Bisphosphonate-related osteonecrosis of the jaw in malignant tumor patients with bone metastases: clinical analysis of six cases

Q4 Medicine

肿瘤研究与临床 Pub Date : 2019-10-28 DOI:10.3760/CMA.J.ISSN.1006-9801.2019.10.006

Pengfei Xin, Z. Tian, G. Xue

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Abstract

Objective To analyze the clinical manifestation, imaging characteristics and prevention of medication-related osteonecrosis of the jaw (MRONJ) after intravenous bisphosphonate (BP) for cancer patients with bone metastases. Methods The clinical data and radiographic findings of 6 primary breast cancer patients with bone metastases diagnosed as MRONJ from January 2014 to April 2018 in Shanxi Dayi Hospital were retrospectively analyzed. Results All 6 patients were female, with the median age of 65.5 years old. All patients had no history of systemic application of hormone therapy, no history of diabetes, no history of radiation therapy, no history of metastasis of the jaw, and no history of infection. The average usage time of BP was 28 months. MRONJ occurred in 2 cases on maxilla and 4 cases on mandible. There were 2 patients with tooth extractions history in BP treatment. Clinical symptoms included maxillofacial pain, loosened teeth, fistula suppuration, and exposed sequestrum. Radiographic findings included osteolysis and bone sclerosis or the mixed manifestation of both, with or without periosteal reaction. In addition, nonhealing tooth sockets and sequestrum separation imaging were also included. Conclusions Tooth extraction is considered as an increased risk for MRONJ in patients with malignant bone metastases after BP therapy. MRONJ is more likely to appear in the mandible, but it can also appear in the maxilla. Early screening and initiation of appropriate dental care are necessary for the patients before using BP therapy. Key words: Neoplasm metastasis; Diphosphonates; Skeleton; Medication-related osteonecrosis of the jaw

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恶性肿瘤合并骨转移患者双膦酸盐相关性颌骨骨坏死6例临床分析

目的分析癌症骨转移患者静脉注射双磷酸盐（BP）后发生药物相关性颌骨坏死（MRONJ）的临床表现、影像学特点及预防措施。方法回顾性分析2014年1月至2018年4月在山西省大邑医院诊断为MRONJ的6例原发性癌症骨转移患者的临床资料和影像学表现。结果6例患者均为女性，中位年龄65.5岁。所有患者均无激素治疗全身应用史、糖尿病史、放射治疗史、颌骨转移史和感染史。BP的平均使用时间为28个月。MRONJ上颌骨2例，下颌骨4例。BP治疗有2例患者有拔牙史。临床症状包括颌面部疼痛、牙齿松动、瘘管化脓和暴露的螯合。影像学表现包括骨溶解和骨硬化或两者的混合表现，伴有或不伴有骨膜反应。此外，还包括未愈合的牙窝和骨隔离成像。结论BP治疗恶性骨转移患者后，拔牙被认为会增加MRONJ的风险。MRONJ更可能出现在下颌骨，但也可以出现在上颌骨。在使用BP治疗之前，有必要对患者进行早期筛查并开始适当的牙科护理。关键词：肿瘤转移；二膦酸盐；骨架；药物相关性颌骨坏死

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来源期刊

肿瘤研究与临床 Medicine-Oncology

CiteScore

0.10

自引率

0.00%

发文量

7737

期刊介绍： "Cancer Research and Clinic" is a series of magazines of the Chinese Medical Association under the supervision of the National Health Commission and sponsored by the Chinese Medical Association. It mainly reflects scientific research results and academic trends in the field of malignant tumors. The main columns include monographs, guidelines and consensus, standards and norms, treatises, short treatises, survey reports, reviews, clinical pathology (case) discussions, case reports, etc. The readers are middle- and senior-level medical staff engaged in basic research and clinical work on malignant tumors.