Figure 4. Tumor volume.

A) A representative two dimensional image created from a horizontal slice prior to denosumab treatment at the level of the femoral head taken from a thin slice CT study that was used to measure tumor volume (see Methods). B) A similar image taken two months after the final dose of denosumab. C) This panel shows the change in tumor volume over time. The first and last time points were derived from the studies done for panels A&B. The start of denosumab treatment is indicated. There were 13.5 months between the initial study and the scan done prior to start of denosumab. The solid line represents the change in volume assuming a linear rate of growth. Per report of the patient's mother and orthopedic surgeon, expansion began acutely and progressed rapidly over six weeks prior to initiation of denosumab, represented by the dashed line. Initiation of treatment was associated with marked decrease in the rate of tumor growth.