PDF 
Views 
Share
Interferons as Neoadjuvant Chemotherapy for Giant Cell Tumor: A Hospital-Based Prospective Pilot Study
CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(04): 312-319
DOI: DOI: 10.1055/s-0043-1775817
Abstract
Introduction Neoadjuvant chemotherapy is now considered an effective way to treat Campanacci grade 2 and 3 giant cell tumors (GCTs). Assessment of these drugs is essential clinically, radiologically, and pathologically. This study analyzes the early results of angiogenesis inhibitors (interferons) in the aggressive GCT of bone.
Methodology A prospective pilot study was conducted from January 2021 to July 2022 including eight biopsy-proven GCT patients subjected to interferon therapy. Radiological assessment was done with changes on plain radiograph, computerized tomography scan, and magnetic resonance imaging. Histopathological examination was done by changes in the biopsy and resected segment.
Results Out of the eight patients included in the study, 26% (n = 3) were males and 62% (n = 5) were females, with mean age of the patients being 24.6 ± 8.48 years (range: 22–38). There was significant reduction of the size of swelling (p-value: 0.049), significant reduction in Visual Analog Scale score (p-value: 0.011), significant decrease in swelling size on radiograph (p-value: 0.012), significant marginal sclerosis (p-value: 0.001), significant neocortex formation on radiographs (p-value: 0.001), significant result in and osteoid formation (p-value: 0.001) on histology. Whereas Campanacci grade on plain radiographs, number of viable cells, and number of viable stromal cell were not statistically different in comparison with pretherapy and posttherapy status.
Conclusion Interferon therapy in a GCT has potential beneficiary effect in terms of clinical, radiological, and pathological outcomes. It might prove to be an effective alternative to standard neoadjuvant chemotherapy in the management of aggressive GCT of bones.
Level of Evidence III.
Keywords
giant cell tumor - neoadjuvant chemotherapy - interferon - Campanacci grading - ICDS criteria - RECIST criteriaPatient Consent
Consent was taken with each individual for the enrollment of study and publication of data on research paper. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Ethical Review Committee Statement
Clearance obtained from institutional ethical clearance committee. A copy of the Certificate of Ethical Clearance is available for review by the Editor-in-Chief of this journal on request.
Authors' Contributions
S.P.S.: Planning of study, data management, writing, and revising the manuscript.
A.R.: Data management and manuscript preparation.
B.B.N.: Data management and manuscript preparation.
A.S.: Data management.
M.D.: Planning of study, revising the manuscript, and as corresponding author.
Financial Support and Sponsorship
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publication History
Article published online:
30 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Abstract
Introduction Neoadjuvant chemotherapy is now considered an effective way to treat Campanacci grade 2 and 3 giant cell tumors (GCTs). Assessment of these drugs is essential clinically, radiologically, and pathologically. This study analyzes the early results of angiogenesis inhibitors (interferons) in the aggressive GCT of bone.
Methodology A prospective pilot study was conducted from January 2021 to July 2022 including eight biopsy-proven GCT patients subjected to interferon therapy. Radiological assessment was done with changes on plain radiograph, computerized tomography scan, and magnetic resonance imaging. Histopathological examination was done by changes in the biopsy and resected segment.
Results Out of the eight patients included in the study, 26%-(n = 3) were males and 62%-(n = 5) were females, with mean age of the patients being 24.6 ± 8.48 years (range: 22–38). There was significant reduction of the size of swelling (p-value: 0.049), significant reduction in Visual Analog Scale score (p-value: 0.011), significant decrease in swelling size on radiograph (p-value: 0.012), significant marginal sclerosis (p-value: 0.001), significant neocortex formation on radiographs (p-value: 0.001), significant result in and osteoid formation (p-value: 0.001) on histology. Whereas Campanacci grade on plain radiographs, number of viable cells, and number of viable stromal cell were not statistically different in comparison with pretherapy and posttherapy status.
Conclusion Interferon therapy in a GCT has potential beneficiary effect in terms of clinical, radiological, and pathological outcomes. It might prove to be an effective alternative to standard neoadjuvant chemotherapy in the management of aggressive GCT of bones.
Level of Evidence III.
Keywords
giant cell tumor - neoadjuvant chemotherapy - interferon - Campanacci grading - ICDS criteria - RECIST criteriaIntroduction
Giant cell tumor (GCT) is a peculiar benign neoplasm with features of local as well as distant aggressiveness. The bones around the knee are common sites, followed by the distal radius.[1] Owing to the variation in histology, clinical, and radiographic appearance, neoadjuvant chemotherapy has been used prior to different surgical options including local curettage, extended curettage to excision, and reconstructive arthroplasty.[2]
Neoadjuvant chemotherapy, which has been used for the treatment of GCTs, are bisphosphonates (zoledronic acid), denosumab, and calcitonin.[3] Interferons were initially used for viral infection and acted by inhibiting protein synthesis. They have also been shown to act on the cells that exhibit basic fibroblast growth factor (BFGF). The cells of GCT also overexpress BFGF on them and so, in turn, will respond to interferon therapy by inhibiting angiogenesis. There have been reports of trying this drug in the GCT of the jaws and recurrent GCT with varying results, but very few studies are available for its use in musculoskeletal GCT.[4] This drug's limitation includes its increased administration frequency and prolonged use. It has also been shown to have allergic manifestation and flaring of autoimmune disorders.[5]
In view of the high recurrence rate in GCTs (0–65%-depending on the type of treatment),[6] neoadjuvant chemotherapy is now considered an effective way to treat Campanacci grade 2 and 3 GCTs.[7] Quantification of response is important for the assessment of these drugs on the clinical and pathological effects of tumors.[8] These assessment tools not only help in evaluation but also guide for change in any treatment strategy. In combination with other indicators of patient condition, response evaluation helps in the therapeutic efficacy decision-making process.[9]
Clinical examination still holds good for the qualitative evaluation of the response of drugs to tumors. It not only gives the actual comparative assessment between the pre- and posttherapy but also gives an edge to the treating physician to decide the further mode in case of any untoward outcomes. Its disadvantage is that there are chances of bias and it is difficult to quantify.[9] [10]
Imaging plays a pivotal role in the evaluation of the response of neoadjuvant chemotherapy in musculoskeletal disorders. The assessment of treatment response and residual tumor influence the patient's prognosis and surgical strategy.[11] The radiographic response has been correlated with improved local control and overall survival.[12]
Quantification of this radiological information in advanced imaging modalities like computed tomography (CT) scan and magnetic resonance imaging (MRI) identifies the early benefits of neoadjuvant chemotherapy and helps in limb salvage resections.[13] Since both clinical and radiological assessment is done before the biopsy and after the completion of neoadjuvant chemotherapy, comparative analysis can be easily done to establish the response to the drug treatment.[14]
In the available literatures, interferon has been used as an effective method for the treatment in recurrent GCT of the mandible and recurrent and metastatic GCT of the spine.[15] [16] Its use in GCT has proven to play an effective role in various nonappendicular skeleton. However, there are lacunae in knowledge regarding the use of interferon as a neoadjuvant chemotherapy. This research aims to analyze the changes in the tumor in terms of clinical, radiological, and histological parameters to establish the drug treatment response after the use of interferons in musculoskeletal GCTs.
Methodology
A single center-based prospective cohort pilot study was conducted from January 2021 to July 2022 after obtaining clearance from the institutional ethical committee. Verbal and written consent was taken from all patients included in the study.
The histologically proven case of GCT of any bone between the ages of 20 and 40 years with Campanacci grade 2 and 3 GCT, including locally aggressive and recurrent GCT, subjected to interferon therapy, were included in the study. All patients with Campanacci grade 1 GCT, not ready to undergo systemic therapy or not fit for systemic therapy due to any systemic and autoimmune cause, and patients subjected to other systemic therapy like denosumab were excluded from the study.
After a biopsy-proven histopathological diagnosis of GCT, patients were subjected to routine biochemical investigations in the form of renal function test, liver function test, and thyroid function test, in addition to hemogram and dental examination. After ruling out possible autoimmune disorders, these patients were given interferons on alternate days. A total of 45 doses of interferons alfa-2b in a dose of 3 miu/m2 of body surface area via a subcutaneous route on alternate days were given for a total 3 months' course, all patients received a full course of therapy of 45 cycles over 90 days on an alternate day basis.
The patient demographic data, site and side of the lesion and the duration of symptoms was assessed at the time of biopsy. Clinical, radiological, and histological assessment was done at the time of biopsy, followed by evaluation by the same parameters after the completion of interferons alfa-2b. Clinical assessment was done by the size of swelling, consistency of swelling as soft, firm, and hard, and pain score in the form of a Visual Analog Scale (VAS) from 0 to 10.[17] Radiological assessment was done with a plain radiograph, CT scan, and MRI. In the plain anteroposterior radiograph, the size of the lesion, the border of the lesion (Campanacci grading),[10] marginal sclerosis as an increase in opacity on a margin of radiolucent lesion, and neocortex formation were assessed ([Supplementary Fig. S1], available in the online version only). CT scan and MRI were performed where the longest diameter in the axial view in the CT scan and MRI was used in the pretherapy and posttherapy period, and the reduction in %-of the size and increase in %-of density was assessed ([Figs. 1]
| Fig 1 : (A) Representative image of plain radiograph of patient with giant cell tumor (GCT) in the proximal tibia. (A) Pretherapy and (B) posttherapy, for the assessment of the size of the lesion, the border of the lesion (Campanacci grading), marginal sclerosis, and neocortex formation.
| Figure 2: (A) Representative image of computed tomography (CT) scan of patient with giant cell tumor (GCT) in the proximal tibia. (A) Pretherapy and (B) posttherapy, where the longest diameter in the axial view used to compare the reduction in %-of the size and increase in %- of density.
%-reduction in size (%S): The %-reduction in size (%S) was calculated as:
%S = longest diameter pretherapy – longest diameter posttherapy × 100.18
Longest diameter pretherapy: The %-increase in the density (%D) was assessed as:
%D= (pretherapy density) – (posttherapy density) × 100.19
Pretherapy Density
Size and density were calculated with the help of Radiant DICOM software. On the Radiant DICOM in the axial view of the involved segment, an ellipse was measured, and the mean density of the tumor was measured and calculated. The assessment criterion used was: inverse Choi density/size criteria (ICDS)[20] and Response Evaluation Criteria in Solid Tumor (RECIST).[21]
Histopathological assessment was done in the specimen of biopsy (pretherapy) and in the final histopathology obtained after curettage/resection in terms of the number of viable tumor cells, number of viable stromal cells, and osteoid formation ([Fig. 3]).[22]
| Figure 3: (A) Representative image magnetic resonance imaging (MRI) of patient with giant cell tumor (GCT) in the proximal tibia. (A) Pretherapy and (B) posttherapy, where the longest diameter in the axial view used to compare the reduction in % of the size and increase in % of density.
Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, New York, United States). Results on continuous measurement is presented as mean ± standard deviation; median (interquartile range) and categorical as frequency and percentage. Paired t-test used to compare between the mean of the paired samples. Inferential statistics like the Wilcoxon signed rank test (to compare median values pre- and posttherapy) and the McNemar test (compare count pre- and posttherapy) were used. A p-value of < 0.05 was considered statistically significant.
Result
Out of a total of 37 patients with proven histological GCT who attended to the tumor clinic of the department during the study period, five were between the ages of < 20 and > 40 years. Four patients were of Campanacci grade 1, two patients were not willing to systemic therapy, and one patient was fit for systemic therapy due to antinuclear antibody positive autoimmune disease, systemic lupus erythematosus. Out of 25 patients of Campanacci grade 2 and 3 fit for systemic therapy, patients were offered either denosumab or interferon according to the duration of systemic therapy required, compliance to more prolonged doses of therapy, and its cost-effectiveness. Among those included, 17 patients were willing to go for denosumab, and were excluded, and the final eight patients willing to go for interferon therapy were included in the study ([Supplementary Fig. S2], available in the online version only).
Patient's Demography
Out of the eight patients included in the study, 26% (n = 3) were males and 62% (n = 5) were females. The mean age of the patients was 24.6 ± 8.48 years (range: 22–38), with a median age of 21 years. Among the included cases, 37.5% (n = 3) were GCT of proximal tibia, 25% (n = 2) were GCT of distal end femur, 25% (n = 2) were GCT of distal end radius, and 12.5% (n = 1) were GCT of proximal humerus. The mean duration of symptoms of swelling was 6.12 ± 4.24 months (range: 2–12), with median duration of symptoms being 6 months ([Supplementary Table S1], available in the online version only). All the patients completed the treatment course and follow-up evaluation after completion of the course. Initial therapy manifested flu-like symptoms, myalgia, and fever after the first dose within 12 to 48 hours in three cases, which were managed by symptomatic nonsteroidal anti-inflammatory drugs, but on subsequent doses, there were no such side effects.
Clinical Assessment
The mean size of swelling prior to therapy was 27.20 ± 10.57 cm2 (18.0–42.0), and it was decreased to 22.62 ± 8.66 cm2 (15.0–36.0 after therapy) with a p-value of 0.049, which suggests there is a statistically significant reduction of the size of swelling observed pre- and posttherapy ([Table 1]). The mean pretherapy VAS score for pain was 7.50 ± 0.54 (7.0–8.0) with median value of 7.50 (7.0–8.0), which decreased to mean VAS score of 2.88 ± 0.84 (2.0–4.0) with median value of 3.0 (2.0–3.5) after therapy with a p-value of 0.011, which suggests there is a statistically significant decrease in VAS score observed pre- and posttherapy ([Table 1]). All patients had firm consistency prior to therapy, which later changed to the firm to hard consistency after the completion of therapy.
|
Assessment |
Status |
N |
Range |
Median (IQR) |
Mean ± SD |
p-Value |
|---|---|---|---|---|---|---|
|
Swelling |
Pretherapy |
8 |
18.0–42.0 |
20.5 (19.80–38.5) |
27.20 ± 10.57 |
0.049[a] |
|
Posttherapy |
8 |
15.0–36.0 |
20 (15–30) |
22.62 ± 8.66 |
||
|
VAS |
Pretherapy |
8 |
7.0–8.0 |
7.50 (7.0–8.0) |
7.50 ± 0.54 |
0.011[a] |
|
Posttherapy |
8 |
2.0–4.0 |
3.0 (2.0–3.5) |
2.88 ± 0.84 |
||
|
X-ray size |
Pretherapy |
8 |
10.50–48.0 |
22.14 (17.22–25) |
24.17 ± 12.84 |
0.012[a] |
|
Posttherapy |
8 |
9.81–48.28 |
11.95 (11.90–19.76) |
18.94 ± 14.77 |
|
Yes N (%) |
No N (%) |
p-Value |
||
|---|---|---|---|---|
|
X-ray Marginal sclerosis |
Pretherapy |
0 |
8 (100) |
0.001[a] |
|
Posttherapy |
8 (100) |
0 |
||
|
X-ray Neocortex formation |
Pretherapy |
0 |
8 (100) |
0.001[a] |
|
Posttherapy |
8 (100) |
0 |
|
CT ICDS versus MRI ICDS |
||||||
|
Responses |
MRI ICDS |
Total |
||||
|
Partial response |
Progressive |
Stable disease |
Unable to evaluate |
|||
|
CT ICDS |
Partial response |
1 |
0 |
1 |
0 |
2 |
|
Progressive |
0 |
2 |
0 |
0 |
2 |
|
|
Stable disease |
2 |
0 |
2 |
0 |
4 |
|
|
Unable to evaluate |
0 |
0 |
0 |
0 |
0 |
|
|
Total |
3 |
2 |
3 |
0 |
8 |
|
|
CT RECIST versus MRI RECIST |
||||||
|
Responses |
MRI RECIST |
Total |
||||
|
Partial response |
Progressive |
Stable disease |
Unable to evaluate |
|||
|
CT RECIST |
Partial response |
0 |
0 |
1 |
0 |
1 |
|
Progressive |
0 |
2 |
0 |
0 |
2 |
|
|
Stable disease |
0 |
0 |
5 |
0 |
5 |
|
|
Unable to evaluate |
0 |
0 |
0 |
0 |
0 |
|
|
Total |
0 |
2 |
6 |
0 |
8 |
|
References
- Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell tumor of bone - an overview. Arch Bone Jt Surg 2016; 4 (01) 2-9
- Baptista AM, Camargo Ade F, Caiero MT, Rebolledo DCS, Correia LFM, de Camargo OP. GCT: what happened after 10 years of curettage and cement? Retrospective study of 46 cases. Acta Ortop Bras 2014; 22 (06) 308-311
- Singh AS, Chawla NS, Chawla SP. Giant-cell tumor of bone: treatment options and role of denosumab. Biologics 2015; 9: 69-74
- Houglum JE. Interferon: mechanisms of action and clinical value. Clin Pharm 1983; 2 (01) 20-28
- Yasko AW. Interferon therapy for giant cell tumor of bone. Curr Opin Orthop 2006; 17 (06) 568-572
- Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res 2011; 469 (02) 591-599
- van der Heijden L, Dijkstra S, van de Sande M, Gelderblom H. Current concepts in the treatment of giant cell tumour of bone. Curr Opin Oncol 2020; 32 (04) 332-338
- Righi A, Pacheco M, Palmerini E. et al. Histological response to neoadjuvant chemotherapy in localized Ewing sarcoma of the bone: a retrospective analysis of available scoring tools. Eur J Surg Oncol 2021; 47 (07) 1778-1783
- Therasse P. Measuring the clinical response. What does it mean?. Eur J Cancer 2002; 38 (14) 1817-1823
- Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987; 69 (01) 106-114
- Priolo F, Cerase A. The current role of radiography in the assessment of skeletal tumors and tumor-like lesions. Eur J Radiol 1998; 27 (Suppl. 01) S77-S85
- Meric F, Hess KR, Varma DGK. et al. Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas. Cancer 2002; 95 (05) 1120-1126
- Engellau J, Seeger L, Grimer R. et al. Assessment of denosumab treatment effects and imaging response in patients with giant cell tumor of bone. World J Surg Oncol 2018; 16 (01) 191
- Pramesh CS, Deshpande MS, Pardiwala DN, Agarwal MG, Puri A. Core needle biopsy for bone tumours. Eur J Surg Oncol 2001; 27 (07) 668-671
- Kaban LB, Mulliken JB, Ezekowitz RA, Ebb D, Smith PS, Folkman J. Antiangiogenic therapy of a recurrent giant cell tumor of the mandible with interferon alfa-2a. Pediatrics 1999; 103 (6 Pt 1): 1145-1149
- Wei F, Liu X, Liu Z. et al. Interferon alfa-2b for recurrent and metastatic giant cell tumor of the spine: report of two cases. Spine 2010; 35 (24) E1418-E1422
- Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985; 5 (04) 145-148
- Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V. Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans. J Oncol 2015; 2015: 632943
- Wang Y, Huang K, Chen J. et al. Combined volumetric and density analyses of contrast-enhanced CT imaging to assess drug therapy response in gastroenteropancreatic neuroendocrine diffuse liver metastasis. Contrast Media Mol Imaging 2018; 2018: 6037273
- Alothman M, Althobaity W, Asiri Y, Alreshoodi S, Alismail K, Alshaalan M. Giant cell tumor of bone following denosumab treatment: assessment of tumor response using various imaging modalities. Insights Imaging 2020; 11 (01) 41
- Park JO, Lee SI, Song SY. et al. Measuring response in solid tumors: comparison of RECIST and WHO response criteria. Jpn J Clin Oncol 2003; 33 (10) 533-537
- Teo KY, Daescu O, Cederberg K, Sengupta A, Leavey PJ. Correlation of histopathology and multi-modal magnetic resonance imaging in childhood osteosarcoma: predicting tumor response to chemotherapy. PLoS One 2022; 17 (02) e0259564
- Reddy CR, Rao PS, Rajakumari K. Giant-cell tumors of bone in South India. J Bone Joint Surg Am 1974; 56 (03) 617-619
- Gupta R, Seethalakshmi V, Jambhekar NA. et al. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol 2008; 12 (04) 239-248
- Errani C, Ruggieri P, Asenzio MAN. et al. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 2010; 36 (01) 1-7
- López-Pousa A, Martín Broto J, Garrido T, Vázquez J. Giant cell tumour of bone: new treatments in development. Clin Transl Oncol 2015; 17 (06) 419-430
- Feigenberg SJ, Marcus Jr RB, Zlotecki RA, Scarborough MT, Berrey BH, Enneking WF. Radiation therapy for giant cell tumors of bone. Clin Orthop Relat Res 2003; (411) 207-216
- Puri A, Agarwal M. Treatment of giant cell tumor of bone: current concepts. Indian J Orthop 2007; 41 (02) 101-108
- Chawla S, Blay JY, Rutkowski P. et al. Denosumab in patients with giant-cell tumour of bone: a multicentre, open-label, phase 2 study. Lancet Oncol 2019; 20 (12) 1719-1729
- Antonelli G. Biological basis for a proper clinical application of alpha interferons. New Microbiol 2008; 31 (03) 305-318
- Baron S, Tyring SK, Fleischmann Jr WR. et al. The interferons. Mechanisms of action and clinical applications. JAMA 1991; 266 (10) 1375-1383
- Goldman KE, Marshall MK, Alessandrini E, Bernstein ML. Complications of alpha-interferon therapy for aggressive central giant cell lesion of the maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100 (03) 285-291
- Schütz P, El-Bassuoni KH, Munish J, Hamed HH, Padwa BL. Aggressive central giant cell granuloma of the mandible. J Oral Maxillofac Surg 2010; 68 (10) 2537-2544
- O'Connell JE, Kearns GJ. Aggressive giant cell granuloma of the jaws treated with interferon alpha: a report of two cases. Ir J Med Sci 2013; 182 (02) 163-170
- Tarsitano A, Del Corso G, Pizzigallo A, Marchetti C. Aggressive central giant cell granuloma of the mandible treated with conservative surgical enucleation and interferon-α-2a: complete remission with long-term follow-up. J Oral Maxillofac Surg 2015; 73 (11) 2149-2154
Address for correspondence
Publication History
Article published online:
30 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
| Fig 1 : (A) Representative image of plain radiograph of patient with giant cell tumor (GCT) in the proximal tibia. (A) Pretherapy and (B) posttherapy, for the assessment of the size of the lesion, the border of the lesion (Campanacci grading), marginal sclerosis, and neocortex formation.
| Figure 2: (A) Representative image of computed tomography (CT) scan of patient with giant cell tumor (GCT) in the proximal tibia. (A) Pretherapy and (B) posttherapy, where the longest diameter in the axial view used to compare the reduction in % of the size and increase in % of density.
| Figure 3: (A) Representative image magnetic resonance imaging (MRI) of patient with giant cell tumor (GCT) in the proximal tibia. (A) Pretherapy and (B) posttherapy, where the longest diameter in the axial view used to compare the reduction in % of the size and increase in % of density.
References
- Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell tumor of bone - an overview. Arch Bone Jt Surg 2016; 4 (01) 2-9
- Baptista AM, Camargo Ade F, Caiero MT, Rebolledo DCS, Correia LFM, de Camargo OP. GCT: what happened after 10 years of curettage and cement? Retrospective study of 46 cases. Acta Ortop Bras 2014; 22 (06) 308-311
- Singh AS, Chawla NS, Chawla SP. Giant-cell tumor of bone: treatment options and role of denosumab. Biologics 2015; 9: 69-74
- Houglum JE. Interferon: mechanisms of action and clinical value. Clin Pharm 1983; 2 (01) 20-28
- Yasko AW. Interferon therapy for giant cell tumor of bone. Curr Opin Orthop 2006; 17 (06) 568-572
- Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res 2011; 469 (02) 591-599
- van der Heijden L, Dijkstra S, van de Sande M, Gelderblom H. Current concepts in the treatment of giant cell tumour of bone. Curr Opin Oncol 2020; 32 (04) 332-338
- Righi A, Pacheco M, Palmerini E. et al. Histological response to neoadjuvant chemotherapy in localized Ewing sarcoma of the bone: a retrospective analysis of available scoring tools. Eur J Surg Oncol 2021; 47 (07) 1778-1783
- Therasse P. Measuring the clinical response. What does it mean?. Eur J Cancer 2002; 38 (14) 1817-1823
- Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987; 69 (01) 106-114
- Priolo F, Cerase A. The current role of radiography in the assessment of skeletal tumors and tumor-like lesions. Eur J Radiol 1998; 27 (Suppl. 01) S77-S85
- Meric F, Hess KR, Varma DGK. et al. Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas. Cancer 2002; 95 (05) 1120-1126
- Engellau J, Seeger L, Grimer R. et al. Assessment of denosumab treatment effects and imaging response in patients with giant cell tumor of bone. World J Surg Oncol 2018; 16 (01) 191
- Pramesh CS, Deshpande MS, Pardiwala DN, Agarwal MG, Puri A. Core needle biopsy for bone tumours. Eur J Surg Oncol 2001; 27 (07) 668-671
- Kaban LB, Mulliken JB, Ezekowitz RA, Ebb D, Smith PS, Folkman J. Antiangiogenic therapy of a recurrent giant cell tumor of the mandible with interferon alfa-2a. Pediatrics 1999; 103 (6 Pt 1): 1145-1149
- Wei F, Liu X, Liu Z. et al. Interferon alfa-2b for recurrent and metastatic giant cell tumor of the spine: report of two cases. Spine 2010; 35 (24) E1418-E1422
- Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985; 5 (04) 145-148
- Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V. Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans. J Oncol 2015; 2015: 632943
- Wang Y, Huang K, Chen J. et al. Combined volumetric and density analyses of contrast-enhanced CT imaging to assess drug therapy response in gastroenteropancreatic neuroendocrine diffuse liver metastasis. Contrast Media Mol Imaging 2018; 2018: 6037273
- Alothman M, Althobaity W, Asiri Y, Alreshoodi S, Alismail K, Alshaalan M. Giant cell tumor of bone following denosumab treatment: assessment of tumor response using various imaging modalities. Insights Imaging 2020; 11 (01) 41
- Park JO, Lee SI, Song SY. et al. Measuring response in solid tumors: comparison of RECIST and WHO response criteria. Jpn J Clin Oncol 2003; 33 (10) 533-537
- Teo KY, Daescu O, Cederberg K, Sengupta A, Leavey PJ. Correlation of histopathology and multi-modal magnetic resonance imaging in childhood osteosarcoma: predicting tumor response to chemotherapy. PLoS One 2022; 17 (02) e0259564
- Reddy CR, Rao PS, Rajakumari K. Giant-cell tumors of bone in South India. J Bone Joint Surg Am 1974; 56 (03) 617-619
- Gupta R, Seethalakshmi V, Jambhekar NA. et al. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol 2008; 12 (04) 239-248
- Errani C, Ruggieri P, Asenzio MAN. et al. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev 2010; 36 (01) 1-7
- López-Pousa A, Martín Broto J, Garrido T, Vázquez J. Giant cell tumour of bone: new treatments in development. Clin Transl Oncol 2015; 17 (06) 419-430
- Feigenberg SJ, Marcus Jr RB, Zlotecki RA, Scarborough MT, Berrey BH, Enneking WF. Radiation therapy for giant cell tumors of bone. Clin Orthop Relat Res 2003; (411) 207-216
- Puri A, Agarwal M. Treatment of giant cell tumor of bone: current concepts. Indian J Orthop 2007; 41 (02) 101-108
- Chawla S, Blay JY, Rutkowski P. et al. Denosumab in patients with giant-cell tumour of bone: a multicentre, open-label, phase 2 study. Lancet Oncol 2019; 20 (12) 1719-1729
- Antonelli G. Biological basis for a proper clinical application of alpha interferons. New Microbiol 2008; 31 (03) 305-318
- Baron S, Tyring SK, Fleischmann Jr WR. et al. The interferons. Mechanisms of action and clinical applications. JAMA 1991; 266 (10) 1375-1383
- Goldman KE, Marshall MK, Alessandrini E, Bernstein ML. Complications of alpha-interferon therapy for aggressive central giant cell lesion of the maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100 (03) 285-291
- Schütz P, El-Bassuoni KH, Munish J, Hamed HH, Padwa BL. Aggressive central giant cell granuloma of the mandible. J Oral Maxillofac Surg 2010; 68 (10) 2537-2544
- O'Connell JE, Kearns GJ. Aggressive giant cell granuloma of the jaws treated with interferon alpha: a report of two cases. Ir J Med Sci 2013; 182 (02) 163-170
- Tarsitano A, Del Corso G, Pizzigallo A, Marchetti C. Aggressive central giant cell granuloma of the mandible treated with conservative surgical enucleation and interferon-α-2a: complete remission with long-term follow-up. J Oral Maxillofac Surg 2015; 73 (11) 2149-2154