The usefulness of FDG-PET for monitoring hyperbaric oxygen therapy in treatment of bisphosphonate-related osteonecrosis of jaws (BRONJ)

Poster Session Results: Primary sites of their cancers were 1 esophageal cancer, 1 multiple myeloma, 2 prostate cancer, 9 breast cancers and 12 patients associated bone metastasis after each surgery. All Zoledronic acid employed injection formulation and average period was 36.8  21.1 months from 10 to72 months. Before BRONJ arised, three were performed tooth extraction. The risk factors for onset of BRONJ, three diabetes merger, cancer chemotherapy has been carried out in all patients. Based on staging,one was stage 0, 3 were stage 1, 9 were stage 2 at initial examination. The withdrawal of the BP preparation (just after start of therapy) were 12 cases.Subsequently,2cases were resumed. In choice of the treatment of BRONJ, all patients were selected as conservative treatment (oral health care and medication) and of 3 were underwent curettage, sequestrum removal were performed. 3 of 13 were selected surgical treatment respectively. Conclusion: On the Management of BRONJ including the prophylaxis of BRONJ, the oral health care before and after the treatment with BP injectable preparation is very important. However , in the case of extension of BRONJ disturbs quality of life, We should choose the surgical treatment.

Results: FDG-PET detected the focal area of inflammation in all osteonecrosis cases. SUVmax after HBO (average 3.13  0.96, range 1.79-4.69) was significantly lower (p=0.03) than those of before HBO (average 4.42  1.13, range 2.68-5.64), 4 cases showed remarkably decreased SUVmax. Although the 3 phase static and pool bone images did not change, FDG-PET and perfusion bone image showed remarkable response to HBO for BRONJ (before HBO: 1.75  1.04, after HBO: 0.75  0.71, p = 0.03). All 8 cases showed good clinical course avoiding extended surgery. Conclusions: These preliminary results indicate that FDG-PET is useful for monitoring the effect of HBO for BRONJ. HBO combined with minor conservative surgery may hold a promise for treatment strategy in patients with refractory BRONJ. References: 1. FDG-PET may predict the effectiveness of hyperbaric oxygen therapy in a patient with bisphosphonate-related osteonecrosis of the jaw: report of a case.Fatema CN et.al.Odontology. 2013 Aug 2.[Epub ahead of print] 2. Use of FDG PET to evaluate hyperbaric oxygen therapy for bisphosphonate-related osteonecrosis of the jaw.Yamazaki Y et.al.Clin Nucl Med. 2010 Aug;35(8):590-1

POSTER 70 The usefulness of FDG-PET for monitoring hyperbaric oxygen therapy in treatment of bisphosphonate-related osteonecrosis of jaws (BRONJ) T. Asaka: Hokkaido University Graduate School of Dental Medicine, Y. Kitagawa, H. Hata, J. Sato, A. Satoh, M. Miyakoshi Objectives: Bisphosphonate-related osteonecrosis of jaws (BRONJ) is one of the most complicated inflammatory conditions in oral and maxillofacial region. It is very difficult to correctly evaluate the degree and extent of necrosis and infection. This refractory osteonecrosis often needs extended surgery, leading to impaired quality-of-life. We have performed hyperbaric oxygen therapy (HBO) combined with conservative surgery for advanced cases. The aim of this prospective study was to appraise the value of FDG-PET in the diagnosis and management of this condition. Methods: Eight patients (Age: 76-90; M/F: 1/7) with BRONJ were enrolled in this study. The treatment protocol includes 20 times of pre-operative HBO, conservative surgery, and then 10 times of post-operative HBO. Each patient underwent FDG-PET and 3-phase bone scintigraphic studies prior to and after the pre-operative HBO. SUVmax was calculated for quantitative analysis of FDG uptake in the lesions. Each image of 3-phase bone scan (perfusion, pool, static) was analyzed using 4 point grading system (G0-G3). e-90

POSTER 71 Successful Treatment of BRONJ in the Palatal Torus with Teriparatide K. Mizohata: Osaka Dental University, T. Sano, Y. Matsuo, K. Oishi, S. Morita Introduction: It was first reported by Marx in 2003, an effective treatment for bisphosphonate-associated osteonecrosis of the jaw (BRONJ) has yet to be established. However, in recent years, favorable outcomes have been reported with the administration of teriparatide acetate (teriparatide), a parathyroid hormone (PTH) preparation. The present paper reports and discusses a case of successful teriparatide treatment of stage 2 BRONJ in the palatal torus. Case Report: The patient was a 78-year-old woman with a previous history of osteoporosis, diabetes mellitus, hypertension, colorectal cancer (postoperative), pancreatic cancer (postoperative) and lumbar compression fracture. The patient’s osteoporosis was treated with risedronate sodium hydrate from 2005 to 2012. At the end of August 2012, while eating, she suffered thermal burns and soon after noticed apthous stomatitis on the palatal torus, and on November 7, 2012, she visited our department for further testing because her symptoms had not resolved. Intraoral findings on initial examination comprised ulceration on the palatal torus with exposed bone and swelling, erythema, and purulent discharge of the surrounding AAOMS  2014