|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 412
Authors' reply to Tandon et al., Kudva et al., and Krishnan et al.
Ankita Ahuja, Abhishek Mahajan
Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Submission||15-Apr-2020|
|Date of Decision||17-Apr-2020|
|Date of Acceptance||20-Apr-2020|
|Date of Web Publication||19-Jun-2020|
Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahuja A, Mahajan A. Authors' reply to Tandon et al., Kudva et al., and Krishnan et al. Cancer Res Stat Treat 2020;3:412
We thank Tandon et al., Kudva and Kumar, and Krishnan et al. for their interest in our article.,, As aptly pointed out by Tandon et al. and Krishnan et al., osteonecrosis of the jaw could be caused by various medications, including denosumab. In the present case, the risk versus benefit ratio was assessed by the clinical team in view of the metastatic disease, and denosumab was administered with monitoring and local examination of the jaw. With reference to Chiu et al.'s comment, the use of long-term steroids is associated with an increased risk of osteonecrosis; however, our patient received only a single epidural injection for the degenerative disease, which is unlikely to be associated with osteonecrosis., In our article, “above mentioned systemic therapy” referred to fulvestrant, letrozole, and zolendronate, with the bisphosphonate being the crux of the discussion. As aptly pointed out by Kudva and Kumar when performing tooth extraction in patients who receive oral bisphosphonates, factors such as the age, extraction site, and duration of administration must be taken into consideration, and close postoperative follow-up should be carried out to facilitate effective and early management. We completely agree with Krishnan et al. on the fact that even after 17 years of existence, the diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is a surprise in many cases; in our case, the patient underwent tooth extraction in an outside clinic and was not advised proper care. This could be possibly due to either a lack of elucidation of the bisphosphonate medication history by the dental specialists or an insufficient awareness about the existence of this oral entity among them. Hence, even today, several case reports on the surprise diagnosis of MRONJ or cases masquerading as jaw metastasis are seen in the literature; we attribute this to our sheer unfamiliarity with this condition. The diagnosis and staging of MRONJ are primarily clinical, and hence, the presence of an open, nonhealing socket or exposed bone within 1 month of extraction had to be specifically looked for in this case. An orthopantomogram (OPG) may fail to show the early changes of MRONJ; however, for a full-blown disease and follow-up of MRONJ, an OPG is an adequate investigation tool. In suspicious cases that are negative on OPG, a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the jaw must be advised. MRI and contrast-enhanced positron-emission tomography/CT are helpful imaging tools in differentiating local recurrence in a previously treated oral cancer versus treatment-induced osteoradionecrosis.,
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