Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.
Department of Stomatology, AC Camargo Cancer Center, São Paulo, Brazil.
Spec Care Dentist. 2024 May-Jun;44(3):621-635. doi: 10.1111/scd.12910. Epub 2023 Aug 3.
Evaluate the existing evidence of osteoradionecrosis (ORN) treatment in adults with head and neck cancer, the methodological quality and the evidence grade within systematic reviews (SRs).
An extensive systematic literature search of SRs that addressed ORN in head and neck cancer patients was conducted with screening of eligible studies, data extraction, methodological (AMSTAR 2) and evidence quality assessment (GRADE) of the SRs by independent and calibrated authors.
A total of six SRs were enrolled. Based primarily on studies from the 1990s, there is critically low- or moderate-quality evidence that hyperbaric oxygen therapy (HBO) improves ORN healing. From 2005 onward, evidence has been discovered in relation to treatment with pentoxifylline and tocopherol (PENTO). The SRs indicate that the management of ORN with PENTO appears to be promising. The greatest rates of healing are seen in mild and moderate stages of ORN. However, the quality of evidence regarding PENTO, surgery and other treatments remains critically low.
There is no standardized protocol to treat ORN. PENTO appears to be the most promising conservative treatment; however, the current level of evidence regarding PENTO is still critically low. More robust clinical studies are needed to establish the best treatment for ORN.
评估现有的头颈部癌症成人放射性骨坏死 (ORN) 治疗证据，评估系统评价 (SR) 中的方法学质量和证据等级。
对涉及头颈部癌症患者 ORN 的 SR 进行广泛的系统文献搜索，筛选合格研究，由独立和校准作者进行数据提取、方法学 (AMSTAR 2) 和 SR 证据质量评估 (GRADE)。
共纳入 6 项 SR。主要基于 20 世纪 90 年代的研究，有极低质量或中等质量证据表明高压氧治疗 (HBO) 可改善 ORN 愈合。自 2005 年以来，已发现与戊四醇和生育酚 (PENTO) 治疗相关的证据。SR 表明，PENTO 治疗 ORN 似乎很有希望。ORN 的轻度和中度阶段的愈合率最高。然而，关于 PENTO、手术和其他治疗的证据质量仍然极低。
目前尚无治疗 ORN 的标准化方案。PENTO 似乎是最有前途的保守治疗方法；然而，关于 PENTO 的当前证据水平仍然极低。需要更强大的临床研究来确定 ORN 的最佳治疗方法。
