Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline
Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline
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DOI：
10.1200/jco.19.01186
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发表时间：
2019-09-01
影响因子：
45.3
通讯作者：
Saunders, Deborah P.
中科院分区：
文献类型：
--
作者：
Yarom, Noam;Shapiro, Charles L.;Saunders, Deborah P.
目的为癌症患者预防和治疗药物相关性颌骨坏死(MRONJ)的最佳实践提供指导。方法多国癌症支持护理协会/国际口腔肿瘤学会(MASCC/ISOO)和ASCO召集了一个多学科专家小组对证据进行评估并提出建议。指南的制定包括对文献的系统审查和正式的协商一致过程。检索PubMed和EMBASE，检索2009年1月至2017年12月发表的与肿瘤学适应症骨修饰剂(BMA)相关的MRONJ预防和管理研究。结果系统综述确定了132篇文献，其中只有10篇是随机对照试验。目前，MRONJ的定义是：(1)目前或以前使用BMA或血管生成抑制剂治疗，(2)暴露的骨或骨可通过颌面部的口内或口外瘘探测并持续超过8周，(3)无颌骨放射治疗或颌骨转移病史。对于开始BMA治疗的患者，预防性护理包括全面的牙科评估，讨论可改变的危险因素，以及在BMA治疗期间避免选择性牙槽手术(即涉及牙齿或毗邻的牙槽骨的手术)。目前尚不确定BMA是否应该在牙槽外科手术前停用。MRONJ的分期应由具有MRONJ管理经验的临床医生进行。保守措施包括MRONJ治疗的初步方法。牙医、牙科专家和肿瘤学家之间的持续合作对最佳患者护理至关重要。(C)2019年美国临床肿瘤学会
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