Annals of Oncology Advance Access published online on October 26, 2008
Annals of Oncology, doi:10.1093/annonc/mdn630
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.
bisphosphonates, jaw, ONJ, osteonecrosis, outcome study
Received for publication June 25, 2008. Revision received August 8, 2008. Accepted for publication August 11, 2008.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  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]
|
|