TY - JOUR
T1 - Medication-related osteonecrosis of the jaw
T2 - MASCC/ISOO/ASCO clinical practice guideline
AU - Yarom, Noam
AU - Shapiro, Charles L.
AU - Peterson, Douglas E.
AU - Van Poznak, Catherine H.
AU - Bohlke, Kari
AU - Ruggiero, Salvatore L.
AU - Migliorati, Cesar A.
AU - Khan, Aliya
AU - Morrison, Archie
AU - Anderson, Holly
AU - Murphy, Barbara A.
AU - Alston-Johnson, Devena
AU - Mendes, Rui Amaral
AU - Beadle, Beth Michelle
AU - Jensen, Siri Beier
AU - Saunders, Deborah P.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85071660885&partnerID=8YFLogxK
U2 - 10.1200/JCO.19.01186
DO - 10.1200/JCO.19.01186
M3 - Journal article
C2 - 31329513
AN - SCOPUS:85071660885
SN - 0732-183X
VL - 37
SP - 2270
EP - 2290
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 25
ER -