Nuove frontiere nel trattamento del Tumore a Cellule Giganti dell'Osso

Giant cell tumor (GCT) of bone is an aggressive neoplasm arising from the medullary and consisting of multinucleated osteoclast-like giant cells and proliferating osteoblast-like stromal cells. It is a rare neoplasm that accounts for approximately 5% of all primary bone tumors in adults, with an incidence of 1 case per million, and is slightly more prevalent in women than in men; it occurs most frequently at the end of long bones, but every bone can be affected. Curettage is the gold standard treatment, but unfortunately sometimes it is impossible because of lack of structural integrity of the segment, or the presence of a fracture or of a local relapse that is difficult to treat surgically. The use of local adjuvant treatment, as phenol or liquid nitrogen, is suggested to decrease the risk of recurrence. In selected cases resection and reconstruction with a prosthesis are recommended to decrease the risk of recurrence. Radiofrequency thermoablation and cryosurgery with probes should be used in the miniinvasive treatment of small lesions or in case of a local and difficult to treat recurrence. Anyway, a medical approach is the great news in the treatment of GCT. Denosumab is a fully human monoclonal antibody that inhibits RANKL, a protein essential for osteoclast formation, function, and survival. Good clinical, radiological and histological results have been reported in the treatment of GTC of bone with denosumab, but more studies are needed to assess its efficacy and side effects.