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(18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect in antiresorptive treatment. Treatment of MRONJ is considered primarily conservative with oral mouth rinses and antibiotics but may demand surgery, depending on the complaints and general condition of the patient, the exten...

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Autores principales: Reinert, Christian Philipp, Pfannenberg, Christina, Gatidis, Sergios, la Fougère, Christian, Nikolaou, Konstantin, Hoefert, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281890/
https://www.ncbi.nlm.nih.gov/pubmed/34277447
http://dx.doi.org/10.3389/fonc.2021.700397
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author Reinert, Christian Philipp
Pfannenberg, Christina
Gatidis, Sergios
la Fougère, Christian
Nikolaou, Konstantin
Hoefert, Sebastian
author_facet Reinert, Christian Philipp
Pfannenberg, Christina
Gatidis, Sergios
la Fougère, Christian
Nikolaou, Konstantin
Hoefert, Sebastian
author_sort Reinert, Christian Philipp
collection PubMed
description Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect in antiresorptive treatment. Treatment of MRONJ is considered primarily conservative with oral mouth rinses and antibiotics but may demand surgery, depending on the complaints and general condition of the patient, the extent of the necrosis, and the overall prognosis with respect to the underlying disease. A 77 year old female patient with invasive ductal breast cancer and bone metastases was treated with intravenous bisphosphonate (BP) zoledronic acid. During therapy, she developed MRONJ in the mandible with severe pain. Clinical examination revealed confluent exposed bone of the lower left jaw and a fistula at the right molar region. The panoramic radiograph revealed a mandibular osseous involvement with diffuse radiopaque areas between radiolucent areas. For preoperative planning, (18)F-fluoride positron emission tomography/computed tomography (PET/CT) of the jaw was performed, showing substantially increased (18)F-fluoride uptake in regions 38 to 47 of the mandible with a focal gap in region 36 (area of clinically exposed bone). CT revealed medullary sclerosis and cortical thickening with confluent periosteal reaction and focal cortical erosion in the regions 37 to 42, whereas the regions 43 to 47 were only subtly sclerotic without cortical thickening. After systemic antibiotic therapy with sultamicillin following significant symptom and pain relief, (18)F-fluoride PET/CT imaging was performed again after 5 months. No changes in either CT and PET were observed in regions 38 to 42, whereas the bony sclerosis was slightly increased in regions 43 to 47 with a slight reduction of (18)F-fluoride uptake. (18)F-fluoride PET/CT showed no significant changes assessing the extent of MRONJ prior and after systemic antibiotic therapy, providing no evidence that conservative treatment reduced the extent of the MRONJ-affected jawbone. The additional information of (18)F-fluoride PET enables to identify the true extent of MRONJ which may be underestimated by CT imaging alone. Patients with MRONJ undergoing conservative treatment could benefit because additional imaging may be avoided as the pre-therapeutic (18)F-fluoride PET/CT delivers all information needed for further treatment. Our findings support the recommendation of a surgical approach as long-term antibiotics cannot downsize the extent of MRONJ.
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spelling pubmed-82818902021-07-16 (18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report Reinert, Christian Philipp Pfannenberg, Christina Gatidis, Sergios la Fougère, Christian Nikolaou, Konstantin Hoefert, Sebastian Front Oncol Oncology Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect in antiresorptive treatment. Treatment of MRONJ is considered primarily conservative with oral mouth rinses and antibiotics but may demand surgery, depending on the complaints and general condition of the patient, the extent of the necrosis, and the overall prognosis with respect to the underlying disease. A 77 year old female patient with invasive ductal breast cancer and bone metastases was treated with intravenous bisphosphonate (BP) zoledronic acid. During therapy, she developed MRONJ in the mandible with severe pain. Clinical examination revealed confluent exposed bone of the lower left jaw and a fistula at the right molar region. The panoramic radiograph revealed a mandibular osseous involvement with diffuse radiopaque areas between radiolucent areas. For preoperative planning, (18)F-fluoride positron emission tomography/computed tomography (PET/CT) of the jaw was performed, showing substantially increased (18)F-fluoride uptake in regions 38 to 47 of the mandible with a focal gap in region 36 (area of clinically exposed bone). CT revealed medullary sclerosis and cortical thickening with confluent periosteal reaction and focal cortical erosion in the regions 37 to 42, whereas the regions 43 to 47 were only subtly sclerotic without cortical thickening. After systemic antibiotic therapy with sultamicillin following significant symptom and pain relief, (18)F-fluoride PET/CT imaging was performed again after 5 months. No changes in either CT and PET were observed in regions 38 to 42, whereas the bony sclerosis was slightly increased in regions 43 to 47 with a slight reduction of (18)F-fluoride uptake. (18)F-fluoride PET/CT showed no significant changes assessing the extent of MRONJ prior and after systemic antibiotic therapy, providing no evidence that conservative treatment reduced the extent of the MRONJ-affected jawbone. The additional information of (18)F-fluoride PET enables to identify the true extent of MRONJ which may be underestimated by CT imaging alone. Patients with MRONJ undergoing conservative treatment could benefit because additional imaging may be avoided as the pre-therapeutic (18)F-fluoride PET/CT delivers all information needed for further treatment. Our findings support the recommendation of a surgical approach as long-term antibiotics cannot downsize the extent of MRONJ. Frontiers Media S.A. 2021-07-01 /pmc/articles/PMC8281890/ /pubmed/34277447 http://dx.doi.org/10.3389/fonc.2021.700397 Text en Copyright © 2021 Reinert, Pfannenberg, Gatidis, la Fougère, Nikolaou and Hoefert https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Reinert, Christian Philipp
Pfannenberg, Christina
Gatidis, Sergios
la Fougère, Christian
Nikolaou, Konstantin
Hoefert, Sebastian
(18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report
title (18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report
title_full (18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report
title_fullStr (18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report
title_full_unstemmed (18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report
title_short (18)F-Fluoride PET/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment—A Case Report
title_sort (18)f-fluoride pet/ct imaging of medication-related osteonecrosis of the jaw in conservative treatment—a case report
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281890/
https://www.ncbi.nlm.nih.gov/pubmed/34277447
http://dx.doi.org/10.3389/fonc.2021.700397
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