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Giant Cell Tumors of the Jaw

Giant Cell

Our work on giant cell bone tumors illustrates how clinical investigation techniques help bring a new treatment option into mainstream clinical practice.

Although benign, giant cell tumors of the jaw can be aggressive, locally destructive, and disfiguring. Traditionally, patients with giant cell tumors faced resection of the jaw, including removal of surrounding bone and nerves, followed by reconstructive surgery.

The Skeletal Biology Research Center developed an alternate treatment for patients with these tumors that involves a single, less radical procedure followed by chemotherapy. First reported in Pediatrics in 1999, Mass General oral and maxillofacial surgeons under the leadership of Dr. Leonard Kaban have had remarkable success treating giant cell tumors with less invasive enucleation of the tumor followed by postoperative antiangiogenic therapy using interferon. This is in contrast to en bloc resection and reconstruction with a bone graft.

The antiangiogenic properties of interferon appear to cripple the highly vascular lesion and to prevent recurrence by impeding revascularization of the area. In addition, the metabolic influence of interferon appears to promote formation of new bone and inhibit resorption of bone at the site of the lesion, eliminating the need for further reconstruction.

Our prospective study now has over 40 subjects on this protocol. The observed recurrence rate is 5% compared to an historic recurrence rate of 30-60% for these types of tumors. When the tumor recurs, it can be retreated with interferon or a combination of interferon and a bisphosphonate. Future studies will include the use of antiangiogenic therapy with no operation.

The SBRC and CACI, working collaboratively, continue to enroll patients, to study the long-term outcomes of those treated, to identify bio-markers associated with clinical behavior, and to compare and contrast the characteristics and genetic signatures of maxillofacial giant cell tumors with giant cell tumors of long bones.

Bibliography

Kaban LB, Troulis MJ, Wilkinson MS, Wilkinson MJ, Ebb D, Dodson TB. Adjuvant antiangiogenic therapy for giant cell tumors of the jaws. J Oral Maxillfac Surg 2007;65(10):2018-24.

Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB. Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws. J Oral Maxillofac Surg 2002;60(10):1103-11.

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