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Head & Neck Dec 2019Exploring the clinicopathological features of ameloblastic carcinoma (AC) and reviewing the literature to improve the diagnosis and treatment of the disease.
OBJECTIVES
Exploring the clinicopathological features of ameloblastic carcinoma (AC) and reviewing the literature to improve the diagnosis and treatment of the disease.
MATERIALS AND METHODS
Clinical data and pathological features of 18 cases of AC were retrospectively analyzed. A systematic review was carried out by searching PubMed and Medline databases using the MeSH terms "ameloblastic" and "carcinoma."
RESULTS
In the systematic analysis, 125 cases of AC from 81 eligible original studies and 18 cases of AC from this research were included. The male-to-female ratio was 2.58:1, and the mandible-to-maxilla ratio was 1.80:1. Mean age of patients was 45.3 years. Thirty-seven cases of recurrence and 27 cases of metastasis were recorded.
CONCLUSION
AC is a rare neoplasm of the odontogenic epithelium. A systematic review indicates that diagnoses at the early phase and a close periodic assessment for recurrence and metastasis are necessary.
Topics: Adult; Aged; Ameloblastoma; Carcinoma; Female; Humans; Male; Mandibular Neoplasms; Maxillary Neoplasms; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Odontogenic Tumors; Retrospective Studies; Survival Rate
PubMed: 31444935
DOI: 10.1002/hed.25926 -
Journal of Stomatology, Oral and... Oct 2022Metastasis to oral and maxillofacial region (MOMFR) is an unusual finding; representing between 1 and 1.5% of all malignancies in the maxillofacial region. A systematic...
OBJECTIVE
Metastasis to oral and maxillofacial region (MOMFR) is an unusual finding; representing between 1 and 1.5% of all malignancies in the maxillofacial region. A systematic review is presented to determine trends in presentation, diagnostic features, and patient outcome.
METHODS
Searches of databases were carried out for papers reporting MOMFR. The variables were demographics, patient symptoms, tumor location, tumor size, histopathology, origin of the tumor, immunohistochemical studies, follow-up and survival.
RESULTS
696 cases were identified; 391 males, and 305 females. The most common race was white. The most common primary tumor for females was from breast 31.1% (n = 95), for males from lung 20.5% (n = 143). The most common location was the mandible 44.9% (n = 313), followed by gingival soft tissue 16.8% (n = 117). A frequent clinical symptom was pain with 17.5% (n = 122). The most common clinical presentation was a mass or tumor 37.4% (n = 260). The mean age was 58.8 years. The average time before diagnosis was 10.3 months, the mean follow-up after diagnosis was 13.1 months, and the average survival was 9.8 months.
CONCLUSION
MOMFR shows a strong predilection for the posterior mandible, with a mass or tumor being the most common clinical presentation. They are frequently painful, and demonstrate a poor prognosis.
Topics: Female; Humans; Male; Middle Aged; Mouth Neoplasms
PubMed: 34933137
DOI: 10.1016/j.jormas.2021.12.009 -
Brazilian Dental Journal 2017Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of... (Review)
Review
Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS's clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.
Topics: Adult; Female; Fibrosarcoma; Humans; Immunohistochemistry; Mandibular Neoplasms; Odontogenic Tumors
PubMed: 28492759
DOI: 10.1590/0103-6440201701050 -
Journal of Oral and Maxillofacial... Oct 2015Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor, usually diagnosed within the first year of age, with a predilection for the maxilla. Although the... (Review)
Review
Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor, usually diagnosed within the first year of age, with a predilection for the maxilla. Although the tumor is usually benign, its rapidly growing nature and ability to cause major deformities in surrounding structures necessitate early diagnosis and intervention. It is important that medical and dental specialists are prepared to make the diagnosis and proceed with appropriate intervention. The authors performed a systematic review of the 472 reported cases from 1918 through 2013 and provided a comprehensive update on this rare entity that can have devastating effects on young patients. This investigation uncovered age at diagnosis as an important prognostic indicator, because younger age correlated with a higher recurrence rate. The authors also present a case report of a 5-month-old girl diagnosed with MNTI and review her clinical presentation and imaging and histopathologic findings.
Topics: Diagnosis, Differential; Female; Humans; Infant; Maxillary Neoplasms; Neuroectodermal Tumor, Melanotic; Tomography, X-Ray Computed
PubMed: 25936939
DOI: 10.1016/j.joms.2015.03.061 -
Head & Neck Apr 2020There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This... (Review)
Review
There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This systematic review focused on the literature about the outcomes of implants placed during ablative surgery in patients with HNC who underwent postoperative RT. Implants placed after radiation therapy and implants placed in reconstructed jaws were excluded. Four comparative studies involving 755 native mandible primary implants were analyzed. The survival rate with postimplantation RT was 89.6% vs 98.6% in patients with no additional radiation. The overall success of implant-retained overdenture in patients with RT performed postimplantation was 67.4% vs 93.1% in patients with implant surgery that was carried out 1 year after the completion of radiation therapy. Only five cases of osteoradionecrosis (ORN) of the jaw were reported. The outcomes for implant survival rates appear to be positive for irradiated implants.
Topics: Carcinoma, Squamous Cell; Dental Implantation, Endosseous; Dental Implants; Head and Neck Neoplasms; Humans; Jaw; Mandible; Osteoradionecrosis
PubMed: 31898358
DOI: 10.1002/hed.26065 -
Journal of Investigative and Clinical... May 2017The current systematic review was performed to assess the functional outcomes of implant-prosthetic treatment on patients who have had surgical resection of oral cavity... (Review)
Review
The current systematic review was performed to assess the functional outcomes of implant-prosthetic treatment on patients who have had surgical resection of oral cavity tumors. The assessment of function, satisfaction, or quality of life (QoL) were the major outcomes that evaluated preoperative and/or before and after implant-prosthetic treatment. Only eight published studies fulfilled the inclusion criteria. Three publications evaluated chewing ability, masticatory performance, and neuromuscular function, and the other five publications used questionnaire as a method of assessment. These publications mainly reported on implant-prosthetic treatment in mandibulectomy patients. It was found that implant-retained prosthesis had a beneficial effect on masticatory performance and masseter muscle activity on the defect side, but not on the non-defect side. Swallowing threshold performance and jaw movement parameters showed no significant differences between non-implant-retained prosthesis and implant-retained prosthesis. Significant improvement in prosthesis and patients' satisfaction with implant-retained prosthesis compared to non-implant-retained prosthesis was observed. However, general improvement in patients' QoL was not observed after implant-prosthetic treatment. Patients with intraoral resection might benefit from implant-retained prosthesis with regard to masticatory function and satisfaction. However, future clinical trials with an adequate sample size are needed to identify the group of patients who are likely to benefit from the implant-prosthetic treatment modality.
Topics: Deglutition; Dental Implants; Dental Prosthesis, Implant-Supported; Humans; Mastication; Mouth; Mouth Neoplasms; Patient Satisfaction; Quality of Life; Treatment Outcome
PubMed: 26749088
DOI: 10.1111/jicd.12207 -
PloS One 2018In advanced prostate cancer, osteoclast inhibitors prevent and palliate skeletal related events associated with bone metastases. However, it is uncertain whether they... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In advanced prostate cancer, osteoclast inhibitors prevent and palliate skeletal related events associated with bone metastases. However, it is uncertain whether they play a disease-modifying role earlier in the course of the disease.
METHODS
Medline, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and ASCO conference proceedings were searched for randomized controlled trials that compared osteoclast inhibitors with placebo and/or standard of care (SOC) in patients with high-risk, non-metastatic prostate cancer. The primary outcome measure was incidence of new bone metastases; secondary outcomes included overall survival (OS), prostate cancer specific survival, mortality unrelated to prostate cancer, toxicity and health related quality of life outcomes. Results are presented as relative risk (RR) with 95% confidence intervals (CI).
RESULTS
Six randomized controlled trials (5947 participants) were included, five evaluating bisphosphonates and one denosumab. Overall, there was no difference in incidence of bone metastases between participants treated with osteoclast inhibitors versus placebo/SOC (RR 1.09, 95%CI 0.84-1.41, p = 0.51) however significant heterogeneity was observed between studies. The denosumab trial was the largest and only positive trial amongst the included studies (RR 0.83, 95%CI 0.73-0.95, p = 0.007). No significant difference was observed in OS (RR 0.99 95% CI 0.89-1.10, p = 0.84) nor prostate cancer specific survival (RR 1.12 95%CI 0.93-1.36, p = 0.24). Most studies reported increased rates of osteonecrosis of the jaw (5% or less) and hypocalcemia (2% or less) with osteoclast inhibitors.
CONCLUSIONS
While there is limited evidence that bisphosphonates alter the natural history of high-risk, non-metastatic prostate cancer, denosumab delays onset of bone metastases in this patient population. Neither class of osteoclast inhibitor demonstrated an impact on survival outcomes. Future trials with better defined patient selection and a robust definition for high risk disease is critical.
Topics: Bone Density Conservation Agents; Bone Neoplasms; Denosumab; Diphosphonates; Humans; Male; Osteoclasts; Outcome Assessment, Health Care; Prostatic Neoplasms; Quality of Life; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 29370211
DOI: 10.1371/journal.pone.0191455 -
The Cochrane Database of Systematic... Oct 2017Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab inhibit other key bone metabolism pathways. We have studied these agents in both early breast cancer and advanced breast cancer settings. This is an update of the review originally published in 2002 and subsequently updated in 2005 and 2012.
OBJECTIVES
To assess the effects of bisphosphonates and other bone agents in addition to anti-cancer treatment: (i) in women with early breast cancer (EBC); (ii) in women with advanced breast cancer without bone metastases (ABC); and (iii) in women with metastatic breast cancer and bone metastases (BCBM).
SEARCH METHODS
In this review update, we searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 19 September 2016.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing: (a) one treatment with a bisphosphonate/bone-acting agent with the same treatment without a bisphosphonate/bone-acting agent; (b) treatment with one bisphosphonate versus treatment with a different bisphosphonate; (c) treatment with a bisphosphonate versus another bone-acting agent of a different mechanism of action (e.g. denosumab); and (d) immediate treatment with a bisphosphonate/bone-acting agent versus delayed treatment of the same bisphosphonate/bone-acting agent.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data, and assessed risk of bias and quality of the evidence. The primary outcome measure was bone metastases for EBC and ABC, and a skeletal-related event (SRE) for BCBM. We derived risk ratios (RRs) for dichotomous outcomes and the meta-analyses used random-effects models. Secondary outcomes included overall survival and disease-free survival for EBC; we derived hazard ratios (HRs) for these time-to-event outcomes where possible. We collected toxicity and quality-of-life information. GRADE was used to assess the quality of evidence for the most important outcomes in each treatment setting.
MAIN RESULTS
We included 44 RCTs involving 37,302 women.In women with EBC, bisphosphonates were associated with a reduced risk of bone metastases compared to placebo/no bisphosphonate (RR 0.86, 95% confidence interval (CI) 0.75 to 0.99; P = 0.03, 11 studies; 15,005 women; moderate-quality evidence with no significant heterogeneity). Bisphosphonates provided an overall survival benefit with time-to-event data (HR 0.91, 95% CI 0.83 to 0.99; P = 0.04; 9 studies; 13,949 women; high-quality evidence with evidence of heterogeneity). Subgroup analysis by menopausal status showed a survival benefit from bisphosphonates in postmenopausal women (HR 0.77, 95% CI 0.66 to 0.90; P = 0.001; 4 studies; 6048 women; high-quality evidence with no evidence of heterogeneity) but no survival benefit for premenopausal women (HR 1.03, 95% CI 0.86 to 1.22; P = 0.78; 2 studies; 3501 women; high-quality evidence with no heterogeneity). There was evidence of no effect of bisphosphonates on disease-free survival (HR 0.94, 95% 0.87 to 1.02; P = 0.13; 7 studies; 12,578 women; high-quality evidence with significant heterogeneity present) however subgroup analyses showed a disease-free survival benefit from bisphosphonates in postmenopausal women only (HR 0.82, 95% CI 0.74 to 0.91; P < 0.001; 7 studies; 8314 women; high-quality evidence with no heterogeneity). Bisphosphonates did not significantly reduce the incidence of fractures when compared to placebo/no bisphosphonates (RR 0.77, 95% CI 0.54 to 1.08, P = 0.13, 6 studies, 7602 women; moderate-quality evidence due to wide confidence intervals). We await mature overall survival and disease-free survival results for denosumab trials.In women with ABC without clinically evident bone metastases, there was no evidence of an effect of bisphosphonates on bone metastases (RR 0.96, 95% CI 0.65 to 1.43; P = 0.86; 3 studies; 330 women; moderate-quality evidence with no heterogeneity) or overall survival (RR 0.89, 95% CI 0.73 to 1.09; P = 0.28; 3 studies; 330 women; high-quality evidence with no heterogeneity) compared to placebo/no bisphosphonates however the confidence intervals were wide. One study reported a trend towards an extended period of time without a SRE with bisphosphonate compared to placebo (low-quality evidence). One study reported quality of life and there was no apparent difference in scores between bisphosphonate and placebo (moderate-quality evidence).In women with BCBM, bisphosphonates reduced the SRE risk by 14% (RR 0.86, 95% CI 0.78 to 0.95; P = 0.003; 9 studies; 2810 women; high-quality evidence with evidence of heterogeneity) compared with placebo/no bisphosphonates. This benefit persisted when administering either intravenous or oral bisphosphonates versus placebo. Bisphosphonates delayed the median time to a SRE with a median ratio of 1.43 (95% CI 1.29 to 1.58; P < 0.00001; 9 studies; 2891 women; high-quality evidence with no heterogeneity) and reduced bone pain (in 6 out of 11 studies; moderate-quality evidence) compared to placebo/no bisphosphonate. Treatment with bisphosphonates did not appear to affect overall survival (RR 1.01, 95% CI 0.91 to 1.11; P = 0.85; 7 studies; 1935 women; moderate-quality evidence with significant heterogeneity). Quality-of-life scores were slightly better with bisphosphonates than placebo at comparable time points (in three out of five studies; moderate-quality evidence) however scores decreased during the course of the studies. Denosumab reduced the risk of developing a SRE compared with bisphosphonates by 22% (RR 0.78, 0.72 to 0.85; P < 0.001; 3 studies, 2345 women). One study reported data on overall survival and observed no difference in survival between denosumab and bisphosphonate.Reported toxicities across all settings were generally mild. Osteonecrosis of the jaw was rare, occurring less than 0.5% in the adjuvant setting (high-quality evidence).
AUTHORS' CONCLUSIONS
For women with EBC, bisphosphonates reduce the risk of bone metastases and provide an overall survival benefit compared to placebo or no bisphosphonates. There is preliminary evidence suggestive that bisphosphonates provide an overall survival and disease-free survival benefit in postmenopausal women only when compared to placebo or no bisphosphonate. This was not a planned subgroup for these early trials, and we await the completion of new large clinical trials assessing benefit for postmenopausal women. For women with BCBM, bisphosphonates reduce the risk of developing SREs, delay the median time to an SRE, and appear to reduce bone pain compared to placebo or no bisphosphonate.
Topics: Administration, Oral; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Clodronic Acid; Denosumab; Diphosphonates; Female; Humans; Imidazoles; Injections, Intravenous; Randomized Controlled Trials as Topic; Zoledronic Acid
PubMed: 29082518
DOI: 10.1002/14651858.CD003474.pub4 -
International Journal of Oral and... Nov 2016The purpose of this systematic review was to answer the clinical question "When should elective neck dissection be performed in maxillary gingival and alveolar squamous... (Review)
Review
The purpose of this systematic review was to answer the clinical question "When should elective neck dissection be performed in maxillary gingival and alveolar squamous cell carcinoma with a cN0 neck?" A systematic review, designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, was conducted by two independent reviewers with three rounds of search and evaluation. Ten studies with 506 patients were included in the final review. The overall risk of cervical metastasis was 23.2% for those who did not receive an elective neck dissection (END), which was 3.4 times higher than that in the END group (6.8%). The 5-year survival rate was higher in those who had an END (80.3%) when compared to those who did not receive an END (67.4%). Overall, 14.1% of the cases with cN0 maxillary squamous cell carcinoma (SCC) presented with positive node(s) in pathological specimens after END. The risk of occult cervical metastasis in a cN0 maxillary SCC case with pathological stage pT1, pT2, pT3, and pT4 was 11.1%, 12.1%, 20%, and 36.1%, respectively. It is therefore concluded that END is recommended in patients with cN0 maxillary SCC, especially in stage T3 or T4 cases.
Topics: Alveolar Process; Carcinoma, Squamous Cell; Elective Surgical Procedures; Gingival Neoplasms; Humans; Lymphatic Metastasis; Maxillary Neoplasms; Neck Dissection; Neoplasm Staging; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome
PubMed: 27289248
DOI: 10.1016/j.ijom.2016.05.021 -
The British Journal of Oral &... Sep 2021Carnoy's solution (CS) is routinely used as adjuvant therapy in the management of odontogenic keratocyst (OKC) and a few other benign lesions. The purpose of this study... (Review)
Review
Carnoy's solution (CS) is routinely used as adjuvant therapy in the management of odontogenic keratocyst (OKC) and a few other benign lesions. The purpose of this study was to explore the evidence of its application and efficacy in benign lesions other than OKC. We have systematically reviewed published articles to identify the evidence of CS in benign jaw lesions other than OKC following the PRISMA guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library database, to find relevant articles from 1980 to March 2020. Finally, 39 studies were analysed in this review. It included studies where CS was used as an adjunct for the benign lesion of the jaw and followed for a minimum of 6 months. Thirty-nine studies with 11 different types of lesion were reported where CS was used as an adjuvant and application time was restricted to 3-5minutes. Recurrence were reported only in ameloblastoma cases [unicystic=10.98% (10/91), mixed=18.18% (26/143)]. Meta-analysis was not possible as all studies were non-controlled in nature. Based on the available data, there was no strong evidence for the use of CS as an adjuvant in the benign lesion of the jaw. Prospective and randomised control studies are recommended for the best stratification for the use of CS.
Topics: Acetic Acid; Chloroform; Ethanol; Humans; Neoplasm Recurrence, Local; Odontogenic Cysts; Prospective Studies
PubMed: 34272109
DOI: 10.1016/j.bjoms.2020.12.019