This protocol addresses patients with unresectable or inoperable giant cell tumor of bone (GCTB), those with metastatic disease, or those with significant functional impairment following resection. The patient must not be pregnant, as denosumab is contraindicated in this setting. Denosumab monotherapy is the current standard strategy for inoperable and metastatic GCTB; this protocol provides structured guidance for the next step when that approach has not achieved adequate disease control.
The preceding line in this pathway is denosumab monotherapy, which aims at cessation of tumor enlargement and relief of symptoms through bone formation and possible tumor shrinkage. This next-line protocol becomes relevant when those goals have not been met — the tumor continues to enlarge or symptoms remain uncontrolled under denosumab monotherapy.
DOI: 10.3390/curroncol31040157
At present, this agent is indicated for unresectable GCTB or in case of significant functional impairment following resection.
Denosumab monotherapy once every 3 months is currently the standard strategy for inoperable patients and those with metastatic GCTB.
Denosumab is contraindicated for pregnant patients.
Therefore, van der Heijden et al. suggested limiting the use of radiation therapy to patients with residual or recurrent GCTB (e.g., spinal or sacral sites) for which surgery is unacceptable, denosumab is contraindicated or unavailable, and the lesion is unresectable and uncontrolled even with embolization.
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