MANDIBULAR OSTEONECROSIS RELATED TO THE USE OF BISPHOSPHONATE IN ONCOLOGY: CASE REPORT

Objective: Evidence that the inflammation, infection, necrosis and pain present in osteonecrosis may be related to the use of bisphosphonates in oncology. Methods: It’s a clinical case report of mandibular osteonecrosis, female, 73 years old, treated and under medical and multiprofessional oncology follow-up, at the Oncology Center of the Oswaldo Cruz University Hospital of the University of Pernambuco, for control of invasive ductal carcinoma of breast (Anatomopathological115134) and bilateral bone and lung metastases. Currently, using Faslodex 250mg – 02 ampoules and Zometa (bisphosphonate). Results: With a extraction history performed during the use of bisphosphonate, and with a removable upper and lower total dental prosthesis, attended the Dental Service of aforementioned Oncology Center, presenting bone exposure in the anterior mandible region and complaining of local pain. After clinical and radiographic evaluation, the diagnosis of osteonecrosis was confirmed, characterized by necrosis, pain and bone infection. Considering the mandibular clinical and radiographic condition, and the oncological condition, the Oral Care’s Standard Operational Protocol for Osteonecrosis was initiated, adapted from the Dentistry Service of the National Cancer Institute, but without the Low Power Laser. After 4 months, clinical improvement was noted and the absence of painful symptoms was reported. In addition, it follows the Oral Care Protocol and is being followed up at the aforementioned specialized Service. Conclusion: Invasive surgical procedures and local trauma should be avoided during therapy with bisphosphonates, as they can favor the development of osteonecrosis, in individuals who don’t have oral metastasis and have never undergone radiotherapy in the jaws.

Giant Cell Tumor of Bone, current treatments, and potential therapeutic alternatives

Giant cell tumor of bone (GCTB) is a primary bone tumor, locally aggressive. For many, a GCTB is considered a tumor with an unpredictable behavior, particularly regarding recurrences, pulmonary implants, and the possibility of primary malignancy. In terms of risk of recurrence, it is known that it is associated with the type of treatment used initially for the GCTB. The greater the number or recurrences, the greater the risk of pulmonary implants, and the greater the risk of malignant degeneration. Therefore, much of the prognosis of this tumor could be related to the type of initial treatment. Hence the importance of the treatment theme. This review includes a comparison between the various modalities for treatment in GCTB, considering the advantages and disadvantages of each one. Existing GCTB treatments are not 100% safe and effective at the same time. and this is the reason why the search for other treatment modalities should continue to offer a better oncologic and functional outcome to patients. In the end of this review, based on research work, we also mention other possible therapeutic options that could be explored and used in the future for GCT treatment.