Poster 107: Treatment for Osteosarcoma of the Mandible With Chemotherapy: A Case Report

Scientific Poster Session Statement of the Problem: Chemoradiotherapy-induced nausea, vomitting and anorexia are autonomic dysfunction. The patient’s quality of the life is seriously disturbed by their adverse reaction. Therefore, the alleviation of the these symptoms is very important. However, it is difficult to asssess the autonomic nervous dysfunction, which accompany chemoradiotherapy. We evaluated autonomic dysfunction of patients under chemoradiation for oral cancer by using heart rate variability with holter ECG. Materials and Methods: The subjects were 10 patients, who visited our department, and were diagnosed with oral cancer. They underwent radiation therapy at 2Gy/day (total 60Gy) and superselective intra-arterial chemotherapy with cisplatin (5mg/m2/ day, total dose 150mg), following docetaxel (15mg/ m2/week, total dose 90mg) via a superficial temporal artery infused for 6 weeks. Autonomic nervous function data output from ECG were analyzed with the Memcalc software(GMS, Tokyo) for heart rate variability power spectrum (Memcalc based on a maximum entropy method). Method of Data Analysis: High frequency (HF:0.150.4Hz) was used as the parameter of the parasympathetic nervous activity, while low frequency (LF:0.040.15Hz)/HF ratio was used as the parameter of the sympathetic nervous activity. We made studies comparing of heart rate (HR), HF and LF/HF for a period of 24 hours, and sleep status (21:00 to 6:00) once a week. We used Wilcoxon signed-ranks for statistical method. Results: Chemoradiotherapy qualitatively induced autonomic function. These findings suggested that both sympathetic and parasympathetic functions were lowered. Nevertheless, it was suggested that a lowering of parasympathetic function was predominant because of increasing the heart rate. Our data suggested that frequency analysis of heart rate variabilty is effective in monitoring autonomic dysfunction during chemoradiotherapy. Conclusion: The heart rate increased after the treatment. In addition, HF decreased and the parasympathetic nervous system function lowered. Moreover, LF/HF ratio also decreased and a lowering of sympathetic nervous system function was observed. References Gary R. Marrow, Jane T. Hickok, Brent DuBeshter, et al: Changes in clinical measures of autonomic nervous system function related to cancer chemotherapy-induced nausea. J.Autonomic Nervous System 78:57-63,1999 Peter J. Gianaros, Robert M. Stern, Gary R. Marrow, et al: Relationship of gastric myoelectrical and cardiac parasympathetic activity to chemotherapy-induced nausea. J.Psychosomatic Reseach 50:263266,2001

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POSTER 107 Treatment for Osteosarcoma of the Mandible With Chemotherapy: A Case Report Eiki Yamachika, DDS, PhD, Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama City, 700-8525, Japan (Sawaki M; Shirasu N; Matsubara M; Nakano M; Mizukawa N; Ueno T; Sugahara T) Statement of the Problem: Osteosarcoma of the oral and maxillofacial region is rare. Because of its rarity, there are many questions about osteosarcoma of this region in clinical features, treatment, and prognosis. And therefore it is difficult to establish a standard treatment. On the other hand, prognosis of osteosarcoma of long bone has improved dramatically since the introduction of chemotherapy. Today, using preoperative chemotherapy followed by surgical therapy and postoperative chemotherapy, long term, disease-free survival can be achieved in 60-70% of patients of osteosarcoma of long bone. We report here a case of osteosarcoma of the mandible treated with preoperative chemotherapy, surgical resection and postoperative chemotherapy. Materials and Methods: A 46-year-old woman was referred to our department, for evaluation of painful swelling and numbness of her left mandible. Extraoral examination revealed facial asymmetry related to the left lateral mandibular swelling. Numbness was detected in her left lower lip. Intraoral examination revealed some ulcer formations on her left mandibular gingiva. A computed tomography scan showed a round tumor like mass involving the left mandibular angle, with lateromedial expansion accompanied by peripheral bone destruction. Biopsy specimens were obtained from the mandibular bone and diagnosed as osteosarcoma. Method of Data Analysis: This is a single case report. Results: Chemotherapy was administered before and after operation. The preoperative chemotherapy was 2 cycles of high dose ifosfamide and one cycle of the combination with cisplatin and doxorubicin. Post operative chemotherapy was one cycle of high dose ifosfamide and one cycle of the combination with cisplatin and doxorubicin. As a surgical operation, a unilateral mandibulectomy and a simultaneous reconstruction using a titanium plate and artificial condyle were performed. A follow-up examination at 12 months revealed no recurrence and no metastasis. Conclusion: Osteosarcoma of the oral and maxillofacial region occurs usually in the fourth or fifth decade of life, but most patients with osteosarcoma are adolescents or young adults. This may be one of the reasons why treatment for osteosarcoma of the oral and maxillofacial region was done without chemotherapy. How43.e61

Scientific Poster Session ever recently a European review of outcomes came to the result that osteosarcoma in older patients is a curable condition and warrants intensive treatment with chemotherapy and surgical resection. Osteosarcoma has very good chemosensitivity and in our case good chemotherapeutic efficacy was admitted. A preoperative chemotherapy followed by surgical therapy and the postoperative chemotherapy may become the standard treatment for osteosarcoma of the oral and maxillofacial region. References Yamaguchi S, Nagasawa H, Suzuki T, Fujii E, Iwaki H, Takagi M, Amagasa T. Sarcomas of the oral and maxillofacial region: a review of 32 cases in 25 years. Clin Oral Investig. 2004;8(2):52-5 Smeland S, Wiebe T, Bohling T, Brosjo O, Jonsson K, Alvegard TA. Chemotherapy in osteosarcoma. The Scandinavian Sarcoma Group experience. Acta Orthop Scand Suppl. 2004;75(311):92-8 Meyers PA, Schwartz CL, Krailo M, Kleinerman ES, Betcher D, Bernstein ML, Conrad E, Ferguson W, Gebhardt M, Goorin AM, Harris MB, Healey J, Huvos A, Link M, Montebello J, Nadel H, Nieder M, Sato J, Siegal G, Weiner M, Wells R, Wold L, Womer R, Grier H. Os

and served as control. Five animals in each group were killed at 4 and 8 weeks. Histomorphometric analysis was used to quantify the amount of new bone within the defects. Method of Data Analysis: The histomorphometric results had been analyzed by descriptive statistics (mean, SD) and and analytical statistics using SPSS. The Wilcoxon test for pareated variables had been used and the Kruskal-Wallis test. A level of significance was 5% (0.05). Results: The results showed that demineralized bone matrix treated defects had significantly more new bone at 4 weeks compared to calcium-phosphate cement treated defects (p⫽ .03). Demineralized bone matrix treated defects had also significantly more new bone at 8 weeks compared to unfilled defects (p⫽ .04). Conclusion: We can conclude in this study that the demineralized bone matrix was superior to calciumphosphate cement in bone regeneration. And it seems that calcium-phosphate cement acted inhibiting the osteogenesis when associated to demineralized bone matrix and this combination should not be recommended.

POSTER 108 Comparative Study Between a Demineralized Bone Matrix and Calcium-Phosphate Cement in Bone Regenereation: Histologic and Histomorphometric Analysis in Critical Bone Defects in Rats Calvaria Jose´ Rodrigues Laureano Filho, PhD, Viconde de Jequitinhonha Avenue, n1144, Office 906, Boa Viagem, Recife/PE, 51030-020, Brazil (Bezerra TP; da Silva LCF; Maurette PE) Statement of the Problem: The reconstruction of bone defects has been one of the biggest challenges for the oral and maxillofacial surgeon and the autogenous bone remains the gold standard option to be used in the reconstructions of the craniofacial skeleton. However, had to the increase of the surgical morbidity for the necessity of a donor site and the limited bone volume in oral donor sites, researchers have attemped, throughout the years, to find an ideal bone substitute for these reconstructions. The purpose of this study was to compare bone regeneration in critical sized defects in rat calvarium using demineralized bone matrix and calciumphosphate cement. Materials and Methods: Thirty Wistar rats were divided into 3 groups of 10 animals each. Bilateral 5 mm calvarial critical defects were made in the parietal bones of each animal. Group I had calcium-phosphate cement placed in one defect, Group II had one defect filled with demineralized bone matrix and Group III had one defect filled with the association of the matrix with cement at equal parts. All the animals had the other defect left unfilled 43.e62

References Orsini, G.; Ricci, J.; Scarano, A. et al. Bone-defect healing with calcium-sulfate particles and cement: an experimental study in rabbit. J Biomed Mater Res, v. 68B, p. 199-208, 2004 Donos, N.; Lang, N. P.; Karoussis, I. K. et al. Effect of GBR in combination with deproteinized bovine bone mineral and/or enamel matrix proteins on the healing of critical-size defects. Clin Oral Implants Res, v. 15, p. 101-111, 2004 Chen, N. T.; Glowacki, J.; Bucky, L. P. et al. The roles of revascularization and resorption on endurance of craniofacial onlay bone grafts in the rabbit. Plast Reconstr Surg, v. 93, p. 714-722, 1994

POSTER 109 The Autogenous Bone Marrow Cells Transplant Using Atherocollagen Carrier to Rabbit Cranial Bone Defect Michio Kato, DDS, PhD, Japan (Sato J; Tanaka T; Kato T; Gomi K; Mikimoto K; Morita M; Tohyama T; Hayashi K; Arai T; Seto K) Statement of the Problem: Bone transplants are mainly performed for oral bone defects. Autogenous bone transplants are performed for large bone defects, but there are problems such as limited quantities of bone and the occurrence of postoperative infection. Therefore, a tissue engineering method has been receiving attention as an alternative method of bone transplantation, and in our department, it has been confirmed that bone formation occurs when bone-marrow cells are transplanted with AC (atherocollagen) as a carrier. However, further experiments using autogenous cell transplantation are necessary before clinical application can be carried out. So far there have only been few such studies and therefore many questions remain to be clarified. In our experAAOMS • 2007