Novel approach to central giant cell granuloma of the Jaw: Low-dose intralesional denosumab treatment in a case series of nine patients

Abstract

Central giant cell granuloma (CGCG) is a rare non-neoplastic but locally destructive intraosseous lesion of the jaw. While surgical resection remains the golden standard, associated morbidity has led to exploration of pharmacological alternatives, such as denosumab. This case series evaluates the efficacy of monthly direct low-dose intralesional Prolia® (60 mg denosumab/mL) in patients with histologically confirmed CGCG. Before therapy, dental focus examination and screening blood tests were performed. Calcium carbonate/colecalciferol (1.25G/400IU) tablets were administered during treatment. Baseline and follow-up CBCT scans were performed at 3, 6, 12, and 18 months to assess mineralization and lesion volume regression. Nine patients (age range: 7-67 years, median 29 years, five males) received an average of 8 (range: 6-11) low-dose intralesional injections. Median follow-up was 18 (IQR 12) months. CBCT scans showed rapid mineralization within 3-6 months and volume regression within 6-12 months. One patient interrupted therapy due to pregnancy plans at subtotal remission but experienced recurrence, necessitating postpartum treatment. One child showed no response after six injections. Monthly direct intralesional denosumab (≥8 injections) gave complete remission in 7-9 patients after ≥8 injections and is an alternative for CGCG treatment when surgery is harmful. Note rebound hypercalcemia in children.