RESUMEN
OBJECTIVE: A systematic review with meta-analysis was conducted to define the incidence of osteoradionecrosis (ORN) in patients with oral cavity cancer (OCC) treated with intensity-modulated radiotherapy (IMRT), and to identify the risk factors influencing its development. STUDY DESIGN: Six databases were searched systematically. A meta-analysis was performed to determine overall, spontaneous, and dental extraction-attributed incidences of ORN. The Grading of Recommendations Assessment, Development, and Evaluation tool evaluated evidence certainty. RESULTS: Out of 11 eligible studies, 6 underwent meta-analysis for the overall aggregated ORN incidence in OCC patients receiving IMRT, resulting in an incidence rate of 8% (95% CI: 6%-11%). Regarding development reasons, 2 studies were assessed, revealing an incidence of 36% (95% CI: 1%-98%) for spontaneous ORN, and 17% (95% CI: 5%-44%) ensued from dental extraction exclusively pre-RT. All rates had very low certainty of evidence. Factors significantly correlated with ORN development included postoperative RT use (78%), employment of therapeutic doses above 50 Gy, and mandibular involvement (80.5%). CONCLUSION: The findings suggest that IMRT alone is not sufficient to decrease ORN rates in OCC patients, underscoring the importance of precisely identifying the involved risk factors. However, further detailed primary studies will be necessary.
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Neoplasias de la Boca , Osteorradionecrosis , Radioterapia de Intensidad Modulada , Humanos , Osteorradionecrosis/etiología , Osteorradionecrosis/epidemiología , Radioterapia de Intensidad Modulada/efectos adversos , Incidencia , Neoplasias de la Boca/radioterapia , Factores de Riesgo , Enfermedades Maxilomandibulares/epidemiología , Enfermedades Maxilomandibulares/etiologíaRESUMEN
INTRODUCTION: This retrospective study aimed to investigate if pretreatment platelet (PLT) levels can predict the risk of osteoradionecrosis of the jaw (ORNJ) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) who received concurrent chemoradiotherapy (CCRT). MATERIAL &METHODS: ORNJ instances were identified from LA-NPC patients' pre- and post-CCRT oral exam records. All pretreatment PLT values were acquired on the first day of CCRT. Receiver operating characteristic curve analysis was used to determine the optimal PLT cutoff that divides patients into two subgroups with distinctive ORNJ rates. The primary outcome measure was the association between pretreatment PLT values and ORNJ incidence rates. RESULTS: The incidence of ORNJ was 8.8 % among the 240 LA-NPC patients analyzed. The ideal pre-CCRT PLT cutoff which divided the patients into two significantly different ORNJ rate groups was 285,000 cells/µL (PLT ≤ 285,000 cells/µL (N = 175) vs. PLT > 285,000 cells/µL (N = 65)). A comparison of the two PLT groups revealed that the incidence of ORNJ was substantially higher in patients with PLT > 285,000 cells/L than in those with PLT≤285,000 cells/L (26.2% vs. 2.3 %; P < 0.001). The presence of pre-CCRT ≥3 tooth extractions, any post-CCRT tooth extractions, mean mandibular dose ≥ 34.1 Gy, mandibular V57.5 Gy ≥ 34.7 %, and post-CCRT tooth extractions > 9 months after CCRT completion were also associated with significantly increased ORNJ rates. A multivariate Cox regression analysis demonstrated that each characteristic had an independent significance on ORNJ rates after CCRT. CONCLUSION: An affordable and easily accessible novel biomarker, PLT> 285,000 cells/L, may predict substantially higher ORNJ rates after definitive CCRT in individuals with LA-NPC.
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Quimioradioterapia , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Osteorradionecrosis , Humanos , Estudios Retrospectivos , Osteorradionecrosis/etiología , Osteorradionecrosis/diagnóstico , Osteorradionecrosis/epidemiología , Osteorradionecrosis/terapia , Masculino , Femenino , Carcinoma Nasofaríngeo/terapia , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/patología , Persona de Mediana Edad , Quimioradioterapia/efectos adversos , Recuento de Plaquetas , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/sangre , Adulto , Anciano , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/epidemiología , Enfermedades Maxilomandibulares/terapia , Enfermedades Maxilomandibulares/etiología , Incidencia , Valor Predictivo de las PruebasRESUMEN
OBJECTIVE: Efforts have been made to reduce epidemiological indicators of osteoradionecrosis in patients with head and neck cancer over recent years. This umbrella review aims to synthesize the information of the systematic reviews/meta-analyses investigating the effect of radiotherapy in patients with head and neck cancer on the frequency of osteoradionecrosis and to identify and analyze the gaps in current scientific literature. MATERIAL AND METHODS: A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Qualitative analysis of the reviews and their quality evaluation were performed. RESULTS: A total of 152 articles were obtained, and ten of them were selected for the final analysis, where six were systematic reviews and four were meta-analysis. According to the guide Assessing the Methodological Quality of Systematic Reviews (Amstar), eight articles included were of high quality and two of medium quality. These descriptive systematic reviews/meta-analyses included a total of 25 randomized clinical trials, showing that radiotherapy has positive effects on the frequency of osteoradionecrosis. Even though a reduction in the incidence of osteoradionecrosis was observed back in the history, in systematic reviews with meta-analysis, overall effect estimators were not significant. CONCLUSIONS: Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of osteoradionecrosis in patients with head and neck cancer treated by radiation. Possible explanations are related to factors such as the type of studies analyzed, indicator of irradiated complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.
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Neoplasias de Cabeza y Cuello , Enfermedades Maxilomandibulares , Osteorradionecrosis , Humanos , Neoplasias de Cabeza y Cuello/radioterapia , Maxilares , Enfermedades Maxilomandibulares/etiología , Osteorradionecrosis/etiología , Osteorradionecrosis/prevención & control , Revisiones Sistemáticas como Asunto , Metaanálisis como AsuntoRESUMEN
PURPOSE: Osteoradionecrosis of the jaw is a therapy-resistant condition that may occur after treatment for head and neck cancer. The aim of this study was to investigate the incidence of osteoradionecrosis in patients with oropharyngeal cancer in relation to tooth extraction prior to radiation therapy. METHODS: Patients who had undergone radiation therapy for oropharyngeal cancer 5-10 years earlier were included and evaluated for the development of osteoradionecrosis (n = 75). RESULTS: Among the 75 patients, 62 had molar teeth present in the >50 Gy radiation field and 36 of those patients had teeth extracted prior to radiation therapy. Extraction of molars before radiotherapy significantly increased the risk of developing osteoradionecrosis (P < 0.05). There were no identifiable statistically significant correlations between the time from tooth extraction and the start of radiation therapy, the number of teeth in the radiation field, smoking habits, human papillomavirus-status, gender, age or tumor location and the development of osteoradionecrosis. CONCLUSION: Tooth extraction prior to radiation therapy increases the risk of developing osteoradionecrosis. For patients with good oral hygiene and absence of dental disease, avoidance of tooth extraction in the radiation field could therefore reduce the risk of complications.
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Neoplasias de Cabeza y Cuello , Neoplasias Orofaríngeas , Osteorradionecrosis , Extracción Dental , Extracción Dental/efectos adversos , Neoplasias Orofaríngeas/complicaciones , Neoplasias Orofaríngeas/radioterapia , Osteorradionecrosis/complicaciones , Osteorradionecrosis/epidemiología , Enfermedades Maxilomandibulares/epidemiología , Enfermedades Maxilomandibulares/etiología , Neoplasias de Cabeza y Cuello/complicacionesRESUMEN
OBJECTIVE: Over the last 2 decades, investigations have demonstrated a decreased trend in the likelihood of osteoradionecrosis of the jaw (ORNJ) after extraction. The aim of this study was to explore the potential risk factors for ORNJ in irradiated head and neck cancer by using patients' electronic dental records (EDRs). METHODS: Patients diagnosed with head and neck cancer who had irradiation between January 2010 and December 2020 were included in this retrospective cohort analysis. Patient charts showing evidence of "head and neck cancer," "oral cancer," "radiotherapy," "radiation," and "oral complication" were identified by an informatics analyst querying the EDR. Subsequently, the charts were manually reviewed, and data quality was assessed on 3 dimensions: completeness, accuracy, and consistency. The patient, tumor, systemic condition/drug, oral condition, treatment/trauma, and radiation were all categorized as potential risk factors. RESULTS: A total of 359 patients were included. With the exception of radiation-related factors, we found that the data quality was generally sufficient to support the research. Multivariate logistic regression analysis demonstrated that the following factors were significant in predicting the occurrence of ORNJ development in irradiated head and neck cancer: smoking (odds ratio [OR], 9.0; 95% CI, 1.9 to 43.0; P = 0.006), steroid use (OR, 6.4; 95% CI, 1.3 to 30.8; P = 0.021), oral health status (OR, 23.7; 95% CI, 2.7 to 211.0; P = 0.005), and postirradiation extraction (OR, 3.8; 95% CI, 1.0 to 14.4; P = 0.050). CONCLUSIONS: A 10-y retrospective analysis of data from an EDR revealed that smoking, steroid use, poor oral status, and postirradiation extraction are all factors linked to an increased risk of developing ORNJ. The quality of EDR data may be systematically assessed by determining the completeness, accuracy, and consistency of the underlying data. Radiation-related factors in particular were poorly documented, highlighting the need for collecting or incorporating this information into the EDR. KNOWLEDGE TRANSFER STATEMENT: EDRs can be used to identify risk factors for developing ORNJ in irradiated head and neck cancer and can help clinicians with selecting treatments by incorporating risk and complication considerations.
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Neoplasias de Cabeza y Cuello , Enfermedades Maxilomandibulares , Osteorradionecrosis , Humanos , Osteorradionecrosis/etiología , Osteorradionecrosis/complicaciones , Estudios Retrospectivos , Registros Odontológicos , Enfermedades Maxilomandibulares/epidemiología , Enfermedades Maxilomandibulares/etiología , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/complicaciones , EsteroidesRESUMEN
OBJECTIVE: Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS. METHODS: This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age. RESULTS: The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02). CONCLUSION: Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.
Asunto(s)
Anemia de Células Falciformes , Enfermedades de la Pulpa Dental , Hidroxiurea , Enfermedades Maxilomandibulares , Humanos , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/tratamiento farmacológico , Estudios Transversales , Enfermedades de la Pulpa Dental/diagnóstico por imagen , Enfermedades de la Pulpa Dental/etiología , Enfermedades de la Pulpa Dental/fisiopatología , Hemoglobinas , Hidroxiurea/uso terapéutico , Enfermedades Maxilomandibulares/diagnóstico por imagen , Enfermedades Maxilomandibulares/etiología , Factores de RiesgoRESUMEN
La osteonecrosis de los maxilares (ONM) secundaria al consumo de medicamentos antirresortivos y antiangiogénicos es una patología oral que afecta el funcionamiento del organismo de los seres humanos no sólo a nivel bucal, sino que disminuye su calidad de vida y aumenta su morbilidad. La ONM se define como la presencia de hueso necrótico expuesto que puede ser explorado mediante una fístula en el territorio maxilofacial, que se mantiene durante un periodo mínimo de ocho se- manas. Los fármacos antirresortivos y antiangiogénicos son indicados a pacientes que presentan patologías osteometabólicas, cáncer, entre otras, de ahí la importancia de mantener una estrecha relación entre médico tratante-odontólogo-paciente. El propósito de este artículo es establecer un protocolo de cuidado oral básico y definir las funciones del médico tratante, cirujano dentista y cirujano maxilofacial mediante una revisión bibliográfica con el fin de crear una propuesta preventiva para el tratamiento de estos pacientes (AU)
Medication-related osteonecrosis of the jaw (MRONJ), secondary to the consumption of antiresorptive and antiangiogenic drugs is an oral pathology that affects the functioning of the human body, not only at the oral level, but also decreasing their quality of life and increasing their morbidity. MRONJ is defined as the presence of exposed necrotic bone that can be explored through a fistula in the maxillofacial territory, which is maintained for a minimum period of eight weeks. Antiresorptive and antiangiogenic drugs are indicated for patients with osteometabolic pathologies, cancer, among others. For the same reasons, the importance of maintaining a close relationship between the treating physician, dentist and patient. The purpose of this article is to establish a clinical guide for basic oral care and define the functions of the treating physician, dental surgeon and maxillofacial surgeon through a bibliographic review; in order to create a preventive proposal for the treatment of these patients (AU)
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Humanos , Masculino , Femenino , Inhibidores de la Angiogénesis/efectos adversos , Conservadores de la Densidad Ósea/efectos adversos , Osteonecrosis de los Maxilares Asociada a Difosfonatos/complicaciones , Grupo de Atención al Paciente , Enfermedades Maxilomandibulares/etiología , Protocolos Clínicos , Atención Dental para Enfermos Crónicos/métodos , Osteonecrosis de los Maxilares Asociada a Difosfonatos/prevención & controlRESUMEN
BACKGROUND: Tooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy. METHODS: A retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted. RESULTS: Seventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular canal. Using multivariate analysis, the odds of developing an ORN from a surgical procedure was 6.50 (CI 1.37-30.91, p = 0.02). Dental extraction of more than 5 years after radiotherapy and invisible upper cortical line of mandibular canal on the DPT have the odds of 0.06 (CI 0.01-0.25, p < 0.001) and 9.47 (CI 1.61-55.88, p = 0.01), respectively. CONCLUSION: Extraction more than 5 years after radiotherapy, surgical removal procedure and invisible upper cortical line of mandibular canal on the DPT were the predictors of ORN.
Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Enfermedades Maxilomandibulares/diagnóstico , Osteorradionecrosis/diagnóstico , Extracción Dental/efectos adversos , Adulto , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/epidemiología , Humanos , Enfermedades Maxilomandibulares/epidemiología , Enfermedades Maxilomandibulares/etiología , Malasia/epidemiología , Masculino , Canal Mandibular/efectos de la radiación , Persona de Mediana Edad , Osteorradionecrosis/epidemiología , Osteorradionecrosis/etiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Extracción Dental/estadística & datos numéricosRESUMEN
Osteoradionecrosis of the jaw (ORNJ) is one of the most devastating complications caused by radiation therapy in head and neck region, which is among the greatest challenges within stomatology. Treatment methods have been enriched because of expanded understanding of the pathogenic mechanism of ORNJ. Meanwhile, the diagnosis and treatment of ORNJ have been uniformed and improved gradually in China, making progress on several aspects from the establishment of classification and hierarchy system and publication of the consensus on ORNJ treatment. In the present comment, the author reviewed the history and current situation of diagnosis and treatment of ORNJ and prospected the hot topics of basic, translational and clinical research.
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Neoplasias de Cabeza y Cuello , Enfermedades Maxilomandibulares , Osteorradionecrosis , China , Humanos , Maxilares , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/etiología , Enfermedades Maxilomandibulares/terapia , Osteorradionecrosis/diagnóstico , Osteorradionecrosis/etiología , Osteorradionecrosis/terapiaRESUMEN
Osteonecrosis of the jaw (ONJ) is necrosis of mandibular or maxillary bone, which sometimes leads to bone exposure and sequestration. There is evidence that the microenvironment of the marrow stromal system is severely and irreversibly damaged after haematopoietic stem cell transplantation (HSCT) leading to a deficit in the quantity and quality of osteoblastic progenitors, compromising the ability to regenerate a normal osteogenic cell population and abnormality in bone remodelling/turnover. While osteonecrosis of the appendicular skeleton is a common complication after HSCT, there have been no reports of an association with ONJ. This is a report of the first case of ONJ secondary to HSCT in a 69-year-old woman who developed a unique pattern of osteonecrosis involving all four quadrants of the jaw 2 months after allogeneic stem cell transplantation.
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Conservadores de la Densidad Ósea , Trasplante de Células Madre Hematopoyéticas , Enfermedades Maxilomandibulares , Osteonecrosis , Anciano , Difosfonatos , Femenino , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Maxilares , Enfermedades Maxilomandibulares/etiología , Mandíbula , Osteonecrosis/etiologíaRESUMEN
OBJECTIVE: Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. STUDY DESIGN: Retrospective multi-institutional review. SETTING: Tertiary care centers. METHODS: Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. RESULTS: Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). CONCLUSION: The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Colgajos Tisulares Libres/irrigación sanguínea , Enfermedades Maxilomandibulares/etiología , Enfermedades Maxilomandibulares/cirugía , Osteonecrosis/cirugía , Procedimientos de Cirugía Plástica/métodos , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Osteonecrosis/etiología , Osteonecrosis/patología , Radioterapia/efectos adversos , Recuperación de la Función , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
BACKGROUND: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters. METHODS: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation. RESULTS: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). CONCLUSIONS: V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.
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Neoplasias de Cabeza y Cuello/radioterapia , Enfermedades Maxilomandibulares/etiología , Osteorradionecrosis/etiología , Radioterapia de Intensidad Modulada/efectos adversos , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Maxilares/efectos de la radiación , Enfermedades Maxilomandibulares/epidemiología , Masculino , Persona de Mediana Edad , Osteorradionecrosis/epidemiología , Dosificación Radioterapéutica , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) among the therapeutic alternatives: surgical, pharmacological and combined. MATERIAL AND METHODS: The review was organized according to the PRISMA protocol with regards to the following PICO question: patients with ORN of the jaws (P=Patient); all interventions reported (I = intervention); between all therapies (C=Comparison); healing of lesions (O=outcome). RESULTS: Surgical treatment was the most common choice (46.3%) followed by pharmacological treatment, exclusively (25.9%) or combined (26.9%). Treatment exclusively by surgical intervention seems to be most effective option, with 51.2% of the lesions healed, OR for healing of 5.7 (CI95% 1.9-16.9, p=0.002). Only 1 case (0.9%) corresponded to low level laser therapy. CONCLUSIONS: It seems clear that early intervention with conservative surgical combined with pharmacological methods improves the prognosis of ORN.
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Neoplasias de Cabeza y Cuello , Enfermedades Maxilomandibulares , Osteorradionecrosis , Humanos , Maxilares , Enfermedades Maxilomandibulares/etiología , Osteorradionecrosis/cirugía , PronósticoRESUMEN
BACKGROUND: Osteoradionecrosis (ORN) of the jaw is currently defined by the development of osteonecrosis in head/neck irradiated patients, regardless of lesion exposure. To diagnose medication-related osteonecrosis of the jaw (MRONJ), a history of any radiation therapy to the jaw region must be ruled out. The aim of this study was to assess the accuracy of current osteonecrosis criteria, while introducing new modifications for improved diagnosis and treatment. METHODS: One hundred and forty-one necrotic lesions were analyzed from patients exposed to bone-modifying agents (BMAs) and/or received head and neck regional radiation therapy, where the maximal dose of radiation exposure to the jaw osteonecrosis site was calculated. Modified diagnostic criteria were used to reassess all cases and a comparison of outcomes was performed using Pearson's Chi-Square/Fisher's exact test. RESULTS: Only in patients with primary head and neck carcinomas did the maximal mean radiation dose in the necrotic jaw site reach ranges associated with ORN formation (>40 Gy), with individual cases showing exposures as low as 0-2 Gy. Based on the modified diagnostic criteria almost 2/3 of the necrotic cases diagnosed as ORN should be diagnosed as MRONJ. CONCLUSIONS: ORN diagnosis should only be considered in cases of radiation exposure >40 Gy to prevent misdiagnosis and suboptimal treatment. A modified criterion for MRONJ diagnosis is recommended where radiation exposure <40 Gy in the necrotic site is included. In cases with exposure >40 Gy and BMA administration, an additional modification to diagnostic criteria of 'medication- and radiation-related osteonecrosis of the jaw', should be used.
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Conservadores de la Densidad Ósea , Enfermedades Maxilomandibulares , Neoplasias , Osteonecrosis , Osteorradionecrosis , Humanos , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/etiología , Necrosis , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Osteorradionecrosis/diagnóstico , Osteorradionecrosis/etiologíaRESUMEN
OBJECTIVE: This study aims to explore the molecular mechanism of macrophages and γδ-T cells in the ZOL drug-induced osteonecrosis of jaws based on the IFN-γ involved osteoblast differentiation signaling pathway. RESULTS: The number and apoptotic rate of CD11b+Gr1hi cells and γδ-T cells in the ONJ group were significantly higher. The TNF-α, IL-1ß, IFN-γ, CCL3, CCL4, IL-12 and IL-13 levels were significantly higher in the ONJ group. The expression of CTSK and FGFR3 was lower in the ONJ group, but was higher in the NF-κB and ERBB2IP group. CONCLUSION: The proliferation of macrophages and γδ-T cells promote the inflammation in ZOL-induced jaw necrosis. METHODS: A total of 20 patients with osteonecrosis of the jaw from January 2016 to March 2018 were collected and assigned into the observation group, while 20 healthy subjects were assigned into the control group. Furthermore, 40 SD rats were selected and assigned into observation group, while 10 non-treatment SD rats were selected and assigned as controls. The distribution and proportion of CD11b+Gr1hi cells and γδ-T cells in the necrotic tissues of the jaw were analyzed. Then, the TNF-α, IL-1ß, IFN-γ, CCL3, CCL4, IL-12 and IL-13 levels were measured. Afterwards, the expression of CTSK, FGFR3, NF-κB and ERBB2IP in the necrotic tissues of the jaw in the animal models were analyzed.
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Linfocitos Intraepiteliales/fisiología , Enfermedades Maxilomandibulares/etiología , Macrófagos/fisiología , Osteonecrosis/etiología , Adulto , Anciano , Animales , Diferenciación Celular/fisiología , Modelos Animales de Enfermedad , Humanos , Enfermedades Maxilomandibulares/inducido químicamente , Enfermedades Maxilomandibulares/inmunología , Masculino , Persona de Mediana Edad , Osteoblastos/fisiología , Osteonecrosis/inducido químicamente , Osteonecrosis/inmunología , Ratas , Ratas Sprague-DawleyRESUMEN
Osteoradionecrosis of the jaw (ORNJ) is one of the most devastating and progressive complications of head and neck radiotherapy. It can cause emaciation, deformity, and pathological fractures, resulting in decreased quality of life. The aim of this study was to evaluate the preoperative index and outcomes of treatment for ORNJ. A retrospective study of 252 ORNJ cases treated at one institution between January 2010 and January 2018 was made. The abnormal items from the preoperative examination and follow-up after different treatments were recorded, and the differences between the noteworthy items were compared using univariate and multivariate models. Most ORNJ patients in the middle and late stages had abnormal items, such as hypoproteinaemia, anaemia, and leucocytosis. Partial mandibulectomy with flap reconstruction was significantly more effective than without reconstruction. Advanced ORNJ patients tended to have more abnormal items, which might have a negative influence on treatment. For better outcomes, it is essential and effective to completely remove the necrotic lesion and reconstruct it with a flap. The surgeons should provide sufficient perioperative management and strive for suitable surgical treatment.
Asunto(s)
Neoplasias de Cabeza y Cuello , Enfermedades Maxilomandibulares , Osteorradionecrosis , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Maxilares , Enfermedades Maxilomandibulares/etiología , Enfermedades Maxilomandibulares/cirugía , Osteorradionecrosis/cirugía , Calidad de Vida , Estudios RetrospectivosRESUMEN
OBJECTIVE: Radiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national healthcare database, we reviewed the contraindications and analysed other risk factors for ORNJ. DESIGN: A retrospective cohort study. SETTING: By using Taiwan's National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1-21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1-7 days and 8-21 days. PARTICIPANTS: Taiwanese patients with head and neck cancer. MAIN OUTCOMES MEASURE: Univariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ. RESULTS: The overall incidence of ORNJ in the included patients was 1.03% (mean follow-up duration, 4.07 ± 3.01 years; range, 1.00-13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio [HR] =0.734; P = .312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488) and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all P < .001). CONCLUSION: In a mean follow-up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7-21 days before RT.
Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Enfermedades Maxilomandibulares/epidemiología , Osteorradionecrosis/epidemiología , Extracción Dental , Femenino , Humanos , Incidencia , Enfermedades Maxilomandibulares/etiología , Masculino , Persona de Mediana Edad , Osteorradionecrosis/etiología , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología , Factores de Tiempo , Cicatrización de HeridasRESUMEN
A patient suffering from acute promyelocytic leukemia (APL) was referred to the dental department before introduction of chemotherapy by all-trans retinoic acid and arsenic trioxide (ATO). A panoramic radiography showed his third upper maxillary left tooth included into the maxillary bone. The patient presented with a febrile episode. Consequently, the infectious gateway was researched. A left maxillary sinus migration of his third upper left tooth together with a bony sequestrum has been observed on a CT-scan. A surgery was then performed to remove the bony sequestrum and the tooth. The first hypothesis of tooth migration could be that the patient had an infection prior to introduction of chemotherapy. However, neither clinical or radiographic signs were observed during the initial check-up. The second hypothesis is that ATO caused osteonecrosis of the jaw (ONJ) induced the formation of a bony sequestrum associated to the tooth migration into the sinus. ONJ could be a potential adverse of ATO chemotherapy.
Asunto(s)
Trióxido de Arsénico/efectos adversos , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/etiología , Leucemia Promielocítica Aguda/complicaciones , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trióxido de Arsénico/administración & dosificación , Biomarcadores , Terapia Combinada , Humanos , Enfermedades Maxilomandibulares/terapia , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Osteonecrosis/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Commercial bone substitutes that are widely used for bone augmentation for dental implants are predisposing factors in the development of osteonecrosis of the jaw (ONJ), overlooking this situation may lead to serious problems. Most of these materials are supplied as inorganic porous granules of calcium phosphate, which have characteristics that exceed the bone resorption ability of normal osteoclasts; therefore, they can be equally regarded as existing antiresorptive necrotic bony granules in the body, i.e., micro-ONJs. In addition, because dental implants directly contact the surrounding bone without the periodontium with immunoprotective functions, the mucosal penetration of the dental implant itself predisposes the underlying bone to the risk of infection, latent osteomyelitis, and ONJ. Therefore, the remaining porous granules surrounding the dental implant pose an additional iatrogenic risk, even though the tissue may appear superficially healthy. In an aging society, an individual who was systemically healthy at the time of implantation with bone augmentation could develop osteoporosis or cancer bone metastasis later in life. ONJ can occur more easily if an antiresorptive agent such as bisphosphonates or denosumab is administered without sufficiently recognizing an intraoral situation. If the latent risk is known in advance, the selection or use of medicines could be restricted. Such restrictions can result in other crucial issues that are beyond the discretion of the dentists; however, dentists have not been warned about such possibilities. The use of antiresorptive agents and bone substitutes for dental implants should be reconsidered to avoid numerous adverse events such as ONJ.
Asunto(s)
Sustitutos de Huesos/efectos adversos , Implantes Dentales/efectos adversos , Enfermedad Iatrogénica , Enfermedades Maxilomandibulares/etiología , Osteonecrosis/etiología , Humanos , Japón , Enfermedades Maxilomandibulares/diagnóstico por imagen , Osteonecrosis/diagnóstico por imagen , Medición de Riesgo , Factores de RiesgoRESUMEN
We report the case of an 84-year-old woman with poorly differentiated non-small cell carcinoma of the right parotid who presented with headache, was found to have a primary right parotid gland cancer as well as metastatic disease, and underwent palliative radiotherapy to the primary site. The patient received no chemotherapy or immunotherapy, but both the primary site and several non-irradiated foci in the lungs regressed or completely resolved. The patient remained free of disease for about one year before progression. The case is a rare instance of abscopal regression of metastatic disease in the absence of pharmacologic immunomodulation. A literature review surveys the history of the abscopal effect of radiation therapy, attempts to understand the mechanisms of its successes and failures, and points to new approaches that can inform and improve the outcomes of radioimmunotherapy.