Claeys, T.

Fossion, E.

Huizing, Manon

van den Wyngaert, Tim

Vermorken, Jan Baptist

Abstract: Background: Overall survival (OS) and outcome of cancer patients with bisphosphonate-associated osteonecrosis of the jaw (ONJ) using conservative treatment (chlorhexidine 0.12% rinse, intermittent antibiotics, and careful sequestrectomy) are unknown. Design: In all, 33 ONJ patients were studied for OS and ONJ outcome. Results: Median duration of bisphosphonate treatment was 27 months (range 4115) and was stopped in 25 (76%) patients. Nine (27%) cases presented with stage 1, 21 (64%) with stage 2, and 3 (9%) with stage 3 disease. During median follow-up of 23 months, 11 patients (33%) died (median survival 39 months), with no ONJ-related fatalities. Out of 30 assessable patients, 53% no longer had exposed bone, 37% had stable lesions, and 10% showed progressive necrosis. The hazard ratio for healing with doubling of bisphosphonate exposure was 0.419 [95% confidence interval (CI) 0.1780.982; P = 0.045], stage 2 versus stage 1 disease 0.216 (95% CI 0.0630.738; P = 0.015), and stage 3 versus stage 1 disease 0.084 (95% CI 0.0080.913; P = 0.042). Cessation of bisphosphonate treatment did not influence outcome. Conclusions: Conservative treatment of ONJ leads to mucosal closure in 53% of patients. Doubling the exposure time to bisphosphonates and higher stages of ONJ significantly reduce ONJ healing rates

Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome

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