Introduction: Anti-resorptive agent-related osteonecrosis of the jaw (ARONJ) is a slowly progressive disease occurring due to the chronic use of antiresorptive agents (e.g., bisphosphonates) and rarely presents with pathologic fractures. The frequency of pathologic fractures is rare, especially in patients with osteoporosis who are prescribed, low-dose bone-modifying agents. Herein, we report a case of rapidly progressive ARONJ with a pathologic fracture in a patient with hemodialysis.
Case Report: A 64-year-old woman with hemodialysis due to the microscopic polyangiitis who was treated with corticosteroids, immunosuppressants, and ibandronate presented with tooth pain of left mandibular second premolar and second molar, necessitating extraction. After extraction, ARONJ developed in the left mandibular. Anti-resorptive agent-related osteonecrosis of the jaw progressed rapidly during the follow-up at the 12th and 15th months, furthermore, ARONJ also developed in the right mandibular second premolar and second molar lesion, requiring extensive surgery. We performed curative segmental and marginal mandibulectomy in the left and right hemimandible, respectively. The postoperative course was uneventful.
Conclusion: We report a rare case of rapidly progressive ARONJ with pathologic fracture in a patient with hemodialysis. This report suggests a potential role of hemodialysis as a risk factor for disease progression and pathologic fracture development. Further studies regarding factors that inhibit the healing of ARONJ are still needed.
Introduction: This study aimed to evaluate survival in patients aged ≥80 years with oral squamous cell carcinoma (OSCC) treated with intra-arterial chemotherapy using docetaxel, cisplatin, and peplomycin combined with intravenous chemotherapy using 5-fluorouracil (IADCPIVF). Methods: The present study was a retrospective analysis of 32 OSCC patients who were determined to require reconstructive surgery. We performed IADCPIVF as neoadjuvant chemotherapy and then minimally invasive surgeries (MIS) on patients with complete responses or good partial responses.
Results:The study population included 16 patients with stage II OSCC, seven with stage III, and nine with stage IV. The primary tumor response rate was 100% (complete response rate, 37.5%; good partial response rate, 28.1%; and fair partial response rate, 34.4%). After IADCPIVF, 32 patients underwent surgery; MIS was performed on 21 patients. The 3-year overall survival rate was 76.5% (stage II, 77.9%; stage III, 85.7%; and stage IV, 55.6%). In the multivariate analysis of survival, clinical tumor response was a significant prognostic factor. The rate of grade 3 adverse events was 46.9%, and most of the events were due to mucositis in the area of the intra-arterial injection. Conclusion: IADCPIVF is highly safe and has an excellent antitumor effect by itself, so it may be a possible new treatment method with high curability, even for patients aged ≥80 years who want to avoid reconstructive surgery and preserve oral function.
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