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
3690 - PD-L1 expression in resected undifferentiated pleomorphic sarcoma and its clinical implications
Presenter: Kyoungmin Lee
Session: Poster Display session 1
Resources:
Abstract
2013 - PD-L1 expression as a potential therapeutic target and prognostic biomarker in well-differentiated and dedifferentiated liposarcoma.
Presenter: Heejung Chae
Session: Poster Display session 1
Resources:
Abstract
5021 - Soft tissue sarcomas express a distinct mRNA immune profile
Presenter: Viktor Grünwald
Session: Poster Display session 1
Resources:
Abstract
3029 - The molecular landscape of fusion genes in endometrial stromal sarcomas include three nosological entities with different natural history
Presenter: Mehdi Brahmi
Session: Poster Display session 1
Resources:
Abstract
3914 - Clinical validation of a novel assay for the detection of diagnostic alterations in sarcomas
Presenter: Lauren Mc Connell
Session: Poster Display session 1
Resources:
Abstract
1912 - A prospective correlative trial of personalized patient-derived xenograft (PDX) as avatars for drug therapy in patients with metastatic or recurrent soft tissue sarcomas (STS).
Presenter: Kanan Alshammari
Session: Poster Display session 1
Resources:
Abstract
5097 - Fusion of immortalized myoblasts induces genomic instability that drives tumor development and progression.
Presenter: Candice Merle
Session: Poster Display session 1
Resources:
Abstract
1383 - let-7a suppress Ewing sarcoma CSCs' malignant phenotype through forms a positive feedback regulation loop with lin28 via STAT3
Presenter: Xu Jiang
Session: Poster Display session 1
Resources:
Abstract
3386 - Myoepithelial Tumors of Soft Tissues and Extraskeletal Myxoid Chondrosarcomas feature a distinct transcriptional pattern
Presenter: Dominga Racanelli
Session: Poster Display session 1
Resources:
Abstract
1844 - In Vivo Efficacy and Enhanced Tumor Accumulation of Liposomal Vinorelbine (TLC178) in Human Sarcoma Xenograft Mice Model
Presenter: Wan-ni Yu
Session: Poster Display session 1
Resources:
Abstract