背景:Denosumab(DMB)是一种用于治疗骨质疏松症或骨骼转移性癌症的骨骼抗再吸收剂。然而,denosumab相关的颌骨坏死(DRONJ)已成为癌症患者的常见并发症。据估计,双膦酸盐相关病例(1.1至1.4%)和denosumab相关病例(0.8至2%)的癌症患者中颌骨坏死(ONJ)的患病率相似。据报道,加上抗血管生成药物的辅助治疗,其患病率增加到3%。(规范护理牙医36(4):231-236,2016)。本研究的目的是报告使用DMB治疗的癌症患者的DRONJ(Xgeva®,120mg)。
方法:在本研究中,我们在接受DMB治疗的74例转移性癌症患者中发现了4例ONJ.四个病人中,三人患有前列腺癌,一人患有乳腺癌。发现在最后一次DMB注射后2个月内拔牙是DRONJ的危险因素。病理检查发现3例患者有急慢性炎症,包括放线菌菌落。在提到我们的四名DRONJ患者中,3例成功治疗,无并发症,手术治疗后无复发,一个人没有跟进。愈合后,1例患者在不同部位复发.在抗生素治疗和停止使用DMB的联合下,经证明可以有效控制病情。经过平均5个月的随访,ONJ部位愈合。
结论:保守手术,随着抗生素治疗和停用DMB,被发现能有效地控制病情。需要更多的研究来调查类固醇和抗癌药物对颌骨坏死的贡献,多中心病例的患病率,以及与DMB是否存在药物相互作用。
BACKGROUND: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer patients is estimated to be similar for both bisphosphonate-related cases (1.1 to 1.4%) and denosumab-related cases (0.8 to 2%), with the addition of adjunctive therapy with anti-angiogenic agents reportedly increasing its prevalence to 3%. (Spec Care Dentist 36(4):231-236, 2016). The aim of this study is to report on DRONJ in cancer patients treated with DMB (Xgeva®, 120mg).
METHODS: In this study, we identified four cases of ONJ among 74 patients receiving DMB therapy for metastatic cancer. Of the four patients, three had prostate cancer and one had breast cancer. Preceding tooth extraction within 2 months of the last DMB injection was found to be a risk factor for DRONJ. Pathological examination revealed that three patients had acute and chronic inflammation, including actinomycosis colonies. Among the four patients with DRONJ referred to us, three were successfully treated without complications and had no recurrence following surgical treatment, while one did not follow up. After healing, one patient experienced a recurrence at a different site. Sequestrectomy in conjunction with antibiotic therapy and cessation of DMB use proved to be effective in managing the condition, and the ONJ site healed after an average 5-month follow-up period.
CONCLUSIONS: Conservative surgery, along with antibiotic therapy and discontinuation of DMB, was found to be effective in managing the condition. Additional studies are needed to investigate the contribution of steroids and anticancer drugs to jaw bone necrosis, the prevalence of multicenter cases, and whether there is any drug interaction with DMB.