Cork University Dental School and Hospital, University College Cork, Cork, Ireland.
Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland.
Eur J Med Res. 2024 Aug 2;29(1):402. doi: 10.1186/s40001-024-01912-6.
Bone-modifying agents (BMAs) are integral to managing patients with advanced cancer. They improve quality of survival by reducing skeletal-related events, treating hypercalcaemia and chemotherapy-induced bone loss (Coleman in Clin Cancer Res 12: 6243s-6249s, 2006), (Coleman in Ann Oncol 31: 1650-1663, 2020). Two decades ago, medication-related osteonecrosis of the jaw (MRONJ) was first reported following BMA therapy (Marx in J Oral Maxillofac Surg 61: 1115-1117, 2003). The risk of MRONJ extends over a decade following BMA treatment with bisphosphonates, complicating dental care such as extractions. In addition, MRONJ has been reported following additional therapies such as antiangiogenic agents, cytotoxic agents, immunotherapy, and targeted agents. The use of BMAs in the curative and adjuvant cancer setting is increasing, consequently the implication of MRONJ is growing. Over the past 20 years, the literature has consolidated major risk factors for MRONJ, the pathophysiology and management strategies for MRONJ. Our review aims to document the development of MRONJ preventative and management strategies in cancer patients receiving a BMA. The authors advocate the incorporation of dental oncology strategies into contemporary cancer care, to optimise long-term quality of survival after cancer treatment.
骨修饰剂（BMAs）是治疗晚期癌症患者的重要手段。它们通过减少骨骼相关事件、治疗高钙血症和化疗引起的骨丢失来提高生存质量（Coleman 在 Clin Cancer Res 12: 6243s-6249s, 2006），（Coleman 在 Ann Oncol 31: 1650-1663, 2020）。二十年前，首次报道了在 BMA 治疗后发生药物相关性下颌骨坏死（MRONJ）（Marx 在 J Oral Maxillofac Surg 61: 1115-1117, 2003）。双膦酸盐治疗 BMA 后，MRONJ 的风险可延续十余年，使拔牙等牙科护理变得复杂。此外，在接受抗血管生成剂、细胞毒性剂、免疫疗法和靶向药物等其他治疗后也有报道发生 MRONJ。BMA 在癌症治疗中的应用，无论是在治愈性还是辅助性癌症治疗中，都在不断增加，因此 MRONJ 的影响也在不断增加。在过去的 20 年里，文献已经确定了 MRONJ 的主要危险因素、MRONJ 的病理生理学和管理策略。我们的综述旨在记录癌症患者接受 BMA 治疗时，MRONJ 预防和管理策略的发展。作者主张将牙科肿瘤学策略纳入当代癌症护理中，以优化癌症治疗后长期的生存质量。
