分别是1区+4区、2区+3区;3例骶骨中2例为S1～3,1例为S2～4;3例四肢分别为肱骨近端、桡骨远端、胫骨远端,均为囊内刮除术后复发,肿瘤体积巨大,边界不清。男2例,女12例,年龄(34.79±16.89)岁。手术前应用方法为:地舒单抗120 mg,第1、8、15、31、61、91天行皮下注射。最后一次用药后2周作CT和MRI,用作于用药后测量。对比用药前后肿瘤最大径、病变的CT值,并作统计学分析。疼痛程度通过VAS评分衡量。2例骨盆肿瘤患者和3例四肢肿瘤患者均行整块切除术,骶骨肿瘤患者均行囊内刮除;5例脊柱肿瘤患者,2例行术前用药,已应用4 mg×120 mg,尚未手术,另外3例均行en-bloc切除,并分析术中大体标本及术后病理结果。同时,对手术后>6个月病例随访结果进行分析。结果用药前肿瘤最大径为(62.58±21.88) cm,用药后为(54.17±22.65) cm,P=0.000。用药前病变中心及边缘平均CT值为(43.30±19.71) HU和(97.15±42.68) HU,用药后为(97.97±54.37) HU和(223.95±116.63) HU,P值分别为0.027和0.010 (P<0.05)。用药后VAS评分平均1分。手术后随访时间>6个月的8例,平均随访26.5 (16～35)个月,分别为3例脊柱0复发,1例骨盆0复发,3例骶骨2例复发,1例肱骨近端出现可切除的软组织复发。结论地舒单抗治疗四肢长骨复发、边界不清的III级及中轴骨GCTB,可明显使患者临床症状减轻,使肿瘤钙化、缩小。推荐骶骨或四肢肿瘤需要囊内切除者减少用量。更多还原

【Abstract】 Objective To observe the role of denosumab in the treatment of giant cell tumor of bone (GCTB). Methods Fourteen patients (2 males and 12 females, mean age 34.79 years) with refractory GCTB were treated with denosumab from January 2016 to December 2018. There were 6 cases in the spine, 2 cases in the pelvis, 3 cases in the sacrum and 3 recurrent cases in extremities. Five of the 6 cases of the spinal GCTB were treated with denosumab before surgery. The remaining recurrent patient was inoperable and experienced lung metastasis after two surgeries. One of the 2 pelvic cases was in the 1 and 4 region, the other case was in the 2 and 3 region. Two of the 3 sacral cases involved sacrum 1-3, the other case involved sacrum 2-4. Three recurrent extremity cases were in the proximal humerus, distal radius and distal tibia respectively. All patients were given subcutaneous injections of denosumab (120 mg) every 4 weeks (with additional doses on days 1, 8 and 15 in cycle 1 only) and were radiologically evaluated for tumor response. Symptoms were measured using Visual Analog Score (VAS). The maximum diameter and CT value of the lesions before and after the treatment were compared. The two pelvic tumors and three extremity tumors were resected. All the lesions in the sacrum were resected; 2 of 5 patients of spinal tumors were given 4 mg × 120 mg denosumab preoperatively, and the other 3 patients had en-bloc resection. Gross specimens and postoperative pathological results were analyzed. Follow-up status was also analyzed. Results The mean diameter of tumors was (62.58 ± 21.88) cm before the treatment, and (54.17 ± 22.65) cm after the treatment (P = 0.000). The mean CT values of the central and periphery area were (43.30 ± 19.71) HU, (97.15 ± 42.68) HU before the treatment, and (97.97 ± 54.37) HU, (223.95 ± 116.63) HU after the treatment respectively (P = 0.027, P = 0.010). Eight cases had more than 6 months’ follow-up. The mean follow-up was 26.5 months (range: 16-35 months). No local recurrence occurred in the spine and pelvis; 2 local recurrence occurred in the sacrum; 1 soft tissue recurrence occurred in the proximal humerus and was treated with resection subsequently. Conclusions Denosumab remarkably alleviates clinical symptoms, shrinks the tumor for the GCTB of axis bone and recurrent grade III extremities, while its dose and duration should be reduced for patients indicted resection surgery.更多还原