THE ROLE OF CONSERVATIVE MANAGEMENT IN PATIENTS WITH MEDICATION-RELATED OSTEONECROSIS OF JAW: A MEMORIAL SLOAN KETTERING CANCER CENTER EXPERIENCE

Abstract

<h3>Objectives</h3> Medication-related osteonecrosis of jaw (MRONJ) is a debilitating disease that may affect the quality of life in patients on antiresorptive treatment. The aim of this study is to report our institution's experience in conservative management of a cohort of oncologic patients who developed MRONJ after antiresorptive treatment. <h3>Study Design</h3> Patients included in this 19-year retrospective single-center study fulfilled the following criteria: (1) received treatment at Memorial Sloan Kettering Cancer Center with pamidronate, zoledronic acid, and/or denosumab for bone metastasis or multiple myeloma and (2) diagnosed with MRONJ and followed for at least 12 months in the Dental Service of MSKCC between 1999 and 2018. Various demographic and treatment-related variables including the number of medication doses, time to onset of MRONJ, and clinical outcome associated with different interventions were analyzed. <h3>Results</h3> One hundred ten patients (46 men, 64 women) were included in the study. Breast cancer was the primary diagnosis in 53 patients (48%). Zoledronic acid (n = 71,64.5%) was the most commonly prescribed first antiresorptive medication and 58 patients were switched to another antiresorptive medication after the onset of MRONJ (53%). The median time interval between the first medication onset and MRONJ diagnosis was 28 months (range, 1-163). The median number of first medication doses before development of MRONJ was 22, 23, and 19 for denosumab (range, 1-38), pamidronate (range, 1-70), and zoledronic acid (range, 1-60), respectively. Fifty-two patients developed spontaneous MRONJ (47%). The mandible was the most common site (61%). Conservative management including use of antimicrobial rinses and/or antibiotics and pain medications was prescribed for all patients. Pentoxifylline and tocopherol were prescribed in 12 patients (11%), with resolution seen in 6 patients (50%). At a median follow-up of 27.5 months (range, 12-181), 56 patients had complete resolution (51%). Sixteen patients had symptomatic improvement (14.5%) and 13 patients had stable disease (11.8%). Twenty-five patients had progressive disease (22.7%). The remaining data analysis is currently ongoing and will be statistically analyzed for more definitive results. <h3>Conclusions</h3> Our study showed that close follow-up, conservative management with a focus on maintaining and enhancing patients' quality of life through alleviation of symptoms and prevention of superinfection can contribute to improved outcome for patients with MRONJ.