A 27-year-old woman presented with complaints of back pain in 2007 while living in Japan. Initial imaging revealed a T6 vertebral mass, and biopsy confirmed a diagnosis of GCTB. She underwent resection of the tumor with spinal stabilization. The patient was then lost to followup. In January 2010, she presented again with a 10.3 cm paraspinal mass in the T6 area on surveillance magnetic resonance imaging (MRI). This mass pushed the upper portion of the lungs posteriorly, the carina anteriorly, and the thoracic aorta laterally. Recurrent GCTB was confirmed by fine needle aspiration and biopsy. A resection was planned, and the patient was taken to surgery. Unfortunately, the tumor was unresectable due to extensive vertebral and vascular involvement. The patient was referred to radiation oncology and underwent intensity-modulated radiation therapy (5040 cGy) to the mass from March to April 2010. Follow-up computed tomographic imaging in May 2010 demonstrated an increase in the size of the mass from 9 x 8.9 cm AP to 10.2 x 9.2 cm (Figures 1(a) and 2(a)). The patient was then started on monthly denosumab in July 2010, with no major complications, and showed marked treatment response on serial imaging studies. By May 2011, the tumor had shrunk to 1.9 x 5.4 cm (Figures 1(b) and 2(b)). Three months later, the mass was found to be stable, and a repeat attempt at surgical resection was planned. In September 2011, she underwent thoracotomy with resection of the right lower lobe of the lung and removal of lateral portions of the T5-T8 vertebrae, along with the costal heads. Postoperative pathology showed a complete chemotherapeutic response, with extensive necrosis and fibrosis throughout the entire specimen and only focally recognizable tumor remaining, all of which was necrotic (Figures 3(a) and 3(b)). No viable tumor was identified. The patient had a slow but uneventful postoperative recovery. She remained free of recurrence, and an MRI done in April 2012 showed only postsurgical changes with no evidence of disease recurrence (Figures 4(a) and 4(b)). On the most recent CT imaging done in March 2013, there is no evidence of disease recurrence. The denosumab is now being administered every 3 months. The patient continues to tolerate the treatment without any adverse effects.