Modern management of osteoradionecrosis
Modern management of osteoradionecrosis
复制标题
放射性骨坏死的现代治疗
DOI：
10.1097/moo.0000000000000459
复制
发表时间：
2018
影响因子：
1.6
通讯作者：
Ryan D. Winters
中科院分区：
文献类型：
--
作者：
Blake S. Raggio;Ryan D. Winters
综述尽管放射治疗取得了新的进展，但放射骨坏死(ORN)仍然是头颈部癌症患者放射治疗的常见和困难的并发症。可用的治疗方案是对其复杂的病理生理学和目前可用的ORN发展理论的补充。高压氧治疗的有效性最近受到质疑，针对纤维萎缩过程的治疗已成为ORN治疗的重点。本综述的目的是评估有关下颌骨ORN的文献，重点是可用的治疗方案。最近的发现，最近提出的纤维萎缩学说挑战了传统的低血管-低氧-低细胞学说作为ORN的机制。针对这种纤维萎缩过程的医疗治疗提供了有希望的结果，但尚未得到强有力的临床试验的证实。高压氧治疗的常规使用没有在文献中得到证实，但可能在选定的患者中被证明是合理的。系统性类固醇也可能起到一定作用，尽管数据有限。摘要纤维萎缩过程已被公认为ORN的主要机制。目前尚无黄金标准的治疗方法或共识指南，但应考虑多种治疗策略的组合，同时考虑疾病的严重程度和患者的个体特征。
Purpose of review Despite recent advances in radiotherapy, osteoradionecrosis (ORN) remains a common and difficult complication of radiation therapy in head and neck cancer patients. Available treatment options are complementary to its complex pathophysiology and the currently available theories of ORN development. The efficacy of hyperbaric oxygen therapy has recently been questioned, and therapies targeting the fibroatrophic process have become a focus of ORN treatment. The objective of this review is to evaluate the literature regarding ORN of the mandible, with a focus on available treatment options. Recent findings The recently proposed fibroatrophic theory has challenged the traditional hypovascular-hypoxic-hypocellular theory as the mechanism of ORN. Medical management targeting this fibroatrophic process offers promising results, but has yet to be confirmed with robust clinical trials. The routine use of hyperbaric oxygen therapy is not substantiated in the literature, but may be justified for select patients. Systemic steroids may also have a role, though data are limited. Summary The fibroatrophic process has gained acceptance as a main mechanism of ORN. No gold standard treatment or consensus guidelines exist, though a combination of therapeutic strategies should be considered, taking into account the severity of disease and individual patient characteristics.