Saúde Bucal e Gestão Odontológica

Abstrato

Cancer Patients Receiving Bone-Modifying Agents Show Different Rates of Anti-Resorptive Agent-Related Osteonecrosis of the Jaw Depending on their Primary Disease.

Akifumi Enomoto, Yukako Takigawa, Kazuhide Matsunaga, Hirokazu Nakahara, Miho Sukedai, Suguru Hamada

The continuing development of anti-resorptive drugs, called Bone-Modifying Agents (BMAs), is improving the medical management of metastatic bone disease and improving patients’ Quality Of Life (QOL). However, Anti-Resorptive Agent-Related Osteonecrosis of the Jaw (ARONJ) is a known refractory oral adverse event. Effective measures to treat or prevent ARONJ have not been established, and the current best approach to preventing ARONJ is pre-BMA oral screening and peri-BMA oral management by a dentist. In this study, the incidence of ARONJ and survival time after starting BMAs were examined in lung cancer and breast cancer patients with bone metastases, and the oral management of such patients was considered. The objective of this study is to discuss how oral management should depend on possible survival periods in cancer patients to maintain better QOL. This was a nonrandomized, retrospective study involving 104 lung cancer patients (mean age: 66.5 ± 10.5 y; 62 men, 42 women) and 42 breast cancer patients (mean age: 57.8 ± 9.3 y, 42 women) from January 2013 to December 2017 in our hospital. After the oral screening, oral management was planned and performed, including tooth extraction, periodontal treatment, and/or endodontic treatment to eliminate infectious lesions in the jaw, as needed. The patients were followed-up every three months for oral screening and oral management. ARONJ developed within 5 years after starting treatment with bone-modifying agents (zoledronic acid and/or denosumab) in 5.8% (n=6/104) of lung cancer patients and 16.7% (n=7/42) of breast cancer patients. ARONJ occurred from 4 to 34 months after the first dose of BMAs. For year 2-3 (p<0.05), 3-4 and year 4-5 (both p<0.01), there were significant differences in the incidence of ARONJ between lung and breast cancer patients due to the short survival time of lung cancer patients. In order to minimize the deterioration of patients’ oral quality of life due to measures to prevent ARONJ such as tooth extraction, oral management of patients starting BMAs should differ depending on their anticipated survival time.