Osteorradionecrose e Bifosfonatos: Uma Revisão de Literatura

Rafaela de Brito Ribeiro; Thiago Oliveira Araújo; Danyelle Maria Silva; Lucas Ferreira Alves

doi:10.36489/nursing.2025v30i329p11776-11795

Authors

Rafaela de Brito Ribeiro Acadêmica de Medicina da Pontifícia Universidade Católica de Minas Gerais https://orcid.org/0000-0002-3686-2329
Thiago Oliveira Araújo Acadêmico de Medicina da Pontifícia Universidade Católica de Minas Gerais
Danyelle Maria Silva Acadêmica de Medicina da Pontifícia Universidade Católica de Minas Gerais https://orcid.org/0000-0002-4465-4976
Lucas Ferreira Alves Professor Doutor de Medicina da Pontifícia Universidade Católica de Minas Gerais https://orcid.org/0000-0002-8075-0674

DOI:

https://doi.org/10.36489/nursing.2025v30i329p11776-11795

Keywords:

Osteoradionecrosis, Bisphosphonates, Head and Neck Cancer

Abstract

Introduction: Approximately 0% of patients diagnosed with cancer undergo radiotherapy as part of their treatment,
which can trigger complications such as osteoradionecrosis, a multifactorial dysfunction characterized by chronic bone
exposure, pain, and bone necrosis, which is mainly triggered by high doses of radiation and may be associated with some medications commonly used during the treatment of cancer patients, such as bisphosphonates. Objective: This study sought to conduct a literature review of scientific articles that describe the association between ORN and bisphosphonates and address the clinical approaches used in its treatment. Methodology: This is a review in which articles published between 0 and 0 were analyzed, applying selected filters, in the Virtual Health Library database and also the Medline (PubMed) database. The following descriptors were used: Osteoradionecrosis, Biphosphonates, Radiotherapy, Head and Neck Cancer, Medical Treatment. Articles that were not scientific in nature, did not fit the study theme, and/or were duplicates from different search engines were excluded. Results: A total of articles were found in the search engines before applying the filters and results after applying them, in the VHL and Medline. Then, after excluding articles outside the scope of the research by reading the abstracts, results were obtained in the VHL and Medline. Articles were also included through a citation search, totaling studies for analysis. Based on the results, Excel software was used to remove duplicate articles, generating a final selection of articles, which were read in their entirety. Conclusion: Reading the selected literature, it was possible to understand that the etiopathology of ORN associated
with bisphosphonates remains uncertain and, regarding treatment options, it was evident that there is insufficient robust evidence on the efficacy of HBO and reduction of morbidity and mortality. Therefore, long-term prospective studies are necessary to better understand its pathogenesis, in order to explore and guide the best clinical management for healthcare professionals and their patients.3578912

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References

AKASHI, M. et al. Differences between osteoradionecrosis and medication-related osteonecrosis of the jaw. Oral and maxillofacial surgery, v. 22, p. 59-63, 2018.

ANIMA. Manual revisão bibliográfica sistemática integrativa: a pesquisa baseada em evidências. Grupo Anima. 2014. Disponível em: https://biblioteca.cofen.gov.br/wp-content/uploads/2019/06/manual_revisao_bibliograficasistematica-integrativa.pdf.

ARQUEROS-LEMUS, M. et al. Pentoxifylline and tocopherol for the treatment of osteoradionecrosis of the jaws. A systematic review. Medicina oral, patologia oral y cirurgia bucal, v. 28, n. 3, p. e293, 2023.

BROZOSKI, M. A. et al. Osteonecrose maxilar associada ao uso de bisfosfonatos. Revista Brasileira de reumatologia, v. 52, p. 265-270, 2012.

CAMOLESI, G. C. V. et al. Therapeutic alternatives in the management of osteoradionecrosis of the jaws. Systematic review. Medicina oral, patologia oral y cirugia bucal, v. 26, n. 2, p. e195, 2020.

DA SILVA, F. A. et al. Perfil Epidemiológico dos Pacientes com Câncer de Cabeça e Pescoço em um Centro Oncológico no Sul do Brasil. Revista Brasileira de Cancerologia, [S. l.], v. 66, n. 1, p. e–08455, 2020.

DOD. Osteorradionecrose: uma visão geral. Hospital da Força Aérea de São Paulo. 2019. Disponível em: https://www2.fab.mil.br/hfasp/index.php/ultimas-noticias/457-osteorradionecrose-uma-visao-geral#:~:text=E%20sua%20incid%C3%AAncia%20varia%20de,ap%C3%B3s%20o%20t%C3%A9rmino%20do%20tratamento.

FORNER, L. E. et al. Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. Radiotherapy and Oncology, v. 166, p. 137-144, 2022.

MENDONÇA, L. G. M.; DE CASTRO, P. N.; CONCÍLIO, L. R. da S.; NEVES, A. C. C. Osteorradionecrose - uma complicação da radioterapia na região de cabeça e pescoço: revisão de literatura / Osteoradionecrosis – a complication of radiotherapy in the head and neck region: literature review. Brazilian Journal of Development, [S. l.], v. 7, n. 1, p. 7911–7920, 2021. DOI: 10.34117/bjdv7n1-537. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BRJD/article/view/23520.

MINIELLO, T. G. et al. Influence of bisphosphonates on clinical features of osteoradionecrosis of the maxilla and mandible. Oral Diseases, v. 25, n. 5, p. 1344-1351, 2019.

MINIELLO, T. G. Investigação do uso de cell sheet de células-tronco da polpa dentária humana associada ou não à terapia de fotobiomodulação ou à terapia fotodinâmica antimicrobiana no tratamento da necrose óssea dos maxilares por medicamentos anti reabsortivos em ratos. Tese de Doutorado. Universidade de São Paulo. 2020.

NEVILLE, B. W. et al. Patologia oral e maxilofacial. 4. Rio de Janeiro: Elsevier, 2016

OMOLEHINWA, T. T.; AKINTOYE, S. O. Chemical and radiation associated jaw lesions. Dental clinics of North America, v. 60, n. 1, p. 265, 2016.

RAZIEE, H. R. et al. Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database of Systematic Reviews, n. 11, 2019.

ROLIM, A. E. H. et al. Impact of radiotherapy on the orofacial region. Radiol Bras. 2011.

SAMPAIO, F. C. et al. Mecanismos de ação dos bifosfonatos e sua influência no prognóstico do tratamento endodôntico. Revista da Faculdade de Odontologia de Porto Alegre, v. 51, n. 1, p. 31-38, 2010.

SHAW, R. J. et al. HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): a randomized controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible after dentoalveolar surgery. International Journal of Radiation Oncology Biology Physics, v. 104, n. 3, p. 530-539, 2019.

SILVA, E. C. A. et al. Osteonecrose dos maxilares associada ao uso de bisfosfonatos: Recidiva após radioterapia de cabeça e pescoço. Revista Odontológica do Brasil Central, v. 24, n. 68, 2015.

TROTTI, A. et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003.

VIER, F. V. et al. Manejo da osteorradionecrose em pacientes submetidos à radioterapia de cabeça e pescoço. Revista Odonto Ciência, v. 20, n. 47, p. 23-28, 2005.

VIEGAS, C.F. Osteorradionecrose tratada com ozonioterapia em modelo animal: avaliação histológica e imunológica. Dissertação de Mestrado. Universidade de Brasília. 2018.

YIN, Y. et al. Evaluation of hyperbaric oxygen therapy for the osteoradionecrosis of the jaws: Meta-analysis. Hua xi kou Qiang yi xue za zhi= Huaxi Kouqiang Yixue Zazhi= West China Journal of Stomatology, v. 39, n. 6, p. 690-697, 2021.