Migliorati Cesar A, Schubert Mark M, Peterson Douglas E, Seneda Luis Marcelo
Department of Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Florida 33308-2018, USA.
Cancer. 2005 Jul 1;104(1):83-93. doi: 10.1002/cncr.21130.
The current report presented 17 patients with cancer with bone metastases and 1 patient with osteopenia who received treatment with bisphosphonates and who subsequently developed osteonecrosis of the mandible and/or maxilla.
The authors reviewed information on 18 patients who were referred to oral medicine or oral surgery specialists for evaluation and treatment of mandibular and/or maxillary bone necrosis from June 2002 to September 2004. To be included in the current review, patients must have been treated with either pamidronate or zoledronic acid to control or prevent metastatic disease, or with alendronate for osteoporosis. All patients with cancer had received chemotherapy while receiving bisphosphonate management.
The 17 patients with cancer were receiving active medical care for a malignancy. Cancer treatment included a variety of chemotherapeutic agents. They presented with metastatic disease to bone and were treated intravenously with the bisphosphonates pamidronate or zoledronic acid for a mean time of 25 months (range, 4-41 mos). There were 14 females and 4 males with a mean age of 62 years (range, 37-74 yrs). Malignancies included breast carcinoma (n = 10), multiple myeloma (n = 3), prostate carcinoma (n = 1), ovarian carcinoma (n = 1), prostate carcinoma/lymphoma (n = 1), and breast/ovarian carcinoma (n = 1). One female patient with osteopenia received alendronate. The most common clinical osteonecrosis presentations included infection and necrotic bone in the mandible. Associated events included dental extractions, infection, and trauma. Two patients appeared to develop disease spontaneously, without any clinical or radiographic evidence of local pathology. Despite surgical intervention, antibiotic therapy, hyperbaric oxygen therapy, and topical use of chemotherapeutic mouth rinses, most of the lesions did not respond well to therapy. Discontinuation of bisphosphonate therapy did not assure healing. However, 1 patient with cancer healed after discontinuation of bisphosphonate therapy for 4 months.
The findings in the patient population combined with recent literature reports suggested that bisphosphonates may contribute to the pathogenesis of the oral lesions. The risk factors and precise mechanism involved in the formation of the osteonecrosis are not known. This condition represents a new oral complication in patients with cancer and can be termed bisphosphonate-associated osteonecrosis. Lesions in patients with osteoporosis are worrisome and need to be further evaluated.
本报告介绍了17例患有骨转移癌的患者和1例骨质减少患者，这些患者接受了双膦酸盐治疗，随后发生了下颌骨和/或上颌骨坏死。
作者回顾了2002年6月至2004年9月间因下颌骨和/或上颌骨坏死而转诊至口腔内科或口腔外科专家处进行评估和治疗的18例患者的信息。要纳入本综述，患者必须接受过帕米膦酸或唑来膦酸治疗以控制或预防转移性疾病，或接受阿仑膦酸治疗骨质疏松症。所有癌症患者在接受双膦酸盐治疗期间均接受了化疗。
17例癌症患者正在接受针对恶性肿瘤的积极治疗。癌症治疗包括多种化疗药物。他们出现了骨转移，并接受了帕米膦酸或唑来膦酸双膦酸盐静脉治疗，平均治疗时间为25个月（范围4 - 41个月）。有14名女性和4名男性，平均年龄62岁（范围37 - 74岁）。恶性肿瘤包括乳腺癌（n = 10）、多发性骨髓瘤（n = 3）、前列腺癌（n = 1）、卵巢癌（n = 1）、前列腺癌/淋巴瘤（n = 1）以及乳腺癌/卵巢癌（n = 1）。1例骨质减少的女性患者接受了阿仑膦酸治疗。最常见的临床骨坏死表现包括下颌骨感染和坏死骨。相关事件包括拔牙、感染和创伤。2例患者似乎是自发发病，没有任何局部病变的临床或影像学证据。尽管进行了手术干预、抗生素治疗、高压氧治疗以及局部使用化疗漱口水，但大多数病变对治疗反应不佳。停用双膦酸盐治疗并不能确保愈合。然而，1例癌症患者在停用双膦酸盐治疗4个月后愈合。
该患者群体的研究结果以及近期的文献报道表明，双膦酸盐可能与口腔病变的发病机制有关。骨坏死形成所涉及的危险因素和确切机制尚不清楚。这种情况代表了癌症患者一种新的口腔并发症，可称为双膦酸盐相关骨坏死。骨质疏松症患者的病变令人担忧，需要进一步评估。
