Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Noam Yarom, Chaim Sheba Medical Center Israel, Tel Aviv University
  • ,
  • Charles L. Shapiro, Icahn School of Medicine at Mount Sinai
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  • Douglas E. Peterson, University of Connecticut Health Center
  • ,
  • Catherine H. Van Poznak, University of Michigan, Ann Arbor, Michigan.
  • ,
  • Kari Bohlke, American Society of Clinical Oncology
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  • Salvatore L. Ruggiero, Hofstra University, Stony Brook School of Dental Medicine, New York Center for Orthognathic and Maxillofacial Surgery
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  • Cesar A. Migliorati, University of Florida
  • ,
  • Aliya Khan, McMaster University
  • ,
  • Archie Morrison, Dalhousie University, QEII Health Sciences Centre
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  • Holly Anderson, Breast Cancer Coalition of Rochester
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  • Barbara A. Murphy, Vanderbilt University
  • ,
  • Devena Alston-Johnson, University of North Carolina Cancer Care at Nash
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  • Rui Amaral Mendes, Case Western Reserve University
  • ,
  • Beth Michelle Beadle, Stanford University
  • ,
  • Siri Beier Jensen
  • Deborah P. Saunders, Northern Ontario School of Medicine

PURPOSE To provide guidance regarding best practices in the prevention and management of medicationrelated osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Oncology
Vol/bind37
Nummer25
Sider (fra-til)2270-2290
Antal sider21
ISSN0732-183X
DOI
StatusUdgivet - 2019

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