Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline

被引：214

作者：

Yarom, Noam ^{[1
,2
]}

Shapiro, Charles L. ^{[3
]}

Peterson, Douglas E. ^{[4
]}

Van Poznak, Catherine H. ^{[5
]}

Bohlke, Kari ^{[6
]}

Ruggiero, Salvatore L. ^{[7
,8
,9
]}

Migliorati, Cesar A. ^{[10
]}

Khan, Aliya ^{[11
]}

Morrison, Archie ^{[12
,13
]}

Anderson, Holly ^{[14
]}

Murphy, Barbara A. ^{[15
]}

Alston-Johnson, Devena ^{[16
]}

Mendes, Rui Amaral ^{[17
]}

Beadle, Beth Michelle ^{[18
]}

Jensen, Siri Beier ^{[19
]}

Saunders, Deborah P. ^{[20
]}

机构：

[1] Sheba Med Ctr, Ramat Gan, Israel

[2] Tel Aviv Univ, Tel Aviv, Israel

[3] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[4] UConn Hlth Neag Comprehens Canc Ctr, Farmington, CT USA

[5] Univ Michigan, Ann Arbor, MI 48109 USA

[6] Amer Soc Clin Oncol, 2318 Mill Rd,Suite 800, Alexandria, VA 22314 USA

[7] Hofstra North Shore LIJ Sch Med, Hempstead, NY USA

[8] Stony Brook Sch Dent Med, Stony Brook, NY USA

[9] New York Ctr Orthognath & Maxillofacial Surg, New York, NY USA

[10] Univ Florida, Coll Dent, Gainesville, FL USA

[11] McMaster Univ, Hamilton, ON, Canada

[12] Dalhousie Univ, Halifax, NS, Canada

[13] Queen Elizabeth 2 Hlth Sci Ctr, Halifax, NS, Canada

[14] Breast Canc Coalit Rochester, Rochester, NY USA

[15] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA

[16] Univ North Carolina Canc Care Nash, Rocky Mount, NC USA

[17] Case Western Reserve Univ, Cleveland, OH 44106 USA

[18] Stanford Univ, Med Ctr, Stanford, CA 94305 USA

[19] Aarhus Univ, Aarhus, Denmark

[20] Northern Ontario Sch Med, Sudbury, ON, Canada

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2019年 / 37卷 / 25期

关键词：

BISPHOSPHONATE-RELATED OSTEONECROSIS; METASTATIC BREAST-CANCER; MULTIPLE-MYELOMA PATIENTS; SKELETAL-RELATED EVENTS; BONE-MODIFYING AGENTS; RISK-FACTORS; ZOLEDRONIC ACID; AMERICAN SOCIETY; SURGICAL-MANAGEMENT; INTRAVENOUS BISPHOSPHONATES;

D O I：

10.1200/JCO.19.01186

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE To provide guidance regarding best practices in the prevention and management of medication-related 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. (C) 2019 by American Society of Clinical Oncology

引用

页码：2270 / +

页数：23

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