二膦酸盐药物治疗乳腺癌骨转移发生颌骨坏死的临床特点

目的：乳腺癌是女性最常见的恶性肿瘤之一，骨转移在该类患者中较为常见。二膦酸盐药物是预防和控制恶性肿瘤骨转移的一线化学治疗药物，长期应用可以发生颌骨坏死。本研究旨在深入了解应用二膦酸盐药物治疗乳腺癌骨转移后患者发生颌骨坏死的临床特点。方法：回顾分析自2011年1月至2015年8月于北京大学口腔医院就诊并明确诊断为二膦酸盐颌骨坏死的患者，筛选出其中的乳腺癌患者，分析其临床症状、影像学特征及治疗情况。结果：共纳入14例乳腺癌患者，平均年龄60.21岁，平均罹患肿瘤时间9.77年，平均出现骨转移时间为5.67年，平均应用二膦酸盐药物的时间为3.29年。患者均无系统应用激素治疗史，无糖尿病史。9例患者曾经拔牙，口腔内颌骨坏死症状的平均时间为8.58个月，发生在下颌骨者10例，上颌骨3例，上、下颌骨1例。10例经手术治疗的患者中，3例治愈，6例好转，而4例经保守治疗的患者中2例临床症状明显加重。结论：乳腺癌患者自开始应用二膦酸盐药物至发生颌骨坏死的用药时间较长，多数患者没有糖尿病及应用激素治疗史。拔牙本身与颌骨坏死的严重程度没有直接关系，下颌骨是最常受累的部位，手术治疗可以在一定程度上缓解乳腺癌患者发生二膦酸盐相关性颌骨坏死的临床症状。

Clinical features of osteonecrosis of jaws after bisphosphonates therapy for bone me-tastasis of breast cancer

Objective:To understand the clinical features of osteonecrosis of the jaw after bisphospho-nates use for therapy of breast cancer patients with bone metastasis.Methods:The cases diagnosed as bisphosphonates-related osteonecrosis of the jaws (BRONJ)were retrospectively analyzed from January 201 1 to August 201 5 in the Peking University School and Hospital of Stomatology,and those breast cancer patients with bone metastasis were selected.The clinical symptoms,imaging characteristics and treatment results were summarized.Results:A total of 1 4 cases of breast cancer patients with bone me-tastasis were selected,with an average age of 60.21 years.The average time of suffering from breast cancer was 9 .77 years,and the average time of bone metastasis and bisphosphonates drugs use was 5 .67 and 3 .29 years individually.There was no patient with systemic application history of hormone therapy, and no history of diabetes.There were 9 patients with tooth extractions history,and the mean time of bone necrosis symptoms was 8.58 months.There were 1 0 cases with bone necrosis occurring on mandi-ble,3 cases on maxilla,and one case with both upper and lower jaws involved.Among the 1 0 patients with surgical treatment,there were 3 cases cured,and 6 cases improved.However,the clinical symp-toms of 2 cases with conservative treatment were significantly aggravated.Conclusion:The medication time between the bisphosphonates use beginning and the occurrence of BRONJ is relatively long.The his-tory of diabetes and long-time hormone use did not exist in this group.Tooth extraction itself does not de-termine the severity of BRONJ.Mandible is the most common site involved by BRONJ.Surgical treatment can alleviate the clinical symptoms of BRONJ with breast cancer to some extent.