<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902017000200180</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Denosumab, tratamiento alternativo en tumor óseo de células gigantes]]></article-title>
<article-title xml:lang="en"><![CDATA[Denosumab, an alternative treatment for giant cell tumor of bone]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[Marcos A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Casales]]></surname>
<given-names><![CDATA[Nicolás]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silveri]]></surname>
<given-names><![CDATA[Claudio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cardozo]]></surname>
<given-names><![CDATA[Jaqueline]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Filomeno]]></surname>
<given-names><![CDATA[Paola]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Francescoli]]></surname>
<given-names><![CDATA[Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Clínica de Ortopedia y Traumatología ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de la República Unidad de Patología Oncológica Musculoesquelética (UPOME) ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad de la República Unidad de Patología Oncológica Musculoesquelética (UPOME) ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad de la República Unidad de Patología Oncológica Musculoesquelética (UPOME) ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Universidad de la República Clínica de Ortopedia y Traumatología ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2017</year>
</pub-date>
<volume>33</volume>
<numero>2</numero>
<fpage>180</fpage>
<lpage>191</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902017000200180&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902017000200180&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902017000200180&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  el tumor óseo de células gigantes (TOCG) es un tumor benigno pero localmente agresivo. Se presenta en población joven y a nivel epifiso-metafisario. Está compuesto por una población celular estromal y otra multinucleada similar a los osteoclastos, donde se destaca la interacción RANK-RANKL (receptor del activador del factor nuclear kappa-B y su ligando, respectivamente). El anticuerpo monoclonal humano denosumab actúa inhibiendo específicamente RANKL, lo que evita la formación y activación de células multinucleadas. En la bibliografía se evidencia que denosumab tiene resultados alentadores como tratamiento adyuvante de algunos TOCG, generando planes terapéuticos con una menor morbimortalidad que los planteados previamente a la administración del anticuerpo.  Material y método:  se describe la primera experiencia terapéutica en Uruguay con dos pacientes menores de 40 años que consultaron por gonalgia de larga data, realizándose diagnóstico de TOCG estadio III de Campanacci, donde se realiza tratamiento con denosumab de forma protocolar valorando respuesta clínica, imagenológica, efectos adversos y modificación en plan terapéutico inicial.  Resultados:  se evidenció una respuesta clínica e imagenológica en los pacientes valorados. No se reportaron efectos adversos, logrando preservar la articulación afectada.  Conclusiones:  los resultados obtenidos son alentadores respecto al uso terapéutico de denosumab en los pacientes seleccionados. Esto permite considerar a denosumab dentro de las opciones terapéuticas de determinados pacientes con diagnóstico de TOCG.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ Abstract:  Introduction: giant cell tumor of bone (GCTB) is a benign tumor, although it is locally aggressive. It arises mainly in young people at the epi-metaphyseal level. It consists of stromal cells and osteoclasts-like populations, where the RANK-RANKL (receptor activator of nuclear factor kappa-B and its ligand, respectively) stands out. Denosumab, the human monoclonal antibody, acts by specifically inhibiting RANKL, what prevents the formation and activation of multinucleate cells. The existing bibliography indicates denosumab has obtained encouraging results as adjuvant treatment for some GCTB, enabling therapeutic plans that have lower morbi-mortality rates than those applied prior to administration of the antibody.  Method:  the study describes the therapeutic experience of two patients younger than 40 years old, who consulted in Uruguay for long standing gonalgia. Campanacci Stage III GCTB was diagnosed, and denosumab treatment was initiated. Clinical response was assessed, as well as imaging response, adverse side effects and the modification of initial treatment.  Results:  clinical and imaging response was seen in the assessed patients. No adverse side effects were reported, and the affected joint was preserved.  Conclusions:  the results obtained are encouraging with regard to the therapeutic use of denosumab in the selected patients. This allows for denosumab to be regarded within the therapeutic options for certain patients with a diagnosis of GCTB.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução: o tumor de células gigantes ósseo (TOCG) é um tumor benigno, porém agressivo. Apresenta-se em jovens localizando-se na metáfise e epífise dos ossos; compõe-se de uma população celular estromal e outra multinucleada similar aos osteoclastos, donde se destaca a interação RANK-RANKL (receptor do ativador do fator nuclear kappa-B e seu ligando, respectivamente). O anticorpo monoclonal humano denosumab age inibindo especificamente o RANKL, evitando a formação e a activação de células multinucleadas. A bibliografia mostra que o denosumab tem resultados animadores como tratamento adjuvante de alguns TOCG, com planos terapêuticos com menor morbimortalidade que os utilizados antes da administração do anticorpo.  Material e método:  descreve-se a primeira experiencia terapêutica no Uruguai com dois pacientes com menos de 40 anos que consultaram por gonalgia de longa data, realizando-se diagnóstico de TOCG estádio III de Campanacci; realizou-se tratamento com denosumab de acordo com o protocolo e avaliando a resposta clínica, a imagenología, os efeitos adversos e a modificação no esquema terapêutico inicial.  Resultados:  evidenciou-se uma resposta clínica e na imagenología nos pacientes avaliados. Não se informaram efeitos adversos, sendo possivel preservar a articulação afetada.  Conclusões:  os resultados obtidos são animadores com relação ao uso terapêutico do denosumab nos pacientes selecionados. Isto permite considerar o denosumab como opção terapêutica para determinados pacientes com diagnóstico de TOCG.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Neoplasias óseas]]></kwd>
<kwd lng="es"><![CDATA[Células gigantes]]></kwd>
<kwd lng="es"><![CDATA[Denosumab]]></kwd>
<kwd lng="en"><![CDATA[Bone neoplasms]]></kwd>
<kwd lng="en"><![CDATA[Giant cells]]></kwd>
<kwd lng="en"><![CDATA[Denosumab]]></kwd>
<kwd lng="pt"><![CDATA[Neoplasias ósseas]]></kwd>
<kwd lng="pt"><![CDATA[Células gigantes]]></kwd>
<kwd lng="pt"><![CDATA[Denosumab]]></kwd>
</kwd-group>
</article-meta>
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