Role of neoadjuvant denosumab in pathological fracture associated giant cell tumor of bone: a retrospective case series

Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm that commonly affects young adults and frequently involves the epiphyseal region of long bones. Pathological fractures occur in some patients that complicate the management by increasing the risk of tumor spread, making surgical planning difficult. Denosumab, has shown efficacy in reducing tumor activity and promoting bone formation. However, its role in GCTB presenting with pathological fractures remains unclear. Study Design & setting: We have conducted a retrospective study at Department of Orthopaedic Surgery, from January 2018 to January 2025. Patients with biopsy proven GCTB presenting with pathological fractures and given atleast 4 doses of neoadjuvant denosumab were included in the study. Primary GCTB without fractures were excluded from the study. Analysis was done using SPSS v23, frequency and percentages were mentioned of qualitative variables and quantitative variables were mentioned as mean and standard deviation or median with interquartile range, as appropriate. However, no comparative analysis was performed due to the descriptive nature of the study. Records of 21 patients with GCTB, with pathological fractures and treated with denosumab were analysed. 15 (71.4%) patients were male and 6 (28.6%) were female. Tumor occurrence was most common in the distal femur (33.3%), proximal femur (33.3%), proximal humerus (14.3%), distal radius (9.5%) and femoral neck (9.5%). Lesions involved left side of the body in 13 (61.9%) and right side in 8 (38.1%) cases. After 4 doses of denosumab 19 (90.4%) patients’ tumors margins became sclerotic and delinated at 5 week xray. 16 (76.1%) patients’ surgical plan was changed after denosumab. Complications occurred in 3 (14.2%) patients, that were infection and implant failure. There was no recurrence in a median follow-up of 29.5 months. We recommend to use neoadjuvant denosumab in pathological fractures secondary to giant cell tumors of bone, because it delinates the tumor, calcifies the fracture and organizes the fracture haematoma; heals the fracture that help in easy tumor dissection, prevent tumor leakage, joint preservation and may help surgeon to change decision during definitive treatment, as per their experience. Not applicable.