A systematic review of metastatic cancer presenting in osteonecrosis of the jaws (MC-ONJ) in patients undergoing antiresorptive and/or antiangiogenic therapy for skeletal-related adverse events

Roberto Sacco; Julian Woolley; Julian Yates; Monica Diuana Calasans-Maia; Oladapo Akintola; Vinod Patel

doi:10.1016/j.oooo.2021.01.001

A systematic review of metastatic cancer presenting in osteonecrosis of the jaws (MC-ONJ) in patients undergoing antiresorptive and/or antiangiogenic therapy for skeletal-related adverse events

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Jun;131(6):650-659. doi: 10.1016/j.oooo.2021.01.001. Epub 2021 Jan 8.

Authors

Roberto Sacco¹, Julian Woolley², Julian Yates³, Monica Diuana Calasans-Maia⁴, Oladapo Akintola⁵, Vinod Patel⁶

Affiliations

¹ Clinical Lecturer, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK; Clinical Teacher, King's College Hospital, Oral Surgery Department, London, UK. Electronic address: roberto.sacco@manchester.ac.uk.
² Foundation Training Dentist, Kings College Hospital, Oral Surgery Department, London, UK.
³ Professor of Oral and Maxillofacial Surgery and Implantology, University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK.
⁴ Professor of Oral and Maxillofacial Surgery, Fluminense Federal University, Dental School, Oral Surgery Department, Rio de Janeiro, Brazil.
⁵ Oral Surgery Consultant, King's College Hospital, Oral Surgery Department, London, UK.
⁶ Oral Surgery Consultant, Guys Dental Hospital, Oral Surgery Department, London, UK.

PMID: 33518491
DOI: 10.1016/j.oooo.2021.01.001

Abstract

Introduction: Osteonecrosis of the jaw (ONJ) is reported to be primarily associated with patients receiving bisphosphonate therapies but has been found in patients taking a number of other medications. A number of recent reports have noted the presence of metastatic cancers in the histologic analysis of osteonecrotic lesions from the jaw. The aim of the present review is to estimate the frequency and the type of metastatic cancer most commonly found in ONJ specimens in patients undergoing antiresorptive and/or antiangiogenic drug therapy.

Material and methods: A multidatabase (PubMed, MEDLINE, EMBASE, and CINAHL) systematic search was performed. Any studies involving human participants treated with antiresorptive and antiangiogenic drugs were considered. Where study patients presented with malignant cells within osteonecrotic specimens, further data were collected. Data are presented using descriptive statistics.

Results: A total of 13 studies met the inclusion criteria for this systematic review. Thirty-seven study patients had histologic evidence of malignant cells within medication-related osteonecrosis of the jaw (MRONJ) specimens. The most frequent phenotype of malignant cells found within MRONJ specimens were breast cancer variants (n = 15). The frequency of malignant tumor cells found within the MRONJ specimens was calculated using 4 studies. Out of 604 patients, the frequency was 4.64% (n = 28).

Conclusions: Based on the limited data available in the literature, it is plausible that not histologically analyzing all ONJ specimens could result in a small number of undiagnosed and untreated malignant diseases. Additional data based on a larger cohort of study patients is necessary to understand the role of MRONJ in metastatic spread and the influence of surgical treatment and reoccurrence.

Publication types

Review
Systematic Review

MeSH terms

Bisphosphonate-Associated Osteonecrosis of the Jaw* / epidemiology
Bisphosphonate-Associated Osteonecrosis of the Jaw* / etiology
Bone Density Conservation Agents*
Diphosphonates
Humans
Jaw
Neoplasms*
Osteonecrosis*

Substances

Bone Density Conservation Agents
Diphosphonates