Hoefert Sebastian, Eufinger Harald
Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital of Ruhr-University Bochum, Recklinghausen, Germany.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Oct;110(4):463-9. doi: 10.1016/j.tripleo.2010.04.049. Epub 2010 Aug 9.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate (BP) medication. Tooth extractions are the most frequent causes for BRONJ. In some cases BRONJ is observed spontaneously, with some anatomic sites carrying a higher risk. Sunitinib, a tyrosine kinase inhibitor, is established in renal cell carcinoma and is known to lead to oral mucositis as a side effect, which in BP patients may additionally raise the risk of BRONJ.
We present 3 patients with renal cell carcinoma under BP medication who developed BRONJ during and after sunitinib medication.
In 2 patients, BRONJ was linked to the occurrence of mucositis after sunitinib intake. The third patient showed relapse of completely healed BRONJ lesions shortly after resumption of a sunitinib therapy.
Oral mucositis during chemotherapy may raise the risk of BRONJ in cancer patients with BP medication. Especially in renal cell carcinoma patients under sunitinib therapy and intravenous BP medication, oral mucositis should be observed closely because it could be a risk factor for BRONJ.
双膦酸盐相关颌骨坏死（BRONJ）是双膦酸盐（BP）药物的一种严重副作用。拔牙是BRONJ最常见的病因。在某些情况下，BRONJ可自发出现，某些解剖部位风险更高。舒尼替尼是一种酪氨酸激酶抑制剂，已被用于治疗肾细胞癌，且已知其副作用会导致口腔黏膜炎，这在使用BP药物的患者中可能会额外增加发生BRONJ的风险。
我们报告3例正在接受BP药物治疗的肾细胞癌患者，在使用舒尼替尼期间及之后发生了BRONJ。
2例患者的BRONJ与服用舒尼替尼后出现的黏膜炎有关。第3例患者在恢复舒尼替尼治疗后不久，已完全愈合的BRONJ病变出现复发。
化疗期间的口腔黏膜炎可能会增加使用BP药物的癌症患者发生BRONJ的风险。尤其是在接受舒尼替尼治疗且静脉使用BP药物的肾细胞癌患者中，应密切观察口腔黏膜炎情况，因为它可能是BRONJ的一个风险因素。
