Katharina Theresa Obermeier DMD, MD , Wenko Smolka DMD, MD , Benjamin Palla MD , Moritz Kraus MD , David Steybe DMD, MD , Jens Tobias Hartung DMD, MD , Florian Nepomuk Fegg DMD, MD , Tim Hildebrandt DMD, MD , Ina Dewenter DMD , Nicholas Callahan MD , Philipp Poxleitner DMD, MD , Sven Otto DMD, MD
{"title":"抗骨质吸收疗法与放射治疗相结合会增加坏死和相关并发症的风险","authors":"Katharina Theresa Obermeier DMD, MD , Wenko Smolka DMD, MD , Benjamin Palla MD , Moritz Kraus MD , David Steybe DMD, MD , Jens Tobias Hartung DMD, MD , Florian Nepomuk Fegg DMD, MD , Tim Hildebrandt DMD, MD , Ina Dewenter DMD , Nicholas Callahan MD , Philipp Poxleitner DMD, MD , Sven Otto DMD, MD","doi":"10.1016/j.oooo.2024.07.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore, the aim of this study was to identify the outcome and complications in this highly vulnerable patient cohort.</div></div><div><h3>Study Design</h3><div>Seventeen patients who received both antiresorptive treatment and radiotherapy (medication-related osteonecrosis of the jaw/osteoradionecrosis = the [MRONJ/ORN] group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. Four hundred twenty-four patients with MRONJ (the MRONJ group) and 138 patients with ORN of the jaw were enrolled as two control groups (the ORN group). Demographic data, lesion localization, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded.</div></div><div><h3>Results</h3><div>Pathological fractures, continuity resection, and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared with patients undergoing only one of these treatments. There was a statistically significant difference (<em>P</em> < .001) between the MRONJ/ORN group and the MRONJ group and the MRONJ/ORN group and the ORN group considering recurrence, fracture, and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared with patients with MRONJ and a 1.5-times higher risk for recurrence compared with patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN.</div></div><div><h3>Conclusions</h3><div>Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaw. Therefore, a strict follow-up care schedule is highly recommended.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 1","pages":"Pages 11-19"},"PeriodicalIF":2.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Antiresorptive therapy in combination with radiation results in enhanced risk for necrosis and associated complicatifions\",\"authors\":\"Katharina Theresa Obermeier DMD, MD , Wenko Smolka DMD, MD , Benjamin Palla MD , Moritz Kraus MD , David Steybe DMD, MD , Jens Tobias Hartung DMD, MD , Florian Nepomuk Fegg DMD, MD , Tim Hildebrandt DMD, MD , Ina Dewenter DMD , Nicholas Callahan MD , Philipp Poxleitner DMD, MD , Sven Otto DMD, MD\",\"doi\":\"10.1016/j.oooo.2024.07.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore, the aim of this study was to identify the outcome and complications in this highly vulnerable patient cohort.</div></div><div><h3>Study Design</h3><div>Seventeen patients who received both antiresorptive treatment and radiotherapy (medication-related osteonecrosis of the jaw/osteoradionecrosis = the [MRONJ/ORN] group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. Four hundred twenty-four patients with MRONJ (the MRONJ group) and 138 patients with ORN of the jaw were enrolled as two control groups (the ORN group). Demographic data, lesion localization, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded.</div></div><div><h3>Results</h3><div>Pathological fractures, continuity resection, and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared with patients undergoing only one of these treatments. There was a statistically significant difference (<em>P</em> < .001) between the MRONJ/ORN group and the MRONJ group and the MRONJ/ORN group and the ORN group considering recurrence, fracture, and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared with patients with MRONJ and a 1.5-times higher risk for recurrence compared with patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN.</div></div><div><h3>Conclusions</h3><div>Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaw. Therefore, a strict follow-up care schedule is highly recommended.</div></div>\",\"PeriodicalId\":49010,\"journal\":{\"name\":\"Oral Surgery Oral Medicine Oral Pathology Oral Radiology\",\"volume\":\"139 1\",\"pages\":\"Pages 11-19\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Oral Surgery Oral Medicine Oral Pathology Oral Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2212440324004012\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212440324004012","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
Antiresorptive therapy in combination with radiation results in enhanced risk for necrosis and associated complicatifions
Objective
Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore, the aim of this study was to identify the outcome and complications in this highly vulnerable patient cohort.
Study Design
Seventeen patients who received both antiresorptive treatment and radiotherapy (medication-related osteonecrosis of the jaw/osteoradionecrosis = the [MRONJ/ORN] group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. Four hundred twenty-four patients with MRONJ (the MRONJ group) and 138 patients with ORN of the jaw were enrolled as two control groups (the ORN group). Demographic data, lesion localization, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded.
Results
Pathological fractures, continuity resection, and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared with patients undergoing only one of these treatments. There was a statistically significant difference (P < .001) between the MRONJ/ORN group and the MRONJ group and the MRONJ/ORN group and the ORN group considering recurrence, fracture, and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared with patients with MRONJ and a 1.5-times higher risk for recurrence compared with patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN.
Conclusions
Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaw. Therefore, a strict follow-up care schedule is highly recommended.
期刊介绍：
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology is required reading for anyone in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice dentistry. It is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas. Topics covered include such current issues as dental implants, treatment of HIV-infected patients, and evaluation and treatment of TMJ disorders. The official publication for nine societies, the Journal is recommended for initial purchase in the Brandon Hill study, Selected List of Books and Journals for the Small Medical Library.
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