Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

PURPOSE: To present a case of aggressive sacral osteoblastoma (OB) treated with neoadjuvant denosumab therapy and en bloc resection. METHODS: Case report of a 14-year-old male with an aggressive OB affecting the superior articular process of the left first sacral segment. The lesion was lytic and metabolically active and involved the left-sided posterior elements of S1-S3 with extension into the spinal canal, affecting the left S1, S2, S3, S4 and S5 nerve roots. He was treated for 1 month with neoadjuvant denosumab followed by en bloc resection. RESULTS: Denosumab therapy caused regression of the tumour and converted the diffuse infiltrative mass into a well-defined solid (osteoma-like) structure, aiding surgical resection and preserving the S1, S4 and S5 nerve roots. Histologically, the treated lesion showed abundant sclerotic woven bone and osteoblasts with absence of osteoclasts. CONCLUSIONS: A short course of denosumab caused tumour regression, ossification and conversion of an aggressive OB into a sclerotic, well-defined lesion thus aiding surgical resection and preservation of neural structures. Neoadjuvant therapy reduced osteoclast numbers but PET showed that the lesion remained FDG avid post-therapy.

Original publication

DOI

10.1007/s00586-018-5461-z

Type

Journal article

Journal

Eur spine j

Publication Date

07/2018

Volume

27

Pages

446 - 452

Keywords

Denosumab, Osteoblastoma, RANK, Tumour, Adolescent, Bone Density Conservation Agents, Bone Neoplasms, Denosumab, Humans, Male, Neoadjuvant Therapy, Osteoblastoma, Positron Emission Tomography Computed Tomography, Sacrum, Tomography, X-Ray Computed, Treatment Outcome