Experience with denosumab therapy for giant cell lesions of the facial bones in children

Objective. To demonstrate improved treatment outcomes in children with giant cell lesions of the craniofacial region (GCL) following neoadjuvant denosumab therapy and the development of a “hybrid” approach to the management of these conditions.
Material and methods. The study included 12 patients aged 4 months to 17 years (mean age 10 years) under observation from 2020 to 2025. The primary diagnostic method was multispiral computed tomography (MSCT) to evaluate lesion structure and density. All patients with morphologically confirmed diagnoses received neoadjuvant denosumab therapy. Treatment included an initiation phase (3–4 injections in the first month) and maintenance doses (once monthly). All patients underwent monitoring of calcium-phosphorus metabolism, endocrinological follow-up, renal ultrasound, and concomitant therapy with calcium and vitamin D supplements. Surgical treatment ranged from intralesional curettage to segmental resections with reconstructive plastic surgery, depending on the clinical situation.
Results. The nosological composition of the group was as follows: central giant cell granuloma (CGCG) – 8 patients, aneurysmal bone cyst (ABC) – 3 patients, peripheral giant cell granuloma (PGCG) – 1 patient. Lesion localization: mandible (8/67%), maxilla (4/33%). Denosumab therapy was well tolerated by all patients. All 12 (100%) patients showed positive dynamics on MSCT at 6 and 12 months of therapy: increased bone density of the lesions and formation of a perifocal capsule. In 10 (83.3%) patients, surgical intervention was limited to intralesional curettage with preservation of the anatomical integrity of the affected structures. In one case, a recurrence developed one year after the therapy course, which was stabilized with an additional course of denosumab, thereby avoiding radical resection. In one case, a patient with ABC underwent angiography with embolization of the feeding vessels. Discussion. The hybrid approach to treating GCL in children using denosumab demonstrates high efficacy, allowing for a reduction in the extent of surgical intervention and preservation of the anatomical integrity of the facial bones. The obtained data (increased lesion density, capsule formation) are consistent with international publications. However, direct comparison of our results with literature data is difficult due to the rarity of the diseases, the small sample size of our study, the heterogeneity of the described groups, and the lack of standardized protocols for denosumab use. The absence of unified dosing regimens and protocols for concomitant calcium-correcting therapy, as well as the potential resistance of certain GCL forms to treatment, remain unresolved issues.
Conclusion. Despite its “off-label” status and the presence of unresolved issues, the use of denosumab in children with giant cell lesions of the facial bones is clinically justified. Neoadjuvant anti-resorptive therapy serves as an effective tool, allowing in most cases to avoid mutilating resections and preserve the anatomical and functional integrity of the craniofacial region in the growing patient.
Keywords: giant cell lesions, central giant cell granuloma, aneurysmal bone cyst, denosumab, jaw neoplasms, maxillofacial surgery
Conflict of interest. The authors declare no conflict of interest.
Funding. All authors declared that they had no financial support for the preparation of this manuscript.