Oral management of patients treated with denosumab for giant cell tumor of bone: A retrospective study at the University Hospitals of Strasbourg

Abstract

Objectives: Giant cell tumor of bone (GCTB) is defined as a rare intermediate-grade mesenchymal tumor. The first-line treatment was surgery but since the 2010s, denosumab is a medical therapeutic option that can stop progression of GCTBs with a high efficiency. Osteochimionecrosis of the jaw (ONJ) is a well-documented oral complication associated to denosumab implying careful oro-dental follow-up. So far, GCTB patients constitute a particular subgroup of denosumab-treated patients for whom very few studies about orodental care are described. Materials and methods: All patients diagnosed with GCTB and treated by denosumab therapy and who had oro-dental follow-up were included. Nine patients received denosumab as adjuvant and/or neoadjuvant treatment of surgery and one patient received denosumab as an exclusive therapy. Denosumab was temporary stopped in case of a serious adverse event like ONJ. Results: Of the 10 patients enrolled in this study, 8 started denosumab after undergoing one or more GCTB resection surgeries, and 1 patient was started on denosumab early on because surgery was considered too harmful. Only one patient benefited from denosumab treatment without tumor resection. All patients except one received an oral examination prior to initiation of denosumab treatment, the mean DMFT index was 9.8 and 4 patients had a poor periodontal status. In 5 of our 10 patients, denosumab therapy have been disturbed in order to manage one ONJ and 7 tooth extraction. Conclusion: Oro-dental status can strongly influence denosumab therapy in GCTB patients that's why a close collaboration is required between oncologist and oral surgeon.

Keywords

• Giant cell tumors of Bone
• Denosumab
• Osteonecrosis of the jaw
• Drug holiday
• Oro-dental cares