William E Mendanha, Neal Chawla, Madhuri Sudan, Susan V Bukata, Imran Syed, Suzan P Arasheben, Kumar K Sankhala and Sant P Chawla
We present a case of locally recurring giant cell tumor (GCT) of the bone in the cervical spine of a 12-year-old girl. After three surgeries with two resulting in negative margins, adjuvant chemotherapy with Doxorubicin and Ifosfamide, and two local recurrences of the GCT of the bone within the cervical spine, she was started on a Denosumab clinical trial at the age of 13 years. The patient’s pain and neurologic symptoms decreased significantly within a few weeks and disappeared after 5 months. She has been receiving monthly Denosumab for over five years, totaling 68 doses to date, and will continue this regimen for the forseeable future. GCT of the bone is rarely seen in adolescents or in the cervical spine and effective treatment options are limited. Denosumab is an excellent treatment for non-resectable and recurrent GCT of the bone, it only eliminates giant cells, leaving the stromal cells to reactivate the GCT of the bone after a period of halting Denosumab. While this patient has maintained tumor stability over five years, the effects of receiving life-long Denosumab supplementation are currently unknown. This case demonstrates the efficacy of Denosumab in stabilizing the progression of giant cell tumor of bone but also highlights the need for further investigation into cumulative dose-related side effects and long term treatment planning as patients currently have no other treatment options once stability is achieved.
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