Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil; Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil.
Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil.
Braz J Otorhinolaryngol. 2022 Sep-Oct;88(5):683-690. doi: 10.1016/j.bjorl.2020.09.010. Epub 2020 Oct 25.
Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient's quality pf life.
The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws.
Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6.
As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923).
A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.
药物相关性颌骨坏死是抗吸收和抗血管生成治疗的严重并发症，治疗选择有限，极大地影响了患者的生活质量。
本研究旨在评估接受双膦酸盐治疗的肿瘤患者中与药物相关性颌骨坏死相关的危险因素。此外，还测量了唾液中白细胞介素 6（IL-6）的水平，以研究其与药物相关性颌骨坏死的严重程度和风险的关系。
本病例对照研究纳入了 74 例患有实体瘤和多发性骨髓瘤骨转移的患者。患者被分为三组：1）接受双膦酸盐治疗并发生药物相关性颌骨坏死的患者；2）接受双膦酸盐治疗但未发生药物相关性颌骨坏死的患者；3）接受双膦酸盐预处理的患者。收集患者的人口统计学和医疗数据以评估风险。进行临床评估以诊断药物相关性颌骨坏死，并采集未刺激唾液以定量 IL-6。
结果发现，诊断为药物相关性颌骨坏死的患者接受了更高剂量的双膦酸盐（p=0.001）和每月输注方案（p=0.044；OR=7.75）。在接受双膦酸盐治疗期间未定期接受专科牙医随访和吸烟的患者与药物相关性颌骨坏死相关（p=0.019；OR=8.25 和 p=0.031；OR=9.37）。第 1 组在接受双膦酸盐治疗的同时，更频繁地接受化疗和皮质类固醇治疗以及牙科手术（p=0.129）。各组之间唾液 IL-6 水平无统计学差异（p=0.571），也与药物相关性颌骨坏死的严重程度无关联（p=0.923）。
双膦酸盐周期较多、每月输注方案、无口腔健康维护的牙科随访和吸烟与药物相关性颌骨坏死相关。在接受双膦酸盐治疗期间进行专科牙科随访已被证明是预防这种并发症的重要因素。
