Denosumab combined with curettage after surgical dislocation of the hip in the treatment of giant cell tumors of bone in the femoral head and neck region: a single-center retrospective study.
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BACKGROUND: Giant cell tumor of bone (GCTB) occurring in the femoral head and neck region presents significant therapeutic challenges due to its complex anatomy and aggressive biological behavior. This study aimed to analyse the clinical outcomes of preoperative denosumab therapy combined with curettage after surgical dislocation of the hip in the treatment of GCTB at the femoral head and neck region. METHODS: Between 2016 and 2023, a total of 16 patients with GCTB in the femoral head and neck were treated at the authors' institution, of whom 14 eligible and included in the study (6 males/8 females, aged 17-35 years). All patients received three cycles of Denosumab therapy preoperatively, with treatment response monitored and therapeutic efficacy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Subsequently, surgical dislocation of the hip combined with curettage of the lesion was performed. Regular postoperative follow-up was conducted to monitor for complications. Imaging studies were used performed to evaluate surgical site status, local recurrence, and distant metastasis. Limb function and hip joint function were assessed preoperatively and at 1 year postoperatively using the Musculoskeletal Tumor Society (MSTS) score and Harris Hip Score (HHS), respectively. RESULTS: All 14 patients underwent a full course of preoperative denosumab therapy and underwent successful surgery, with a follow-up period of 24-50 months (mean 38.2 ± 9.0 months). No postoperative complications observed. Imaging revealed shrinkage of residual cavities, blurred boundaries, progressive bone sclerosis, and trabecular bone regeneration at the surgical site. Functional assessments demonstrated significant improvements in MSTS scores (preoperative: 22.3 ± 1.3 compared with postoperative: 27.6 ± 1.2, P <0.001) and HHS (preoperative: 72.4 ± 3.1 compared with postoperative: 88.9 ± 4.3, P <0.001). All patients achieved excellent functional status (MSTS >25, HHS >82) with preserved joint mechanics. Preoperative denosumab therapy achieved partial remission (PR) in 79% (11/14) and stable disease (SD) in 21% (3/14) patients according to RECIST 1.1 criteria. At final follow-up, no patients experienced local recurrence or metastatic progression. CONCLUSIONS: Denosumab treatment combined with curettage after surgical dislocation of the hip successfully treated GCTB in the femoral head and neck. The safety profile of denosumab as adjuvant therapy was favorable, with no drug-related complications observed. Postoperatively, native hip joints were preserved in all patients, with satisfactory functional outcomes and no evidence of tumor recurrence or metastasis.