Annals of Oncology Advance Access originally published online on October 26, 2008
Annals of Oncology 2009 20(2):331-336; doi:10.1093/annonc/mdn630
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quality of life/supportive care/palliative care |
Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome
1 Department of Medical Oncology
2 Department of Nuclear Medicine, Antwerp University Hospital, Edegem
3 Department of Oral and Maxillo-Facial Surgery, ZNA Middelheim, Wilrijk, Belgium
* Correspondence to: Dr T. Van den Wyngaert, Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. Tel: +32-473-542124; Fax: +32-3-8253308; E-mail: tim.van.den.wyngaert{at}skynet.be
Background: Overall survival (OS) and outcome of cancer patients with bisphosphonate-associated osteonecrosis of the jaw (ONJ) using conservative treatment (chlorhexidine 0.12% rinse, intermittent antibiotics, and careful sequestrectomy) are unknown.
Design: In all, 33 ONJ patients were studied for OS and ONJ outcome.
Results: Median duration of bisphosphonate treatment was 27 months (range 4–115) and was stopped in 25 (76%) patients. Nine (27%) cases presented with stage 1, 21 (64%) with stage 2, and 3 (9%) with stage 3 disease. During median follow-up of 23 months, 11 patients (33%) died (median survival 39 months), with no ONJ-related fatalities. Out of 30 assessable patients, 53% no longer had exposed bone, 37% had stable lesions, and 10% showed progressive necrosis. The hazard ratio for healing with doubling of bisphosphonate exposure was 0.419 [95% confidence interval (CI) 0.178–0.982; P = 0.045], stage 2 versus stage 1 disease 0.216 (95% CI 0.063–0.738; P = 0.015), and stage 3 versus stage 1 disease 0.084 (95% CI 0.008–0.913; P = 0.042). Cessation of bisphosphonate treatment did not influence outcome.
Conclusions: Conservative treatment of ONJ leads to mucosal closure in 53% of patients. Doubling the exposure time to bisphosphonates and higher stages of ONJ significantly reduce ONJ healing rates.
Key words: bisphosphonates, jaw, ONJ, osteonecrosis, outcome study
Received for publication June 25, 2008. Revision received August 8, 2008. Accepted for publication August 11, 2008.
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  S. A. Almazrooa and S.-B. Woo Bisphosphonate and Nonbisphosphonate-Associated Osteonecrosis of the Jaw: A Review J Am Dent Assoc, July 1, 2009; 140(7): 864 - 875. [Abstract] [Full Text] [PDF]
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