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1.
Artigo em Inglês | MEDLINE | ID: mdl-32493679

RESUMO

OBJECTIVES: One of the treatment goals for osteonecrotic lesions of the jaw, such as medication-related osteonecrosis of the jaw (MRONJ) or osteoradionecrosis (ORN), is restoration of quality of life (QOL). This study aimed to identify symptoms that negatively affect QOL in patients with unhealed MRONJ or ORN. STUDY DESIGN: This cross-sectional study included patients who were previously diagnosed with MRONJ or ORN and who underwent treatment at the Kobe University Hospital between June 2015 and February 2016. Patient QOL was measured by using the Oral Health Impact Profile (OHIP-14). The predictor variable was disease status (stage and healing). The outcome variable was OHIP-14. One-way analysis of variance and Tukey's test were performed. RESULTS: The study included 74 patients (37 men and 37 women; mean age 70 years). Although there was no significant difference between the OHIP-14 scores of unhealed MRONJ and ORN (stages 1-3) and those of healed ones, the "worsened sense of taste" resulted in significant differences among stages in patients with unhealed MRONJ (P = .027) and the "painful mouth aching" in patients with unhealed ORN (P = .041). CONCLUSIONS: Worsened sense of taste and pain negatively affected QOL in patients with unhealed MRONJ and ORN.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteorradionecrose , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Bucal , Qualidade de Vida
2.
Artigo em Inglês | MEDLINE | ID: mdl-32444333

RESUMO

OBJECTIVE AND STUDY DESIGN: This narrative review summarizes the current state of art of radiation-related caries (RC), an aggressive disease that affects approximately 30% of post-head and neck radiotherapy (HNRT) patients. RESULTS: RC mainly affects the tooth cervical areas and incisal/cuspal tips and develops 6 to 12 months after HNRT. Early RC signs include black/brownish tooth discoloration and enamel cracks, which progress to enamel delamination, exposing underlying dentin to a highly cariogenic oral environment and rapid tooth destruction/dental crown amputation. As RC advances and renders the tooth nonrestorable, it may lead to osteoradionecrosis spontaneously or upon extraction if the tooth is in a highly irradiated field of the oral cavity. This requires aggressive treatment, which would have a negative impact on a cancer survivor's quality of life and contribute to the incremental cost of cancer care. Chlorhexidine mouth rinses and topical fluoride applications are effective agents used in RC prevention; however, there are no well-established treatment protocols. Once RC progresses, dental restorations should be performed with adhesive materials in association with systematic fluoride application as illustrated in the clinical case presented in this review. Post-HNRT patients should be closely followed up for optimal RC prevention, early diagnosis, and prompt treatment. CONCLUSIONS: Future clinical studies are necessary to establish a contemporary, clinically validated protocol for RC management.


Assuntos
Cárie Dentária , Osteorradionecrose , Lesões por Radiação , Humanos , Prognóstico , Qualidade de Vida
3.
Spec Care Dentist ; 40(3): 238-250, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32378765

RESUMO

The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects have a strong, negative influence on the oral functions and are responsible for a drastic reduction in the oral-health-related quality of life of the cancer survivors. In a significant deviation to the earlier approach of advising extraction of all remaining teeth before RT, the concept of preserving a maximum number of teeth in a state of health and for better oral functions postcancer cure has been globally accepted and is adhered to. The effects of radiation and their impact on the general well-being of the patients underscore the relevance of understanding the sequelae of radiation therapy on healthy oral tissues, preexisting oral diseases and their progression, impact on oral treatment needs, limitations in performing the indicated treatment, and shortcoming in treatment outcomes. It is vital for the professionals involved in head and neck cancer care to follow a well-devised referral system for oral care before and after RT and educate patients for a life-long follow-up.


Assuntos
Neoplasias de Cabeça e Pescoço , Doenças da Boca , Osteorradionecrose , Lesões por Radiação , Humanos , Qualidade de Vida
4.
World Neurosurg ; 138: 485-490, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32229304

RESUMO

BACKGROUND: Craniocervical junction chordoma treated with surgery and Proton Beam Therapy evolved with Osteonecrosis and CSF leak. As the vascularization of the head was compromised, we harvested an Anterolateral thigh musculofascial flap to seal the leak. CASE DESCRIPTION: A 56-year-old man presented with a history of chronic headaches and dysarthria with tongue deviation to the right. Magnetic resonance imaging showed a lesion at the craniocervical junction with imaging characteristics compatible with chordoma. Endoscopic endonasal resection was followed by proton beam therapy. Recurrence of the chordoma was subsequently resected via far lateral approach again followed by proton beam therapy accumulating a total dose of 75 Gy. Unfortunately, this led to osteoradionecrosis of the skull base resulting in a cerebrospinal fluid (CSF) leak more than 1 year after treatment. After multiple failed attempts to seal the defect using local vascularized tissue and free fat grafts, the defect was reconstructed with a vastus lateralis free tissue transfer. Six weeks later, the flap had mucosalized, the patient was pain free, and there was no evidence of a CSF leak. CONCLUSIONS: In select cases, vascularized free flaps offer a superior reconstruction for osteoradionecrosis because radiotherapy often compromises the blood supply of local tissues.


Assuntos
Fossa Craniana Posterior/cirurgia , Osteorradionecrose/cirurgia , Terapia com Prótons/efeitos adversos , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vértebras Cervicais/cirurgia , Cordoma/complicações , Cordoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
5.
Br Dent J ; 228(6): 435-440, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32221447

RESUMO

Objectives Dental assessment remains a key intervention for head and neck cancer (HNC) patients pre-radiotherapy (RT). The purpose of this study was to identify the variation in dental status of patients pre-treatment, with respect to population and oncological demographics.Materials and methods The study reviewed dental panoramic radiographs of HNC patients seen on a dedicated pre-RT dental clinic from 2011-2017. Only patients who had undergone intensity-modulated radiotherapy treatment were included within this study. Relevant dental and oncological data were collected.Results A total of 886 patients were included in this study, with oropharyngeal cancer constituting 36% of the cohort. The average number of teeth in HNC patients was <21 at the pre-RT phase, which is below the recognised threshold for a functional dentition. Smoking status has a significant impact on overall DMFT (decay/missing/filled teeth), severity of horizontal bone loss and the number of third molars present (p <0.001). In the latter, males had a higher mean number of third molars compared to females (p <0.005). Comparing dental status of patients based on their tumour sub-site identified significant (p <0.0005) variation in all aforementioned categories.Conclusion There are distinct differences in the dental health of HNC patients due to commence RT, compared to the general population. It varies by cancer sub-site and this should be taken into consideration at dental assessment to tailor a dental care plan to the needs of the individual. Consideration should be given to balancing masticatory function against the risks of osteoradionecrosis on the background of increasingly extended survivorship.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Radioterapia de Intensidade Modulada , Perda de Dente , Feminino , Humanos , Masculino
6.
World Neurosurg ; 138: 381-385, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145424

RESUMO

BACKGROUND: Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone after local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of preprocedural imaging in guiding the decision to biopsy in cases of ORN. CASE DESCRIPTION: Eight patients with a history of prior head and neck cancer, radiation therapy, and suspected ORN at the skull base, occipitocervical junction, and atlantoaxial spine were identified retrospectively from a single academic medical center. In 4 cases, MRI findings and PET imaging were negative for recurrence. One patient in this group underwent an aborted biopsy. Four patients had MRI concerning for infection or recurrent tumor with PET-positive lesions. Three patients in this group underwent biopsy that was negative for recurrent tumor. One patient developed an arteriovenous fistula after biopsy. The fourth patient was observed and did not demonstrate progression at 5 months. At last follow-up for all patients, there was no evidence of tumor recurrence or metastasis at the index site to indicate a misdiagnosis for recurrent tumor. CONCLUSIONS: This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN because no patients with PET-positive lesions had histopathologic evidence of tumor recurrence or metastasis on biopsy.


Assuntos
Articulação Atlantoccipital/diagnóstico por imagem , Articulação Atlantoccipital/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Osteorradionecrose/diagnóstico por imagem , Osteorradionecrose/patologia , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos
7.
Clin Ter ; 171(2): e110-e113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141481

RESUMO

Osteoradionecrosis (ORN) is a well-recognized, debilitating complication of radiotherapy for patients with head and neck cancer. There is no universally accepted treatment for ORN of the jawbones. We report on a case of refractory mandibular ORN treated by sequestrectomy of mandible and autogenous transplantation of fat graft combined with platelet-rich fibrin (PRF). Improved perfusion was observed using the laser Doppler flowmetry. This case highlights the use of autogenous free fat graft and PRF as an adjunct therapy to sequestrectomy in the management of ORN.


Assuntos
Tecido Adiposo/transplante , Doenças Mandibulares/terapia , Osteorradionecrose/terapia , Fibrina Rica em Plaquetas , Terapia Combinada , Humanos , Masculino , Mandíbula/cirurgia , Doenças Mandibulares/cirurgia , Pessoa de Meia-Idade , Fatores de Risco , Cicatrização
8.
Artigo em Inglês | MEDLINE | ID: mdl-32029419

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effect of combined application of pentoxifylline and vitamin E (PENTO) for the treatment of osteoradionecrosis of the jaws (ORNJ) by performing a meta-analysis. STUDY DESIGN: We searched for trials in 4 electronic databases (PubMed, Cochrane library, EMbase, and Web of Science) for studies that compared the effect of PENTO with those of other treatment methods. The range of exposed bone was chosen as the index to assess the effects of the different treatment methods. We performed the meta-analysis by using Review Manager 5.3. RESULTS: We identified 5 trials, which included 184 patients in the PENTO group and 180 patients in the "other treatment methods" (OTHER) group, and we performed a meta-analysis by using the random effect model. PENTO had a better effect compared with all the other treatment methods, and a statistically significant difference was noted (odds ratio [OR] = 4.54; 95% confidence interval [CI] 2.89-7.12; P < .01). PENTO was statistically different from antibiotics (OR = 7.02; 95% CI 1.33-37.01; P < .05) and hyperbaric oxygen therapy (OR = 20.06; 95% CI 1.74-230.78; P < .05) in terms of treatment effect. However, we could not confirm that PENTO was more effective than local surgery (OR = 6.50; 95% CI 0.80-53.09; P < .1). CONCLUSIONS: The results of this meta-analysis suggest that the application of PENTO for the treatment of ORNJ shows superior efficiency relative to the other treatment methods.


Assuntos
Oxigenação Hiperbárica , Osteorradionecrose , Pentoxifilina , Humanos , Arcada Osseodentária , Vitamina E
9.
Int J Oral Maxillofac Surg ; 49(1): 1-6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31296436

RESUMO

Better cancer treatment has led to a steadily growing population of cancer survivors suffering from late adverse effects after cancer treatment. The aim of this study was to investigate whether there has been an increase in free flap reconstruction due to osteoradionecrosis (ORN). A retrospective review was conducted to identify all consecutive head and neck free flap reconstructions performed over an 18-year period (1995-2012) at Karolinska University Hospital. A total of 235 free flaps were identified. Cases were divided into two groups: head and neck cancer reconstructions and ORN reconstructions. A comparison between the two groups showed longer survival (P<0.001) and higher rates of late complications (P<0.001) among ORN cases. ORN as an indication for reconstruction increased over time, from 7.0% of the total number of free flaps performed in 1995-2000, to 15.2% during the period 2001-2006, and to 27.3% in 2007-2012 (P<0.001). This, in accordance with the results of other studies, highlights the importance of the appropriate allocation of resources within the healthcare system to treat this patient group within the steadily increasing population of cancer survivors.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Estudos Retrospectivos
10.
Clin Oral Investig ; 24(1): 455-463, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31111283

RESUMO

OBJECTIVES: The study aimed to investigate the timeline association with specific dental therapy and osteoradionecrosis (ORN) in oral cancer patients. MATERIALS AND METHODS: A total of 7394 oral cancer patients, including 198 ORN subjects, were retrieved from a Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan and were analyzed with the Cox proportional hazard regression to compare the ORN risk of individual dental treatments under different dental treatments. RESULTS: The initial dental treatment time significantly impacted on the risk of ORN in oral cancer patients (P<0.05). Pre-radiotherapy endodontic treatment and post-radiotherapy scaling or subgingival curettage increased ORN prevalence (hazard ratio [HR], 2.28 and 1.77, respectively). Endodontic treatment within 2 weeks to 1 month prior to radiotherapy increased the ORN risk by 5.83-fold. Dental scaling or subgingival curettage initialized from three to 6 months post-radiotherapy raised the ORN prevalence by 2.2-fold. Exodontia initialized within 2 weeks before radiotherapy (HR=1.49) or 1 to 3 months after radiotherapy (HR=2.63) greatly increased ORN prevalence. To perform oral surgery from 3 months pre-radiotherapy to 6 months after radiotherapy increased the 1.85-fold ORN risk. The chemotherapy combined oral surgery increased the ORN prevalence by 2.55-fold. CONCLUSIONS: Timing of dental treatment, including pre-radiotherapy endodontic treatment, post-radiotherapy scaling or subgingival curettage, and oral surgery or exodontia before and after radiotherapy, could closely relate to ORN development in oral cancer patients. CLINICAL RELEVANCE: Choosing right time to perform appropriate dental treatment could effectively reduce oral infection and ORN risk.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Estudos de Coortes , Assistência Odontológica , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Osteorradionecrose/complicações , Osteorradionecrose/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
11.
Int J Oral Maxillofac Surg ; 49(3): 411-419, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31353174

RESUMO

Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This 'expert consensus statement on diagnosis and clinical management of MORN' is for clinical reference.


Assuntos
Osteorradionecrose , Consenso , Humanos , Mandíbula , Distúrbios da Fala , Trismo
12.
Gerodontology ; 37(2): 102-109, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31886587

RESUMO

BACKGROUND: It is strongly recommended to extract teeth with poor prognosis in head and neck cancer (HaNC) patients prior starting treatment with radiotherapy to avoid need for extraction post-radiotherapy and prevent development of osteoradionecrosis (ORN). Dental extraction means that patients are often left with insufficient teeth leading to psychological problems and reducing their quality of life post-radiotherapy. Some clinicians do not advocate the use of dentures in HaNC patients claiming that dentures might lead to soft tissue irritation followed by ORN when constructed on irradiated jaws. AIMS: This systematic review aimed to investigate the existing evidence regarding the impact of denture use on the development of ORN in HaNC patients post-radiotherapy. METHODS: This systematic review followed the Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline. Three database systems were used: Ovid Medline, EMBASE and PsycINFO. PROSPERO was searched for ongoing or recently completed systematic reviews. The https://ClinicalTrials.gov was searched for ongoing or recently completed trials. The Joanna Briggs Institute critical appraisal tools were used to assess quality of studies being reviewed. RESULTS: Only three retrospective case-control studies were included. Numbers of participants included in the three studies are limited with incomparable types of mucosal dentures. None of the studies described the method of measurement of the exposure (denture use) in a standard, validated and reliable way. CONCLUSION: The three included studies suggested no link between denture use and development of ORN. However, very little evidence exists and the robustness of the studies is questionable. Well-powered studies are needed.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Dentaduras , Humanos , Qualidade de Vida , Estudos Retrospectivos
13.
Cochrane Database Syst Rev ; 2019(11)2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31745986

RESUMO

BACKGROUND: Osteoradionecrosis (ORN) of the jaws is among the most serious oral complications of head and neck cancer radiotherapy, arising from radiation-induced fibro-atrophic tissue injury, manifested by necrosis of osseous tissues and failure to heal, often secondary to operative interventions in the oral cavity. It is associated with considerable morbidity and has important quality of life ramifications. Since ORN is very difficult to treat effectively, preventive measures to limit the onset of this disease are needed; however, the effects of various preventive interventions has not been adequately quantified. OBJECTIVES: To assess the effects of interventions for preventing ORN of the jaws in adult patients with head and neck cancer undergoing curative or adjuvant (i.e. non-palliative) radiotherapy. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 5 November 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 10) in the Cochrane Library (searched 5 November 2019), MEDLINE Ovid (1946 to 5 November 2019), Embase Ovid (1980 to 5 November 2019), Allied and Complementary Medicine (AMED) Ovid (1985 to 5 November 2019), Scopus (1966 to 5 November 2019), Proquest Dissertations and Theses International (1861 to 5 November 2019) and Web of Science Conference Proceedings (1990 to 5 November 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) or quasi-RCTs of adult patients 18 years or older with head and neck cancer who had undergone curative or adjuvant radiotherapy to the head and neck, who had received an intervention to prevent the onset of ORN. Eligible patients were those subjected to pre- or post-irradiation dental evaluation. Management of these patients was to be with interventions independent of their cancer therapy, including but not limited to local, systemic, or behavioural interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials from search results, assessed risk of bias, and extracted relevant data for inclusion in the review. Authors of included studies were contacted to request missing data. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Four studies were identified that met pre-determined eligibility criteria, evaluating a total of 342 adults. From the four studies, all assessed as at high risk of bias, three broad interventions were identified that may potentially reduce the risk of ORN development: one study showed no reduction in ORN when using platelet-rich plasma placed in the extraction sockets of prophylactically removed healthy mandibular molar teeth prior to radiotherapy (odds ratio (OR) 3.32, 95% confidence interval (CI) 0.58 to 19.09; one trial, 44 participants; very low-certainty evidence). Another study involved comparing fluoride gel and high-content fluoride toothpaste (1350 parts per million (ppm)) in prevention of post-radiation caries, and found no difference between their use as no cases of ORN were reported (one trial, 220 participants; very low-certainty evidence). The other two studies involved the use of perioperative hyperbaric oxygen (HBO) therapy and antibiotics. One study showed that treatment with HBO caused a reduction in the development of ORN in comparison to patients treated with antibiotics following dental extractions (risk ratio (RR) 0.18, 95% CI 0.43 to 0.76; one trial, 74 participants; very low-certainty evidence). Another study found no difference between combined HBO and antibiotics compared to antibiotics alone prior to dental implant placement (RR 3.00, 95% CI 0.14 to 65.16; one trial, 26 participants; very low-certainty evidence). Adverse effects of the different interventions were not reported clearly or were not important. AUTHORS' CONCLUSIONS: Given the suboptimal reporting and inadequate sample sizes of the included studies, evidence regarding the interventions evaluated by the trials included in this review is uncertain. More well-designed RCTs with larger samples are required to make conclusive statements regarding the efficacy of these interventions.


Assuntos
Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/prevenção & controle , Saúde Bucal , Osteorradionecrose/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
BMJ Case Rep ; 12(11)2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31694827

RESUMO

Nasopharyngeal carcinoma (NPC), an uncommon malignancy in Western Countries and Radiotherapy, remains an effective treatment. Its side effects are classified as either immediate or late; postradiation necrosis is as an important late side effect with a strong impact on the prognosis in patients with NPC. We report the case of 65-year-old Caucasian man presenting with a deep necrotic ulcer of the nasopharynx and osteoradionecrosis of the skull base that appeared 3 months after radiotherapy for nasopharyngeal carcinoma. Conservative treatment was applied with surgical management of the ulcer. Clinical and radiological outcomes are presented. Radiotherapy remains a good treatment option with varying degrees of side effects, in particular, postradiation necrosis and ulcer. Multiple options of treatment have been described. However, the surgical management could be indicated in cases of deep ulcer with life-threatening prognosis.


Assuntos
Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Osteorradionecrose/patologia , Lesões por Radiação/patologia , Úlcera/patologia , Idoso , Endoscopia , Humanos , Masculino , Carcinoma Nasofaríngeo/patologia , Neoplasias Nasofaríngeas/patologia , Nasofaringe/patologia , Osteorradionecrose/cirurgia , Lesões por Radiação/cirurgia , Base do Crânio/patologia , Resultado do Tratamento , Úlcera/cirurgia
15.
Anticancer Res ; 39(10): 5689-5693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570468

RESUMO

BACKGROUND/AIM: To evaluate the association between osteoradionecrosis (ORN) of the mandible and stenosis of the external carotid artery after radiation therapy (RT) for head and neck cancer. PATIENTS AND METHODS: The computed tomography images of 42 patients (36 men, six women; median age, 64.5 years) treated with RT for head and neck cancer between January 2011 and December 2015 were reviewed. The cross-sectional diameters of the bilateral external carotid arteries were measured on contrast-enhanced images taken after completion of RT. RESULTS: Nine of the 42 included patients (21.4%) developed ORN after a median interval of 34 months from completion of RT. Univariate analysis revealed that external carotid artery diameter ≤ the median diameter was significantly associated with ORN development (p=0.008 and 0.013). In multivariate analysis, left external carotid artery diameter ≤ the median was significantly associated with ORN development (p=0.023). CONCLUSION: External carotid artery stenosis was significantly associated with ORN development.


Assuntos
Artéria Carótida Externa/patologia , Mandíbula/patologia , Osteorradionecrose/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/patologia , Estudos Transversais , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Fatores de Risco
16.
Oral Surg Oral Med Oral Pathol Oral Radiol ; 128(5): 491-497.e2, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488389

RESUMO

OBJECTIVE: Medication-related osteonecrosis of the jaw (MRONJ) is a pathologic process resulting in progressive destruction of the jaws. There are no established guidelines for the medical management of MRONJ. Interest in pentoxifylline and tocopherol is growing because these agents have been shown to be effective in treating osteoradionecrosis of the jaw. This review evaluates the clinical usefulness of pentoxifylline and tocopherol in treating MRONJ. STUDY DESIGN: Literature databases were searched for relevant reports of pentoxifylline and tocopherol in treating MRONJ. Only English-language reports and human studies were considered. RESULTS: There were 3 published observational studies and 2 abstracts relevant to this topic. The combination of pentoxifylline and tocopherol is associated with subjective and objective improvements and no major adverse outcomes. CONCLUSIONS: Pentoxifylline and tocopherol has been demonstrated to be effective for managing MRONJ nonsurgically, and, thus, this treatment modality holds promise. However, larger clinical studies are needed to optimize dose and duration.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteorradionecrose , Pentoxifilina , Tocoferóis , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Conservadores da Densidade Óssea/efeitos adversos , Humanos , Osteorradionecrose/tratamento farmacológico , Pentoxifilina/uso terapêutico , Inibidores de Fosfodiesterase/uso terapêutico , Tocoferóis/uso terapêutico
17.
Undersea Hyperb Med ; 46(4): 385-397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509895

RESUMO

Over the past four decades, hyperbaric oxygen (HBO2) therapy has played a prominent role in both the prevention and treatment of mandibular osteoradionecrosis (ORN). It has done so on the strength of laboratory observations and clinical reports, yet only limited efficacy data. This dual role has come under increasing scrutiny in the modern radiotherapy (RT) and surgical eras. The ability to spare healthy "non-target" tissue has markedly improved since the two-dimensional planning and delivery techniques in use when HBO2's prophylactic value was first demonstrated. A recent study failed to identify this same benefit in patients who received high-precision imaging and conformal RT. HBO2 therapy is under challenge as preferred treatment for early stage ORN. A recently introduced "fibroatrophic" mechanism contrasts with the hypovascular-hypocellular-hypoxic injury pattern that formed the basis for HBO2's therapeutic use. This alternative pathophysiologic state appears to benefit from an oral antioxidant medication regimen. The continuing necessity of HBO2 in support of mandibular reconstruction for advanced ORN is in question. Microsurgery-based vascularized bone flaps increasingly represent standard care, invariably in the absence of perioperative HBO2. Renewed interest in hyperbaric oxygen as a radiation sensitizer offers some promise. Hypoxia remains a critical radio-resistant factor in many solid tumors. Malignant gliomas have been a primary focus of several small studies, with resulting improvements in local control and median survival. Hyperbaric radiation sensitization has recently addressed oropharyngeal cancer. Preliminary data indicates that addition of HBO2 to chemo-radiation standard of care is technically feasible, well tolerated and safe. A Phase II efficacy trial will investigate the potential for of HBO2 to improve progression-free and relapse-free survival in newly diagnosed locally advanced head and neck cancers. What follows is a review and summary of relevant peer-reviewed literature.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Oxigenação Hiperbárica , Mandíbula/efeitos da radiação , Osteorradionecrose/terapia , Tolerância a Radiação , Hipóxia Celular/efeitos da radiação , Ensaios Clínicos Fase II como Assunto , Ácido Clodrônico/uso terapêutico , Combinação de Medicamentos , Humanos , Mandíbula/cirurgia , Osteorradionecrose/patologia , Osteorradionecrose/prevenção & controle , Pentoxifilina/uso terapêutico , Radioterapia Conformacional/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos , Tocoferóis/uso terapêutico , Extração Dentária
18.
Undersea Hyperb Med ; 46(4): 399-408, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509896

RESUMO

Mr. Richard Clarke presents in this Journal his arguments against continued application of hyperbaric oxygen (HBO2) therapy to the pre-extraction neoadjuvant treatment or the treatment of frank mandibular ORN. In the same article he advocates a promising renewed interest in HBO2 as a radiosensitizer. Arguments against HBO2 prior to extractions are based on several papers which consistently include low-risk patients. The just-released HOPON trial reports a negative pre-extraction outcome for HBO2, but patients were enrolled with radiation doses as low as 50Gy. For advanced mandibular necrosis (Marx Stage III) requiring resection, fibular free flap reconstruction is advocated. A high complication rate with free flaps is acknowledged but the magnitude of these complications is not discussed. A cost savings for this procedure is suggested, but no mention is made of the typical cost of the procedure ($90,000) or the requirement of a typical one-week hospital stay, including an initial one or two days in the ICU. Nor is mention made of the very low rate of subsequent dental rehabilitation. The success reported by Delainian, et al. employing pentoxifylline, Vitamin E and sometimes a bisphosphonate is equated to the four decades of HBO2 success with the Marx protocol for Stage I and II ORN. In the phase II trial by Delainian (not randomized) six of her 54 patients died secondary to sepsis, and she graded patients as complete responders if 5mm or less bone was exposed. Even at entry patients had an average of only 1.7 cm exposed bone and treatment was prolonged (16 + or -9 months). Any cost comparison studies will have to account for the indirect expenses of this prolonged treatment including lost productivity.


Assuntos
Neoplasias de Cabeça e Pescoço , Oxigenação Hiperbárica , Osteorradionecrose , Procedimentos Cirúrgicos Reconstrutivos , Feminino , Humanos , Masculino , Mandíbula/cirurgia
19.
Acta Oncol ; 58(10): 1373-1377, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31364903

RESUMO

Background: The project aimed at determining the incidence of mandibular osteoradionecrosis (ORN) after radiotherapy, possible risk factors, and mandibular dose-volume effects in a large cohort of head and neck cancer patients (HNC). Methods: The cohort consisted of 1224 HNC patients treated with 66-68 Gy in 2007-2015 predominantly with IMRT. ORN cases were defined from clinical observations at follow-up and through hospital code diagnostics after oral-maxillofacial surgery and cross-checked with the national Danish Head and Neck Cancer database. In a nested case-control study, patients with ORN cases were matched with two controls (1:2) and pre-RT dental procedures including surgery to the mandible were documented. Multivariable Cox regression analysis was applied using demographic and treatment variables including dental procedures, smoking and tumor characteristics, and combined with dosimetric data. Mean mandibular dose (Dmean) was pre-selected for the multivariable model. Results: ORN was recorded in 56 cases (4.6%) with a median time to event of 10.9 months (range 1.8-89.7) after RT, 90% occurred within 37.4 months. Median follow-up time was 22 months (0.3-95). Average Dmean was significantly higher in the ORN event cohort and significant dose-volume differences were observed for population mean DVH doses between 30 Gy and 60 Gy. In univariable analysis, smoking (HR = 1.69; CI 1.14-2.5), pre-RT surgery/tooth extraction (HR = 2.76; 1.48-5.14), and several dosimetric parameters including Dmean (HR = 1.05, 1.02-1.08) were all significantly associated with ORN. Dmean and surgery/tooth extraction remained significant predictors of ORN in multivariable analysis, HR = 1.04 (CI 1.01-1.07) and HR = 2.09 (CI 1.1-3.98), respectively, while smoking only retained its significance in an interaction analysis with pre-RT dental procedures. Conclusion: The onset of ORN of the mandible was early (median 10.8 months) and the incidence low (4.6%) after IMRT in HNC cancer patients. Surgery to the mandible and pre-RT tooth extraction, tobacco smoking, and treatment dose were associated with the development of ORN.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Mandíbula/efeitos da radiação , Osteorradionecrose/epidemiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Incidência , Masculino , Mandíbula/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Bucais/efeitos adversos , Procedimentos Cirúrgicos Bucais/estatística & dados numéricos , Osteorradionecrose/etiologia , Radiometria , Dosagem Radioterapêutica , Fatores de Risco , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia
20.
Curr Opin Otolaryngol Head Neck Surg ; 27(5): 401-406, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389851

RESUMO

PURPOSE OF REVIEW: To describe current standard of care for osteoradionecrosis (ORN) of the mandible and report possible future trends. RECENT FINDINGS: Cutting guides may be used to reduce surgical time and possibly improve outcomes. There has also been recent investigation into the use of pentoxifylline and tocopherol or pentoxifylline, tocopherol and clodronate (a well known conservative medial regime) as a prevention for development of ORN after dental extractions and the first randomized controlled study is upcoming. Augmented reality has shown promise as a comparable and inexpensive possible alternative to cutting guides. SUMMARY: Current standard of care involves conservative/supportive therapy with antioxidants, antibiotics, steroids, and pain control for low-grade ORN with surgery reserved for high-grade/progressive ORN with refractory to conservative therapy and with significant oral dysfunction.


Assuntos
Mandíbula/cirurgia , Osteorradionecrose/cirurgia , Antioxidantes/uso terapêutico , Humanos , Osteorradionecrose/tratamento farmacológico , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos
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