Bisphosphonate therapy for unresectable symptomatic benign bone tumors: A long-term prospective study of tolerance and efficacy

Objectives: To evaluate the long-term tolerance of bisphosphonates proposed as an alternative therapeutic option for symptomatic unresectable benign bone tumors and to evaluate the long-term efficacy of this treatment. Methods: From March 2007 to March 2011, patients with unresectable symptomatic benign bone tumors were consecutively included in this institutional review board-approved study and treated with bisphosphonates. Prospectively long-term follow-up is reported. The study endpoints were to describe the long-term tolerance, the clinical evolution of pain for each patient and the radiological success defined as a complete disappearance of inflammation and ossification of the bone lesion. All complications and side effects were recorded. Results: Eight patients (mean age 16 years; range 7-42) with various tumor subtypes were included: aneurysmal bone cysts (N = 5), Langerhans cell histiocytosis (N = 1), osteoblastoma (N = 1), and a giant cell tumor (N = 1). Tumors were located in cervical (N = 4) or thoracic (N = 1) vertebrae, femoral shaft (N = 1), acetabulum (N = 1) and sacrum (N = 1). Mean number of bisphosphonate cycles was 3 (range: 1-6) over a median period of 10 months. The median clinical and imaging follow-up period was 21 months (6 to 63 months). No severe complications due to treatment or lesion recurrence were reported. Pain disappeared within 6 weeks of the first cycle for all but one patient. Ossification of the bone lesion was observed for all patients but one, complete for two and partial for the five others. Conclusions: Bisphosphonates appear to be an effective option without adverse effects for the non-operative management of symptomatic benign bone tumors. (C) 2013 Elsevier Inc. All rights reserved.