@article{3103484,
    title = "Outcome of lung metastases due to bone giant cell tumor initially managed with observation",
    author = "Tsukamoto, S. and Ciani, G. and Mavrogenis, A.F. and Ferrari, C. and Akahane, M. and Tanaka, Y. and Rocca, M. and Longhi, A. and Errani, C.",
    journal = "Journal of Orthopaedic Surgery and Research",
    year = "2020",
    volume = "15",
    number = "1",
    publisher = "BioMed Central Ltd.",
    issn = "1749-799X",
    doi = "10.1186/s13018-020-02038-1",
    keywords = "bone density conservation agent;  denosumab, adult;  bone tumor;  conservative treatment;  disease exacerbation;  disease free survival;  female;  follow up;  human;  lung resection;  lung tumor;  male;  middle aged;  mortality;  multimodality cancer therapy;  osteoclastoma;  pathology;  procedures;  retrospective study;  time factor;  treatment outcome, Adult;  Bone Density Conservation Agents;  Bone Neoplasms;  Combined Modality Therapy;  Conservative Treatment;  Denosumab;  Disease Progression;  Disease-Free Survival;  Female;  Follow-Up Studies;  Giant Cell Tumor of Bone;  Humans;  Lung Neoplasms;  Male;  Middle Aged;  Pneumonectomy;  Retrospective Studies;  Time Factors;  Treatment Outcome",
    abstract = "Background: The outcomes of patients with lung metastases from giant cell tumor of bone (GCTB) vary from spontaneous regression to uncontrolled growth. To investigate whether observation is an appropriate first-line management approach for patients with lung metastases from GCTB, we evaluated the outcomes of patients who were initially managed by observation. Methods: We retrospectively reviewed the data of 22 patients with lung metastases from histologically confirmed GCTB who received observation as a first-line treatment approach. The median follow-up period was 116 months. Results: Disease progression occurred in 12 patients (54.5%). The median interval between the discovery of lung metastases and progression was 8 months. Eight patients underwent metastasectomy following initial observation. The median interval between the discovery of lung metastases and treatment by metastasectomy was 13.5 months. None of the patients experienced spontaneous regression. Of the 22 patients, 36.4% needed a metastasectomy, and 9.1% required denosumab treatment during the course of the follow-up period. Disease progression occurred in 45.5% of the 11 patients with lung nodules ≤ 5 mm, while all five of the patients with lung nodules > 5 mm experienced disease progression. Progression-free survival was significantly worse in the group with lung nodules > 5 mm compared to the group with lung nodules ≤ 5 mm (p = 0.022). Conclusions: Observation is a safe first-line method of managing patients with lung metastases from GCTB. According to radiological imaging, approximately half of the patients progressed, and approximately half required a metastasectomy or denosumab treatment. However, patients with lung nodules > 5 mm should receive careful observation because of the high rate of disease progression in this group. © 2020, The Author(s)."
}