Hironobu Hata1, Kenji Imamachi2, Michihiro Ueda3, Masashi Matsuzaka4,5, Hiroaki Hiraga6, Toshihisa Osanai7, Toru Harabayashi8, Katsuya Fujimoto9, Satoshi Oizumi10, Masato Takahashi11, Kazuhito Yoshikawa12, Jun Sato12, Yutaka Yamazaki13, Yoshimasa Kitagawa12. 1. Department of Dentistry and Oral Surgery, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. hata.hironobu.wq@mail.hosp.go.jp. 2. Department of Dentistry and Oral Surgery, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 3. Department of Clinical Oral Oncology, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui 4-jo 2-chome, Shiroishi-Ku, Sapporo, 003-0804, Japan. 4. Clinical Research Support Centre, Hirosaki University Hospital, 53 Honcho, Hirosaki, 036-8563, Japan. 5. Department of Medical Informatics, Hirosaki University Hospital, 53 Honcho, Hirosaki, 036-8563, Japan. 6. Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 7. Department of Rehabilitation, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 8. Department of Urology, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 9. Department of Hematology, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 10. Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 11. Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, 3-54 Kikusui4-Jyo 2-Tyoume, Shiroishi-Ku, Sapporo, 003-0804, Japan. 12. Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Faculty of Dental Medicine, Hokkaido University, Nishi 7-Tyoume Kita13-Jyo, Kita-Ku, Sapporo, 060-8586, Japan. 13. Gerodontology Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Nishi 7-Tyoume Kita13-Jyo, Kita-Ku, Sapporo, 060-8586, Japan.
Abstract
PURPOSE: Survival time after bisphosphonate use has been increasingly recognized to be associated with the incidence of medication-related osteonecrosis of the jaw (MRONJ); however, this has not been elucidated sufficiently in the literature. This study aimed to clarify the incidence of MRONJ and the corresponding survival rate of patients treated with zoledronic acid (ZA) for each type of cancer and obtain useful information for the oral/dental supportive care of cancer patients. METHODS: We evaluated 988 patients who were administered ZA at our hospital; among them, 862 patients with metastatic bone tumors or myeloma were included. RESULTS: The median survival time (MST) after ZA initiation was 35, 34, 8, 41, 12, and 6 months for patients with breast, prostrate, lung, myeloma, renal, and other cancers, respectively. Patients with cancers that had a short survival time (lung and other cancers [MST = 8 and 6 months, respectively] and cancers with MST < 10 months) did not develop MRONJ; this could be attributed to the shorter duration of ZA administration. The cumulative incidence of MRONJ in breast cancer, prostate cancer, and multiple myeloma was related to the frequency of anti-resorptive drug use and the increased risk over time. In renal cancer, the cumulative incidence of MRONJ increased early, although the MST was 12 months. CONCLUSION: For the dentists in charge of dental management, it is essential to be aware of prognosis-related factors, predict MRONJ risk for each cancer treatment, and use risk prediction in dental management planning, particularly for cancers with non-poor prognosis.
PURPOSE: Survival time after bisphosphonate use has been increasingly recognized to be associated with the incidence of medication-related osteonecrosis of the jaw (MRONJ); however, this has not been elucidated sufficiently in the literature. This study aimed to clarify the incidence of MRONJ and the corresponding survival rate of patients treated with zoledronic acid (ZA) for each type of cancer and obtain useful information for the oral/dental supportive care of cancer patients. METHODS: We evaluated 988 patients who were administered ZA at our hospital; among them, 862 patients with metastatic bone tumors or myeloma were included. RESULTS: The median survival time (MST) after ZA initiation was 35, 34, 8, 41, 12, and 6 months for patients with breast, prostrate, lung, myeloma, renal, and other cancers, respectively. Patients with cancers that had a short survival time (lung and other cancers [MST = 8 and 6 months, respectively] and cancers with MST < 10 months) did not develop MRONJ; this could be attributed to the shorter duration of ZA administration. The cumulative incidence of MRONJ in breast cancer, prostate cancer, and multiple myeloma was related to the frequency of anti-resorptive drug use and the increased risk over time. In renal cancer, the cumulative incidence of MRONJ increased early, although the MST was 12 months. CONCLUSION: For the dentists in charge of dental management, it is essential to be aware of prognosis-related factors, predict MRONJ risk for each cancer treatment, and use risk prediction in dental management planning, particularly for cancers with non-poor prognosis.
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