Abstract 2504
Background
The most largely used definition (and staging system) of Osteonecrosis of the Jaws (ONJ), more recently named Medication-Releated ONJ (MRONJ), was released by an American Association Oral Maxillofacial Surgery (AAOMS) task force. It is based on clinical features (mainly bone exposure for at least 8 weeks, or – only after 2014 - bone to be probed through a fistula) but the AAOMS is questioned by many experts. A team supported by the Italian Societies of Oral Medicine (SIPMO) and Maxillofacial Surgery (SICMF) suggested adoption of imaging tools (mainly Computed Tomography, CT) together with clinical features (Bedogni et al, Oral Disease 2012) to reach diagnosis (also in suspected cases without bone exposure, so called “Stage 0” according to AAOMS) and to evaluate real disease extension.
Methods
To compare the stage of MRONJ cases at the first observation time in patients receiving antiresorptive therapy (bisphosphonates, denosumab), according to two different staging systems, we reviewed charts and CT scans of cancer and myeloma patients with signs of ONJ.
Results
We collected data of 151 MRONJ patients in two referral centers. Disease: 73 breast cancer; 28 myeloma; 26 prostate cancer; 24 other solid tumors. The AAOMS stage was 0/I/II/III respectively in 34/38/52/27 observed cases. The SIPMO-SICMF stage was I (involvement of only alveolar bone at CT scan)/ II (extended to extralveolar bone) /III (complicated case) respectively in 48/76/27 cases. The 34 AAOMS “stage 0” cases (signs/symptoms without bone exposure) were reclassified as stage I (14) or II (20) or III (0) respectively, according to the Italian staging system.
Conclusions
In cancer and myeloma patients the AAOMS definition and staging system appear inadequate, potentially exposing patients to delayed diagnosis and treatment. The diagnosis and staging should be based not only on clinical data but also on the findings of the maxillofacial region CT scan, since the CT offers larger information about extent and severity of the disease.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
1269 - One-year follow-up results of eribulin for soft-tissue sarcoma including rare subtypes in a real-world observational study in Japan
Presenter: Shunji Takahashi
Session: Poster Display session 1
Resources:
Abstract
2868 - Prevalence of chemotherapy use and its impact on overall survival in patients with bone- and soft tissue sarcomas -A population-based analysis of 3746 patients
Presenter: Herbert Loong
Session: Poster Display session 1
Resources:
Abstract
3042 - Clinical course and therapeutic management of classical and endemic Kaposi’s Sarcoma (C/E KS)
Presenter: Lina Benajiba
Session: Poster Display session 1
Resources:
Abstract
3141 - The final outcomes of study on combined therapy of adult patients with localized synovial sarcoma
Presenter: Katarzyna Kozak
Session: Poster Display session 1
Resources:
Abstract
5449 - Real-world Outcomes of Patients with Locally Advanced or Metastatic Epithelioid Sarcoma
Presenter: Mrinal Gounder
Session: Poster Display session 1
Resources:
Abstract
4465 - SAKK 57/16 Nab-Paclitaxel And Gemcitabine in soft tissue sarcoma (NAPAGE): results from the phase I part of a phase I/II trial
Presenter: Antonia Digklia
Session: Poster Display session 1
Resources:
Abstract
5013 - Outcome of 98 patients with epithelioid sarcoma treated in curative intent: a retrospective study from the French Sarcoma Group (GSF-GETO)
Presenter: Maud Pedrono
Session: Poster Display session 1
Resources:
Abstract
5614 - Comparison of filgrastim and pegfilgrastim prophylaxis in sarcoma patients receiving highly myelosuppressive chemotherapy.
Presenter: Paolo Tarantino
Session: Poster Display session 1
Resources:
Abstract
1033 - Access to clinical trials for soft tissue sarcoma patients in Western and Eastern Europe
Presenter: Vasilii Ostafiichuk
Session: Poster Display session 1
Resources:
Abstract
4094 - Treatment outcomes for adult patients with localized osteosarcoma treated with chemotherapy without methotrexate
Presenter: Marília Silva
Session: Poster Display session 1
Resources:
Abstract