72 results on '"Cherry L. Estilo"'
Search Results
2. Multiple myeloma masquerading as mandibular medication‐related osteonecrosis of the jaw: a case report
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Amanda Rota, Dalal Alhajji, Cherry L. Estilo, Joseph M. Huryn, Annu Singh, and Yoonah Danskin
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medicine.medical_specialty ,Panoramic radiograph ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Mandible ,Plasma cell neoplasm ,Bisphosphonate ,medicine.disease ,Lesion ,stomatognathic diseases ,Biopsy ,medicine ,Radiology ,medicine.symptom ,Osteonecrosis of the jaw ,business ,General Dentistry ,Multiple myeloma - Abstract
This is a unique case report of a 67-year-old female diagnosed with multiple myeloma and extensive use of intravenous bisphosphonate, whose clinical and radiographic presentation of an oral lesion made it challenging to confirm its definitive diagnosis. This patient was referred to the dental service for a suspected medication-related osteonecrosis of the jaw (MRONJ). Clinically, the lesion was located underneath a fixed partial denture in the left posterior mandible. There was a purulent swelling on the lingual side of the fixed partial denture, and a hyperplastic exophytic lesion on the buccal side of the bridge. Panoramic radiograph showed a well circumscribed radiolucent lesion in the left mandible. A biopsy of the gingival lesion on the buccal aspect was inconclusive. As the positron emission tomography scan showed lytic lesions, oral manifestation of multiple myeloma could not be ruled out. A computed tomography-guided biopsy of the left mandible showed plasma cell neoplasm in the histological analysis. Upon confirmed diagnosis, the patient was treated with 20Gy to the left mandible and subsequent debridement of the loose necrotic bone. Following treatment, this gingival lesion resolved completely, and the tumour has remained stable till date.
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- 2021
3. Osteoradionecrosis of the Jaw Following Proton Radiation Therapy for Patients With Head and Neck Cancer
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Annu Singh, Sarin Kitpanit, Brian Neal, Ellen Yorke, Charlie White, SaeHee K. Yom, Joseph D. Randazzo, Richard J. Wong, Joseph M. Huryn, Chiaojung Jillian Tsai, Kaveh Zakeri, Nancy Y. Lee, and Cherry L. Estilo
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Otorhinolaryngology ,Surgery - Abstract
ImportanceProton radiation therapy (PRT) has reduced radiation-induced toxic effects, such as mucositis and xerostomia, over conventional photon radiation therapy, leading to significantly improved quality of life in patients with head and neck cancers. However, the prevalence of osteoradionecrosis (ORN) of the jaw following PRT in these patients is less clear.ObjectiveTo report the prevalence and clinical characteristics of ORN in patients with oral and oropharyngeal cancer (OOPC) treated with PRT.Design, Setting, and ParticipantsThis case series reports a single-institution experience (Memorial Sloan Kettering Cancer Center, New York, New York) between November 2013 and September 2019 and included 122 radiation therapy–naive patients with OOPC treated with PRT. Data were analyzed from 2013 to 2019.Main Outcomes and MeasuresClinical parameters, including sex, age, comorbidities, tumor histology, concurrent chemotherapy, smoking, comorbidities, and preradiation dental evaluation, were obtained from the medical record. Patients with clinical or radiographic signs of ORN were identified and graded using the adopted modified Glanzmann and Grätz grading system. Characteristics of ORN, such as location, clinical presentation, initial stage at diagnosis, etiology, time to diagnosis, management, and clinical outcome at the last follow-up, were also collected.ResultsOf the 122 patients (mean [SD] age, 63 [13] years; 45 [36.9%] women and 77 [63.1%] men) included in this study, 13 (10.6%) developed ORN following PRT during a median (range) follow-up time of 40.6 (Conclusions and RelevanceIn this case series, the prevalence of ORN following PRT was found to be 10.6%, indicating that ORN remains a clinical challenge even in the era of highly conformal PRT. Clinicians treating patients with OOPC with PRT should be mindful of this complication.
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- 2022
4. Intraoral radiation stents—Primer for clinical use in head and neck cancer therapy
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Cherry L. Estilo, Joseph Randazzo, Daphna Y. Gelblum, Joseph M. Huryn, Annu Singh, and Evan B. Rosen
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Mouth ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Head and neck cancer ,medicine.disease ,Oral cavity ,Prosthesis ,Article ,Radiation therapy ,Patient need ,Otorhinolaryngology ,Head and Neck Neoplasms ,Humans ,Medicine ,Stents ,In patient ,Radiology ,Head and neck ,business ,Radiation oncologist - Abstract
Intraoral radiation stents (IRS) are prosthetic devices that assist in the effective delivery of radiation to tumor tissues and aim to avoid unnecessary radiation to adjacent healthy tissues, thus limiting postradiotherapy toxicities. They are used to protect or displace vital structures, assist in positioning of the treatment beam for effective administration of radiotherapy, carry a radioactive material, shield healthy tissues of the oral cavity, and/or maintain the desired mouth opening during radiotherapy. With close collaboration between radiation oncologist and oral health care provider, several IRS can be fabricated by the latter for appropriate targeting and delivery of planned radiation dose and optimized treatment results. Modification of these IRS based on individual patient need is recommended to maximize prosthesis utility. The purpose of this review is to discuss the various types of IRS and highlight their clinical utility and benefits in patients receiving radiation therapy in the head and neck cancers.
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- 2021
5. Osteoradionecrosis of the jaw: A mini review
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Annu Singh, Joseph M. Huryn, Kenneth L. Kronstadt, SaeHee K. Yom, Joseph R. Randazzo, and Cherry L. Estilo
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Osteoradionecrosis (ORN) of the jaw is one of the most dreaded complications of head and neck radiation therapy. Despite the evolution of radiation treatment modalities, ORN continues to remain a therapeutic challenge and its etiopathogenesis still remains unclear. It is clinically characterized by exposed necrotic bone within the head and neck radiation field. Over the past years, several studies have reported on the definition, staging, incidence, etiology, and management of this oral complication. In this review, we summarize the literature on ORN and discuss our institutional experience and management strategies that aim to predict and mitigate risk for ORN.
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- 2022
6. Geographic tongue associated with palbociclib therapy
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Isabel Pennings, Annu Singh, Joseph M. Huryn, and Cherry L. Estilo
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Cancer Research ,Oncology ,Pyridines ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Breast Neoplasms ,Female ,Oral Surgery ,Protein Kinase Inhibitors ,Glossitis, Benign Migratory ,Piperazines - Published
- 2022
7. Relationship Between Clinician-Measured Health Outcomes And Patient-Reported Outcomes Following Head Neck Radiation Therapy
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ANNU SINGH, SALLIE M. LONG, AMY L. TIN, ANDREW J. VICKERS, JENNIFER R. CRACCHIOLO, NANCY Y. LEE, SAEHEE K. YOM, JOSEPH R. RANDAZZO, JOSEPH M. HURYN, and CHERRY L. ESTILO
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Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Pathology and Forensic Medicine - Published
- 2023
8. Osteonecrosis of the jaw risk factors in bisphosphonate‐treated patients with metastatic cancer
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Catherine Van Poznak, Christina L. Gersch, James M. Rae, Jacklyn N. Thibert, Cherry L. Estilo, Daniel F. Hayes, Mimi Hu, Dafydd G. Thomas, Daniel L. Hertz, Bryan P. Schneider, Mousumi Banerjee, and Evan L. Reynolds
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Oncology ,medicine.medical_specialty ,Bevacizumab ,medicine.medical_treatment ,Zoledronic Acid ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Internal medicine ,medicine ,Humans ,General Dentistry ,Bone Density Conservation Agents ,Diphosphonates ,business.industry ,Incidence ,Osteonecrosis ,Cancer ,030206 dentistry ,Odds ratio ,Bisphosphonate ,medicine.disease ,Zoledronic acid ,Otorhinolaryngology ,Case-Control Studies ,030220 oncology & carcinogenesis ,Population study ,Multiple Myeloma ,business ,Osteonecrosis of the jaw ,Pharmacogenetics ,medicine.drug - Abstract
Background A case-control study was performed to define clinical and genetic risk factors associated with osteonecrosis of the jaw in patients with metastatic cancer treated with bisphosphonates. Methods Clinical data and tissues were collected from patients treated with bisphosphonates for metastatic bone disease who were diagnosed with osteonecrosis of the jaw (cases) and matched controls. Clinical data included patient, behavioral, disease, and treatment information. Genetic polymorphisms in CYP2C8 (rs1934951) and other candidate genes were genotyped. Odds ratios from conditional logistic regression models were examined to identify clinical and genetic characteristics associated with case or control status. Results The study population consisted of 76 cases and 126 controls. In the final multivariable clinical model, patients with osteonecrosis of the jaw were less likely to have received pamidronate than zoledronic acid (odds ratio = 0.18, 95% Confidence interval: 0.03-0.97, p = .047) and more likely to have been exposed to bevacizumab (OR = 5.15, 95% CI: 1.67-15.95, p = .005). The exploratory genetic analyses suggested a protective effect for VEGFC rs2333496 and risk effects for VEGFC rs7664413 and PPARG rs1152003. Conclusions We observed patients with ONJ were more likely to have been exposed to bevacizumab and zoledronic and identified potential genetic predictors that require validation prior to clinical translation.
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- 2020
9. Dental status and risk of odontogenic complication in patients undergoing hematopoietic stem cell transplant
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Cherry L. Estilo, SaeHee K. Yom, Heidi J. Hansen, Joseph Randazzo, Armand Karl Solano, Joseph M. Huryn, and Adepitan A. Owosho
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Adult ,Male ,medicine.medical_specialty ,Transplantation Conditioning ,Adolescent ,medicine.medical_treatment ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Child ,Multiple myeloma ,Aged ,Odontogenic infection ,Tooth Abnormalities ,business.industry ,Medical record ,Hematopoietic Stem Cell Transplantation ,Hematopoietic stem cell ,Cancer ,Immunosuppression ,Middle Aged ,medicine.disease ,Lymphoma ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Female ,business ,Complication - Abstract
PURPOSE: Dental evaluation and management prior to hematopoietic stem cell transplant (HSCT) plays a vital role in identifying and treating infections that may be life-threatening. The purpose of this study is to describe the dental management of patients undergoing pre-HSCT examination with the Dental Service at Memorial Sloan-Kettering Cancer Center (MSKCC) and to report on odontogenic complications. METHODS: Patients referred for evaluation as part of the standard preparation for HSCT were included. Following clinical and radiological examination, patients were assigned to one of three groups based on risk of odontogenic infection and treatment was provided as indicated. Patients were followed, and their medical records were reviewed for odontogenic complications during the transplant admission. RESULTS: Of the 375 patients evaluated, 350 patients underwent HSCT: Allogeneic 143 (40.9%), Autologous 207 (59.1%). The distribution of primary cancer diagnosis was as follows: multiple myeloma 104 (29.7%), leukemias 95 (27.1%), Hodgkin’s lymphoma 28 (8.0%), Non-Hodgkin’s Lymphoma 99 (28.3%), and other conditions 24 (6.9%). The median time from dental evaluation to transplant was 29 days. The median Decayed, Missing, Filled Teeth Index was 17. The median Community Periodontal Index was 1. Based on dental status, 145 patients (41.4%) were classified as low-risk, 133 (38%) as moderate-risk and 72 (20.6%) as high-risk of odontogenic infection. 114 patients (32.6%) required dental treatment prior to HSCT and 100 of these (28.6%) completed treatment. 2 (0.57%) patients had odontogenic complications. CONCLUSIONS: With conservative pre-HSCT dental treatment based on an infection risk classification system, a low odontogenic complication rate was observed.
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- 2020
10. Predicting radiation dosimetric distribution in different regions of the jaw in patients receiving radiotherapy for squamous cell carcinoma of the tonsil
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Adepitan A. Owosho, Patrick Hilden, Nipun Verma, Jonathan E. Leeman, Cherry L. Estilo, Joseph M. Huryn, Nancy Y. Lee, SaeHee K. Yom, and Chiaojung Jillian Tsai
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Male ,Molar ,Databases, Factual ,medicine.medical_treatment ,Mean squared prediction error ,Tonsillar Neoplasms ,Radiation ,Risk Assessment ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Predictive Value of Tests ,medicine ,Humans ,Basal cell ,In patient ,Radiation Injuries ,Radiometry ,Aged ,Retrospective Studies ,business.industry ,Head and neck cancer ,Reproducibility of Results ,Dose-Response Relationship, Radiation ,Radiotherapy Dosage ,Middle Aged ,medicine.disease ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,Jaw ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Tonsil ,Carcinoma, Squamous Cell ,Female ,Radiotherapy, Conformal ,business ,Nuclear medicine - Abstract
Background Radiotherapy (RT), the main treatment for patients with head and neck cancer, can lead to dental complications. Methods We identified 244 patients with squamous cell carcinoma of the tonsil treated with RT from 2004 to 2013. For each patient, we contoured the 10 tooth-bearing regions and calculated the radiation dose (gray, Gy) to each region. From this data set, we built two predictive models to determine the expected maximum radiation dose, one for the non-molar regions and another for the molar regions. Results For the non-molars, the final model included location, T-classification, and overall stage, with a median absolute prediction error of 7.0 Gy. For the molars, the final model included location, T-classification, overall stage, and treatment year, with a median absolute error of 6.0 Gy. Conclusions Our current model offers a good estimation of the maximum radiation dose delivered to different regions of the jaw; future work will independently validate these models.
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- 2019
11. Mandibular metastases in neuroblastoma: Outcomes and dental sequelae
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Joseph M. Huryn, Annu Singh, Cherry L. Estilo, Shakeel Modak, Brian H. Kushner, Armand Karl Solano, and Suzanne L. Wolden
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Mandible ,Trismus ,Article ,Metastasis ,Neuroblastoma ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Dentition ,Humans ,Child ,Anodontia ,Retrospective Studies ,business.industry ,Medical record ,Infant ,Retrospective cohort study ,Hematology ,medicine.disease ,Surgery ,Radiation therapy ,Mandibular Neoplasms ,Hypodontia ,Oncology ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,business ,Progressive disease ,030215 immunology - Abstract
Background Although metastatic involvement of bony sites including cranial bones is common in neuroblastoma (NB), mandibular metastases (MM) are uncommon, and specific outcomes have not been reported upon in the modern therapeutic era. Methods In this retrospective study, medical records on patients with MM from NB were reviewed. Statistical analysis was performed using the Kaplan-Meier method. Results Of 29 patients, nine (31%) had MM at diagnosis, whereas in 20 (69%) MM were first detected at NB relapse at a median time of 26 (6-89) months from diagnosis. Median maximal diameter of lesions was 3 (range 0.8-4.9) cm. MM were unilateral in 83% of patients, with ascending ramus (55%) and mandibular body (38%) being the two most common sites. All patients received systemic chemotherapy, and 26 (93%) patients received radiotherapy to MM. At a median follow-up of 37.3 (24.2-219.5) months, eight of nine patients with MM at diagnosis did not experience mandibular progressive disease. Eighteen of 20 patients with MM at relapse received therapeutic radiotherapy; objective responses were noted in 78%. Seventy-two percent (5/18) had not experienced relapse within the radiation field at a median of 12 (2-276) months postradiotherapy. Dental findings at follow-up after completion of NB therapy included hypodontia, hypocalcification of enamel, and trismus. Median 3-year overall survival in patients with relapsed MM was 51 ± 12% months from relapse. Conclusion MM when detected at diagnosis is associated with a prognosis similar to that for other skeletal metastases of NB. Radiotherapy is effective for control of MM detected both at diagnosis and relapse. Significant dental abnormalities posttherapy warrant regular dental evaluations and appropriate intervention.
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- 2021
12. Ramucirumab-related osteonecrosis of the jaw
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Annu Singh, Andrew Pischek, Joseph R. Randazzo, Joseph M. Huryn, Cherry L. Estilo, Isabel Preeshagul, and SaeHee K. Yom
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Cancer Research ,Oncology ,Osteonecrosis ,Humans ,Oral Surgery ,Antibodies, Monoclonal, Humanized ,Article - Published
- 2022
13. Author response for 'Osteonecrosis of the Jaw Risk Factors in Bisphosphonate Treated Patients with Metastatic Cancer'
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Jacklyn N. Thibert, Dafydd G. Thomas, Evan L. Reynolds, Mousumi Banerjee, Christina L. Gersch, Catherine Van Poznak, Daniel L. Hertz, Daniel F. Hayes, Mimi Hu, Bryan P. Schneider, Cherry L. Estilo, and James M. Rae
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Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Cancer ,Bisphosphonate ,business ,medicine.disease ,Osteonecrosis of the jaw - Published
- 2020
14. Parotid gland fat related Magnetic Resonance image biomarkers improve prediction of late radiation-induced xerostomia
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Nanna M. Sijtsema, Cherry L. Estilo, Nancy Y. Lee, Joseph O. Deasy, Tian-Tian Zhai, Johannes A. Langendijk, Maria Thor, Ronald Borra, Walter Noordzij, Aditya Apte, Roel J H M Steenbakkers, Lisanne V. van Dijk, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE)
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Male ,Percentile ,medicine.medical_treatment ,NTCP ,Logistic regression ,STICKY SALIVA ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Parotid Gland ,Head and neck cancer ,Image biomarkers ,SJOGRENS-SYNDROME ,medicine.diagnostic_test ,Radiotherapy Dosage ,Hematology ,Middle Aged ,Prognosis ,Magnetic Resonance Imaging ,F-18-FDG PET/CT ,Parotid gland ,PROGNOSTIC VALUE ,medicine.anatomical_structure ,Adipose Tissue ,Oncology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Predictive value of tests ,Female ,SQUAMOUS-CELL CARCINOMA ,Adult ,NECK-CANCER-PATIENTS ,Adolescent ,SALIVARY-GLANDS ,Radiation Dosage ,Xerostomia ,Article ,Young Adult ,03 medical and health sciences ,stomatognathic system ,Predictive Value of Tests ,TEXTURE ANALYSIS ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,HEAD ,Radiation Injuries ,Radiometry ,Aged ,Radiomics ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Intensity (physics) ,INTENSITY-MODULATED RADIOTHERAPY ,Radiation therapy ,Logistic Models ,Radiotherapy, Intensity-Modulated ,Radiotherapy, Conformal ,business ,Nuclear medicine ,Biomarkers - Abstract
Purpose: This study investigated whether Magnetic Resonance image biomarkers (MR-IBMs) were associated with xerostomia 12 months after radiotherapy (Xer(12m)) and to test the hypothesis that the ratio of fat-to-functional parotid tissue is related to Xer(12m). Additionally, improvement of the reference Xer(12m) model based on parotid gland dose and baseline xerostomia, with MR-IBMs was explored.Methods: Parotid gland MR-IBMs of 68 head and neck cancer patients were extracted from pre-treatment T1-weighted MR images, which were normalized to fat tissue, quantifying 21 intensity and 43 texture image characteristics. The performance of the resulting multivariable logistic regression models after bootstrapped forward selection was compared with that of the logistic regression reference model. Validity was tested in a small external cohort of 25 head and neck cancer patients.Results: High intensity MR-IBM P90 (the 90th intensity percentile) values were significantly associated with a higher risk of Xer(12m). High P90 values were related to high fat concentration in the parotid glands. The MR-IBM P90 significantly improved model performance in predicting Xer(12m) (likelihood-ratio-test; p = 0.002), with an increase in internally validated AUC from 0.78 (reference model) to 0.83 (P90). The MR-IBM P90 model also outperformed the reference model (AUC = 0.65) on the external validation cohort (AUC = 0.83).Conclusion: Pre-treatment MR-IBMs were associated to radiation-induced xerostomia, which supported the hypothesis that the amount of predisposed fat within the parotid glands is associated with Xer(12m). In addition, xerostomia prediction was improved with MR-IBMs compared to the reference model. (C) 2018 The Authors. Published by Elsevier B.V.
- Published
- 2018
15. Dental intervention for the irradiated patient: time to re-evaluate dental treatment algorithms?
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Cherry L. Estilo, E.B. Rosen, Joseph M. Huryn, Zain Uddin Ahmed, Joseph Randazzo, and Sue S. Yom
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0301 basic medicine ,Osteoradionecrosis ,medicine.medical_treatment ,Dentoalveolar surgery ,Oral Surgical Procedures ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,Medicine ,Humans ,Head and neck ,business.industry ,Limiting ,medicine.disease ,Radiation therapy ,030104 developmental biology ,Otorhinolaryngology ,Jaw ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Relative risk ,Surgery ,Oral Surgery ,business ,Algorithm ,Algorithms ,Jaw Diseases - Abstract
Modern radiotherapy delivery systems and treatment strategies are aimed at limiting the irradiation of healthy structures in the head and neck. This seeks to mitigate post-treatment toxicities and complications such as osteoradionecrosis of the jaw. Given the changes to radiotherapy, conventional workflows for the management of patients requiring dentoalveolar surgery may no longer be suitable. It may therefore be appropriate to revisit current treatment algorithms for the management of patients with radiotherapy to the jaws who require dentoalveolar surgery. At present, there are poor data on this. Development of a randomised trial may be warranted to establish the true relative risk for extraction of teeth in the setting of modern radiation therapy delivery systems.
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- 2019
16. Multiple myeloma masquerading as medication-related osteonecrosis of the jaw: a case study
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SaeHee K. Yom, Dalal Alhajji, Cherry L. Estilo, and Yoon Ah Danskin
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medicine.medical_specialty ,business.industry ,Bone metastasis ,Plasma cell neoplasm ,medicine.disease ,Sequestrum ,Pathology and Forensic Medicine ,Prostate cancer ,Zoledronic acid ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Radiology ,Oral Surgery ,Differential diagnosis ,business ,Osteonecrosis of the jaw ,Multiple myeloma ,medicine.drug - Abstract
Background Bisphosphonates, such as zoledronic acid, are commonly used to treat bone metastasis from malignant conditions, such as multiple myeloma, or from solid tumors, such as breast or prostate cancer. Medication-related osteonecrosis of the jaw (MRONJ) is one of the complications of bisphosphonate treatment. The reported incidence of MRONJ among patients with cancers and bone metastases treated with zoledronic acid is 1.3%. MRONJ has been reported to have an incidence rate of up to 18.5%. The clinical and radiographic presentations of MRONJ are very similar to those of bone metastases, making early diagnosis and timely treatment challenging. This is a case report of a patient with multiple myeloma with a history of treatment with zoledronic acid and whose initial presentation of an intraoral lesion made it challenging to distinguish between bone metastasis and MRONJ. Case Summary This is a case report of a 67-year-old female with multiple myeloma, with a history of zoledronic acid, 28 doses taken from 2013 to 2016 and the disease in remission. The patient initially presented with a 1-week history of firm gingival swelling buccal and lingual to a fixed partial denture (FPD) in the left mandible. Panoramic radiography showed a well-defined radiolucent lesion. Considering her history of antiresorptive treatment, MRONJ was considered as one of the diagnoses. However, because of the unusual hyperkeratotic nature of the buccal gingiva, relapsed disease was included in the differential diagnosis. Because of the unconventional clinical manifestation and concerns about relapsed disease, computed tomography guided bone biopsy was performed, and it revealed plasma cell neoplasm and necrotic bone. The patient was treated with palliative radiation therapy and antibiotics, which resulted in a significant decrease in her symptoms. Eventually, a portion of the FPD was removed, and an exposed bony site with a mobile bony sequestrum was revealed. Removal of the sequestrum led to complete gingival healing of the exposed site. Conclusions Maxillofacial manifestation of bone metastasis is common but is often overlooked. Therefore, it should be considered in the differential diagnosis when a patient with a history of antiresorptive medications presents with a gingival mass and/or exophytic bone. Good clinical judgment and well-timed bone biopsy and diagnostic imaging can lead to the correct diagnosis and optimal treatment.
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- 2020
17. Comparison of mean radiation dose and dosimetric distribution to tooth-bearing regions of the mandible associated with proton beam radiation therapy and intensity-modulated radiation therapy for ipsilateral head and neck tumor
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Zhiqiang Han, Kevin Sine, Cherry L. Estilo, SaeHee K. Yom, Nancy Y. Lee, Joseph M. Huryn, and Adepitan A. Owosho
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Diagnostic Imaging ,Male ,Molar ,medicine.medical_treatment ,Proton Beam Radiation Therapy ,Mandible ,Article ,030218 nuclear medicine & medical imaging ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,otorhinolaryngologic diseases ,medicine ,Premolar ,Humans ,Distribution (pharmacology) ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Radiation Injuries ,Radiometry ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Head and neck cancer ,Radiation dose ,Radiotherapy Dosage ,medicine.disease ,Tumor Burden ,Radiation therapy ,stomatognathic diseases ,medicine.anatomical_structure ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Female ,Surgery ,Radiotherapy, Intensity-Modulated ,Oral Surgery ,Nuclear medicine ,business - Abstract
Objective The purpose of this study was to compare the dosimetric distribution of ipsilateral proton beam radiation therapy (PBRT) with intensity-modulated radiation therapy (IMRT) in the tooth-bearing region of the mandible in patients with head and neck cancer (HNC). Study Design The mandibular dosimetric distribution in patients with head and neck cancer treated with ≥60 Gy relative biologic equivalent PBRT was evaluated. The mean radiation doses were calculated in 5 regions: ipsilateral molar, ipsilateral premolar, anterior, contralateral premolar, and contralateral molar (CM) regions. CM was used as the reference region for comparative analysis. The mandibular dosimetric distribution in patients treated with PBRT was compared with that in IMRT patients with similar tumor sites and planning target volumes. Results The mean radiation dose to the contralateral regions was lower in patients treated with PBRT compared with those treated with IMRT. The average mean radiation doses to the reference region (CM) in patients treated with PBRT (relative biologic equivalent) versus IMRT were oropharynx (2.2 Gy vs 23.2 Gy; P P = .01), and oral cavity (0.4 Gy vs 15.6 Gy; P = .006). Conclusions This study revealed the effective tissue-sparing capability of PBRT compared with IMRT. Utilization of PBRT could translate to less radiation-related toxicity.
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- 2016
18. A clinicopathologic study of head and neck rhabdomyosarcomas showing FOXO1 fusion-positive alveolar and MYOD1 -mutant sclerosing are associated with unfavorable outcome
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Shruti Kashikar, Cherry L. Estilo, Cristina R. Antonescu, Sonja Chen, Joseph M. Huryn, Suzanne L. Wolden, Leonard H. Wexler, Shih-Chiang Huang, and Adepitan A. Owosho
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Adult ,Male ,musculoskeletal diseases ,0301 basic medicine ,Cancer Research ,Pathology ,medicine.medical_specialty ,genetic structures ,FOXO1 ,Sclerosing rhabdomyosarcoma ,Article ,03 medical and health sciences ,0302 clinical medicine ,Rhabdomyosarcoma ,medicine ,Humans ,Child ,Spindle cell rhabdomyosarcoma ,Survival analysis ,Aged ,Forkhead Box Protein O1 ,business.industry ,Soft tissue ,Middle Aged ,medicine.disease ,030104 developmental biology ,Oncology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Alveolar rhabdomyosarcoma ,Female ,Embryonal rhabdomyosarcoma ,Oral Surgery ,business - Abstract
Based on their distinctive histologic and genetic features, the latest WHO classification of soft tissue tumors includes four pathologic variants of rhabdomyosarcoma (RMS): embryonal (ERMS), alveolar (ARMS), spindle cell-sclerosing (SRMS-ScRMS) and pleomorphic RMS. The aim of this study focused on a detailed clinicopathologic and survival analysis of head and neck RMS (HNRMS) using the latest pathologic and molecular criteria reflecting this new subclassification in a large cohort.Patients managed for HNRMS in our institution (1996-2015) were analyzed. The presence of a FOXO1 fusion was required for the classification of ARMS. MYOD1 mutations in SRMS-ScRMS were tested when material available. Univariate and multivariate analyses were performed to evaluate variables related to overall survival (OS).Ninety-nine HNRMS patients (52 males and 47 females, mean of 16years) were included in the study after pathologic re-review. The most common location was parameningeal (PM) (n=64), followed by non-orbital/non-PM (n=25) and orbital (n=10). There were 53 ERMS, 33 fusion-positive ARMS and 13 SRMS-ScRMS [SRMS (8); ScRMS (5)]. The 5-year OS rate for ERMS patients was significantly higher (82%) compared to ARMS (53%) and SRMS-ScRMS (50%) [SRMS (75%); ScRMS (30%)]. Univariate analysis showed that survival was dependent on histology (P=0.012), tumor size5cm (P0.001), regional lymph node involvement (P=0.002), metastasis at initial presentation (P0.001), stage (P0.001), and recurrence (P=0.002). Multivariate analysis confirmed histologic subtype to be significant (P=0.043).Our findings reinforce that HNRMS is a heterogenous disease with ARMS and SRMS-ScRMS having an equally unfavorable outcome.
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- 2016
19. Metastatic solid tumors to the jaw and oral soft tissue: A retrospective clinical analysis of 44 patients from a single institution
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Adepitan A. Owosho, Cherry L. Estilo, Bin Xu, SaeHee K. Yom, Joseph Randazzo, Ronald Ghossein, Joseph M. Huryn, and Arvin Kadempour
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Male ,Gingiva ,Mandible ,Metastases ,Jaw neoplasm ,Metastasis ,0302 clinical medicine ,80 and over ,Medicine ,Child ,Cancer ,Aged, 80 and over ,Pediatric ,Mouth neoplasm ,Clinical pathology ,Age Factors ,Soft tissue ,Middle Aged ,Prognosis ,Jaw Neoplasms ,Child, Preschool ,030220 oncology & carcinogenesis ,Mouth Neoplasms ,Female ,Oral Surgery ,Adult ,Pediatric Research Initiative ,medicine.medical_specialty ,Clinical Sciences ,Malignancy ,Article ,03 medical and health sciences ,Clinical Research ,Humans ,Oral soft tissue ,Dental/Oral and Craniofacial Disease ,Preschool ,Survival analysis ,Retrospective Studies ,Aged ,Metastatic tumor ,business.industry ,Infant ,Retrospective cohort study ,030206 dentistry ,medicine.disease ,Survival Analysis ,Surgery ,Jaw ,Otorhinolaryngology ,Dentistry ,business - Abstract
PurposeMetastatic solid tumors to the oral cavity are rare, frequently indicative of an end-stage disease process, and associated with poor survival rates. We performed a 20-year retrospective clinical analysis of our institution's cases of solid metastases to the oral cavity, and investigated these patients' clinical outcomes.Material and methodsA retrospective study of patients with metastatic solid tumors to the oral cavity over a 20-year period (October 1996 to September 2015) was conducted at Memorial Sloan Kettering Cancer Center. Patients were selected if they had a histopathologically confirmed diagnosis. Demographic, pathologic, and clinical information were reviewed to identify patient outcomes.ResultsA total of 44 patients with metastatic non-melanocytic non-hematopoietic tumor to the oral cavity were identified: 24 males and 20 females (39 adults and 5 children) with a mean age of 54.3 years. In all, 24 cases involved the jaw and 20 cases involved the oral soft tissue. Eight patients (18.2%) had oral cavity metastases as the first indication of an occult malignancy. In adult patients, the common primary sites were the lungs (n=9, 20%), kidney (n=7, 16%), breast (n=5, 11%), and colon (n=4, 9%); and in pediatric patients the adrenal gland (3/5) was the most common site. Of the adult patients, 33 (84.6%) died of disease. From the time of metastasis diagnosis, patients with jaw metastases had a median and mean survival of 12 months and 27.7 months, respectively. In comparison, patients with oral soft tissue metastases had a median survival time of 5 months, and mean of 8 months. One pediatric patient (20%) died of disease 8 months after metastasis diagnosis.ConclusionMetastatic solid tumors to the oral cavity can be the first sign of a malignancy. Pediatric patients with oral cavity metastases have a better prognosis compared to adult patients. In this series, adults with oral soft tissue involvement had shorter survival times compared to patients with jaw involvement.
- Published
- 2016
20. Radiographic osteoradionecrosis of the jaw with intact mucosa: Proposal of clinical guidelines for early identification of this condition
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Cherry L. Estilo, Ashok R. Shaha, SaeHee K. Yom, Nancy Y. Lee, Arvin Kadempour, Joseph Randazzo, C. Jillian Tsai, Adepitan A. Owosho, and Joseph M. Huryn
- Subjects
Adult ,Male ,Cancer Research ,Pathology ,medicine.medical_specialty ,Osteoradionecrosis ,medicine.medical_treatment ,Radiography ,Article ,Fibrosis ,medicine ,Carcinoma ,Humans ,Mandibular Diseases ,Aged ,business.industry ,Mouth Mucosa ,Middle Aged ,respiratory system ,medicine.disease ,Pathophysiology ,Radiation therapy ,Oropharyngeal Neoplasms ,Hypocellularity ,Oncology ,Carcinoma, Squamous Cell ,Female ,Mouth Neoplasms ,Oral Surgery ,business ,Complication - Abstract
Osteoradionecrosis (ORN) remains an unintended debilitating complication of radiation therapy despite the advent of intensity-modulated radiation therapy (IMRT) which aims to deliver doses of radiation to the tumor site while minimizing doses to healthy tissues [[1], [2], [3], [4]. The etiopathogenesis of ORN has been attributed to the avascular effect of radiation to the bone resulting in hypoxia, hypovascularity, and hypocellularity [5], [6]. Radiation-induced fibrosis has also been implicated in the pathophysiology of ORN [7. Recent studies have placed reported incidences of ORN at 1–30% [2], [8], [9], [10], [11]. ORN of the jaw was defined as an area of exposed necrotic bone greater than 1 cm in an area of previous irradiation that failed to heal after 6 months [5]. This definition of ORN has been used for years and still remains the most widely used clinical criterion for the diagnosis of ORN though it fails to incorporate cases with radiologic evidence of necrosis with intact mucosa [5], [12], [13], [14], [15]. Although a report by Van Merkesteyn et al. described a case of ORN of the jaw with intact mucosa [16], subsequently only two series have likewise reported this condition. In 2000, Store and Boysen reported 17 patients with radiographic osteoradionecrosis of the jaw (rORN) with intact mucosa at initial diagnosis as did He et al. in a recent article where they described 16 patients presenting with rORN with intact mucosa [17], [18]Thus, it appears that rORN with intact mucosa is underdiagnosed. The objectives of this article are to: 1. Describe new cases of rORN with intact mucosa. 2. Correlate the dosimetric analyses of the involved area with the radiographic presentation and to determine the best predictor of rORN with intact mucosa. 3. Propose modification of Store and Boysen’s staging system of ORN. 4. Propose clinical guidelines for early identification of rORN with intact mucosa.
- Published
- 2015
21. Spontaneous osteoradionecrosis—features and characteristics: the Memorial Sloan Kettering Cancer Center experience
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Cherry L. Estilo, Karl Armand Solano, Elyn Riedel, Bridget O'hara, Sae Hee K. Yom, Dalal Alhajji, Yoon Ah Danskin, and Jessica Flynn
- Subjects
medicine.medical_specialty ,business.industry ,Osteoradionecrosis ,medicine.medical_treatment ,Head and neck cancer ,Cancer ,respiratory system ,medicine.disease ,Primary tumor ,Pathology and Forensic Medicine ,Radiation therapy ,Exact test ,Cohort ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,sense organs ,Radiology ,Oral Surgery ,business ,Radiation treatment planning - Abstract
Objectives Osteoradionecrosis (ORN) is a complication of head and neck radiation therapy (RT) and is associated with significant morbidity. The incidence of ORN is variable, and it has been speculated to be lower with advanced RT techniques. Risk factors that have been associated with the development of ORN mainly include trauma and a radiation dose to the head and neck region greater than 60 Gy. However, in a study conducted by our group, ORN developed spontaneously (without any known history of trauma or dentoalveolar procedure) in 82% of the ORN cohort following intensity-modulated radiation therapy (IMRT).The purpose of this study was to characterize spontaneous ORN and to compare spontaneous ORN with nonspontaneous ORN (e.g., related to trauma or dentoalveolar procedures). Study Design Following approval by the Institutional Review Board of the Memorial Sloan Kettering Cancer Center (MSKCC), the treatment records of 44 patients with spontaneous ORN (group A) and 24 patients with nonspontaneous ORN (group B) treated with IMRT at the MSKCC for head and neck cancer (HNCa) were identified and retrospectively reviewed. Average prescribed mean and maximum radiation doses for the region of ORN were calculated by using MSKCC's proprietary radiation treatment planning software. Furthermore, Fischer's exact test was used to compare patient characteristics, such as primary site, tumor stage, smoking status, and other comorbidities, between the spontaneous ORN group and the nonspontaneous ORN group. Results According to preliminary data from 12 patients in group A and 6 patients from group B, the patients in group A appeared to have been exposed to higher radiation doses (Dmax; greater than 70 Gy) compared with group B. Furthermore, no statistical significance was noted between the 2 groups with regard to primary tumor, tumor stage, smoking status, and comorbidities, such as cardiovascular disease and hypertension (P > .05). However, statistical significance was evident for diabetes in group B (P Conclusions Collection of data on the expanded cohort of patients from each group, as well as other variables, such as radiation therapy fractionation, is ongoing. Our initial data indicates that increased radiation dose greater than 70 Gy may be associated with the development of spontaneous ORN.
- Published
- 2020
22. Medication-related osteonecrosis of the jaw: An update on the memorial sloan kettering cancer center experience and the role of premedication dental evaluation in prevention
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Adepitan A. Owosho, Cherry L. Estilo, Adi Z. Sax, Joseph M. Huryn, Kant Wu, See Toh Yoong Liang, and SaeHee K. Yom
- Subjects
Male ,Indoles ,Pamidronate ,Angiogenesis Inhibitors ,Zoledronic Acid ,0302 clinical medicine ,Neoplasms ,Sunitinib ,Cancer ,Diphosphonates ,Bone Density Conservation Agents ,Incidence (epidemiology) ,Incidence ,Osteonecrosis ,Imidazoles ,Middle Aged ,Bevacizumab ,Denosumab ,030220 oncology & carcinogenesis ,Premedication ,Female ,Bisphosphonate-Associated Osteonecrosis of the Jaw ,Oral Surgery ,medicine.drug ,Adult ,medicine.medical_specialty ,Ipilimumab ,Article ,Pathology and Forensic Medicine ,03 medical and health sciences ,Clinical Research ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Pyrroles ,Dental/Oral and Craniofacial Disease ,Retrospective Studies ,Aged ,business.industry ,Prevention ,Retrospective cohort study ,030206 dentistry ,medicine.disease ,Zoledronic acid ,Dentistry ,Surgery ,business ,Osteonecrosis of the jaw ,Jaw Diseases - Abstract
ObjectiveThe aim of this study was to investigate the relationship between type of antiresorptive medication and medication-related osteonecrosis of the jaw (MRONJ) onset and the role of premedication dental evaluation (PMDE) in the prevention of MRONJ.Study designOur database of patients with MRONJ was reviewed. The Kruskal-Wallis test was used to analyze the onset dose of the 3 frequent medication types associated with MRONJ. To evaluate the role of PMDE in the prevention of MRONJ, all patients on antiresorptive and/or antiangiogenic medications seen in the Dental Service of Memorial Sloan Kettering Cancer Center during a 10-year period were subclassified into 2 groups. Group I comprised patients seen for PMDE before the commencement of A/A and group II patients seen after prior exposure to antiresorptive and/or antiangiogenic medications. Fischer's exact test was used to compare the incidence of MRONJ in both groups.ResultsPatients on denosumab developed MRONJ earlier compared with zoledronate and pamidronate (P = .003). Group I had a significantly reduced incidence of MRONJ (0.9%) compared with group II (10.5%) (P
- Published
- 2018
23. A Clinicopathologic Study of Head and Neck Malignant Peripheral Nerve Sheath Tumors
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Cristina R. Antonescu, Ping Chi, Cherry L. Estilo, Joseph M. Huryn, and Adepitan A. Owosho
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Pathology ,Adolescent ,Malignant peripheral nerve sheath tumor ,Kaplan-Meier Estimate ,Biology ,Disease-Free Survival ,Pathology and Forensic Medicine ,Histones ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Biomarkers, Tumor ,Humans ,Rhabdomyosarcoma ,Child ,Original Paper ,Melanoma ,Soft tissue ,Middle Aged ,medicine.disease ,Synovial sarcoma ,030104 developmental biology ,Oncology ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Immunohistochemistry ,Female ,Sarcoma ,Neurilemmoma - Abstract
Head and neck high grade malignant peripheral nerve sheath tumors (HN-MPNSTs) are rare highly aggressive soft tissue sarcomas that show overlapping morphologic and immunophenotypic features with melanoma and other high grade sarcomas, resulting in diagnostic challenges, particularly in sporadic settings. Recent discoveries have implicated loss of function mutations in the polycomb repressive complex 2 (PRC2) components, including EED or SUZ12 genes, as one of the leading pathogenetic mechanisms in high grade MPNST. MPNSTs with PRC2 loss are associated with complete loss of trimethylation at lysine 27 of histone H3 (H3K27me3), which emerged as a reliable immunohistochemical marker in the diagnosis of sporadic and radiation induced MPNST. As the diagnosis of MPNST in the HN is particularly challenging to distinguish from melanoma and other sarcoma types, we carried out a clinicopathologic analysis on HN-MPNST patients managed at our institution over a 20-year period (1997-2016), using the latest diagnostic criteria including H3K27me3 staining and other molecular investigations. The overall survival of HN-MPNST was compared with other HN soft tissue sarcomas. The diagnosis of HN-MPNST was confirmed in 13 patients (seven males and six females), with a mean age of 31 years; with 3 (23%) patients being of pediatric age. The most common site was the neck soft tissue (77%). Two-thirds of patients (n = 9) had stigmata of NF1, three had prior radiotherapy and only one developed a de novo MPNST. All except one tumor (86%) tested showed loss of H3K27me3 expression, including all non-NF1 patients. The 2 and 5-year DSS rates were 50 and 30%. The 2-year DFS rate was 21%. Adverse predictors on DSS included adult age (p = 0.011), prior-history of RT (p = 0.003) and recurrence (p = 0.003). Compared to other molecularly confirmed subsets of HN sarcomas (Ewing and Ewing-like sarcoma, rhabdomyosarcoma and synovial sarcoma), HN-MPNST had the worst overall survival (p
- Published
- 2017
24. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience
- Author
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Adi Z. Sax, Joseph Randazzo, Spyridon Varthis, Ryan S. Lee, Joseph M. Huryn, Esther Drill, Haley Freymiller, Snehal G. Patel, SaeHee K. Yom, Evan B. Rosen, Nancy Y. Lee, Elyn Riedel, Adepitan A. Owosho, Arvin Kadempour, Cherry L. Estilo, and C. Jillian Tsai
- Subjects
Male ,Cancer Research ,Multivariate analysis ,0302 clinical medicine ,Risk Factors ,Intensity-Modulated ,Prevalence ,Head and neck cancer ,Fisher's exact test ,Cancer ,Mouth neoplasm ,Univariate analysis ,Oropharyngeal cancer ,Oral cancer ,respiratory system ,Middle Aged ,Oropharyngeal Neoplasms ,Oncology ,030220 oncology & carcinogenesis ,symbols ,Public Health and Health Services ,Mouth Neoplasms ,Female ,Oral Surgery ,Adult ,medicine.medical_specialty ,Intensity-modulated radiation therapy ,Osteoradionecrosis ,Oncology and Carcinogenesis ,Article ,03 medical and health sciences ,symbols.namesake ,Clinical Research ,Internal medicine ,medicine ,Humans ,Oncology & Carcinogenesis ,Dental/Oral and Craniofacial Disease ,Retrospective Studies ,Aged ,Radiotherapy ,business.industry ,Prevention ,fungi ,Retrospective cohort study ,030206 dentistry ,medicine.disease ,Surgery ,Good Health and Well Being ,Dentistry ,Radiotherapy, Intensity-Modulated ,sense organs ,business ,Digestive Diseases ,Jaw Diseases - Abstract
Objective To determine the prevalence and correlation of various risk factors [radiation dose, periodontal status, alcohol and smoking] to the development of osteoradionecrosis (ORN). Patients and methods The records of 1023 patients treated with IMRT for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) between 2004 and 2013 were retrospectively reviewed to identify patients who developed ORN. Fisher exact tests were used to analyze patient characteristics between ORN patients with OCC and OPC. Paired Wilcoxon tests were used to compare the dose volumes to the ORN and contralateral non-ORN sites. To evaluate an association between ORN and risk factors, a case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by gender, tumor site and size. General estimation equations models were used to compare the risk factors in ORN cases and matched controls. Results 44 (4.3%) patients developed ORN during a median follow-up time of 52.5 months. In 82% of patients, ORN occurred spontaneously. Patients with OPC are prone to develop ORN earlier compared to patients with OCC (P = 0.03). OPC patients received a higher Dmax compared to OCC patients (P = 0.01). In the matched case-control analysis the significant risk factors on univariate analysis were poor periodontal status, history of alcohol use and radiation dose (P = 0.03, 0.002 and 0.009, respectively) and on multivariate analysis were alcohol use and radiation dose (P = 0.004 and 0.026, respectively). Conclusion In our study, higher radiation dose, poor periodontal status and alcohol use are significantly related to the risk of developing ORN.
- Published
- 2017
25. Left parotid mass in a 71-year-old woman
- Author
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Cherry L. Estilo, Nora Katabi, Eugene Ko, and Joseph M. Huryn
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Diagnostic Imaging ,medicine.medical_specialty ,Standardized uptake value ,Malignancy ,Pathology and Forensic Medicine ,Acinic cell carcinoma ,Diagnosis, Differential ,Pleomorphic adenoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Family history ,Aged ,business.industry ,medicine.disease ,Combined Modality Therapy ,Parotid Neoplasms ,Adenocarcinoma ,Female ,Surgery ,Salivary gland neoplasm ,Radiology ,Oral Surgery ,Differential diagnosis ,business ,Adenocarcinoma, Clear Cell - Abstract
CASE PRESENTATION In October 2012, a 70-year-old black woman presented to her ophthalmologist, who noted that she had a left parotid mass. She was subsequently referred to a hospital to have the mass evaluated. It was unclear how long the mass was present, but there were no symptoms. The patient reported no family history of malignancy, and her health was significant for type 2 diabetes mellitus, non-insulin-dependent. The patient had smoked 2 packs a day for 22 years, but she stated that she had quit 40 years ago. She stated she drank 1 to 2 alcoholic beverages per month. At an outside hospital, ultrasonography found a heterogeneously hypoechoic mass with irregular margins containing focal necrosis with possible deep extracapsular extension measuring 1.96 2.49 cm. No increased flow signal was seen on Doppler mode. A fine-needle aspiration (FNA) of the parotid mass was suspicious for acinic cell carcinoma. Within the same month, the patient was sent to Memorial Sloan Kettering Cancer Center. A computed tomography (CT) scan of the neck found an ill-defined, enhancing soft tissue mass in the left parotid tail with no deep parotid involvement, measuring 2.3 1.9 2.0 cm (Figure 1). No abnormal lymphadenopathy was noted in the neck. A second FNA taken of the left parotid found a salivary gland neoplasm with a cylindromatous pattern, which favored pleomorphic adenoma (Figure 2). The FNA slides from the previous hospital were also reviewed, and ultimately the diagnoses encompassed a differential diagnosis that included both acinic cell carcinoma and pleomorphic adenoma. A positron emission tomographyecomputed tomography scan found a 1.3 1.5-cm left parotid nodule with a maximum standardized uptake value of 2.7 (Figure 3). No hypermetabolic lymphadenopathy was noted in the neck.
- Published
- 2014
26. A clinicopathologic study on SS18 fusion positive head and neck synovial sarcomas
- Author
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SaeHee K. Yom, Cherry L. Estilo, Evan B. Rosen, Cristina R. Antonescu, Joseph M. Huryn, and Adepitan A. Owosho
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Male ,Cancer Research ,Pathology ,genetic structures ,Oncogene Proteins, Fusion ,0302 clinical medicine ,Recurrence ,030223 otorhinolaryngology ,Head and neck ,t(X ,Cancer ,Oncogene Proteins ,Pediatric ,Sarcoma ,Middle Aged ,Combined Modality Therapy ,Magnetic Resonance Imaging ,Synovial sarcoma ,Oncology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Public Health and Health Services ,Female ,Oral Surgery ,Adult ,medicine.medical_specialty ,Oncology and Carcinogenesis ,Article ,03 medical and health sciences ,Sarcoma, Synovial ,Rare Diseases ,Proto-Oncogene Proteins ,medicine ,Head and neck sarcomas ,Humans ,In patient ,Oncology & Carcinogenesis ,SS18-SSX ,Dental/Oral and Craniofacial Disease ,Fusion ,18) ,Aged ,Retrospective Studies ,Synovial ,business.industry ,medicine.disease ,Survival Analysis ,Repressor Proteins ,Dentistry ,business - Abstract
ObjectiveTo determine clinicopathologic factors on survival in patients with head and neck synovial sarcoma.Patients and methodsWe retrospectively identified patients with molecularly confirmed synovial sarcomas of the head and neck (SS-HN), either by the presence of SS18-SSX fusion transcript by RT-PCR or SS18 gene rearrangement by FISH, who were managed at our institution over a 20-year period (1996-2015). Kaplan-Meier survival analysis and log-rank test were performed to evaluate variables related to disease specific survival (DSS). Fisher exact test was performed to evaluate variables related to local recurrence.ResultsThirty-four patients (20 males and 14 females, mean of 31years) with SS18-SSX fusion-positive SS-HN were identified. The parapharyngeal region of the neck was the most common site. The mean tumor size was 4.8cm (0.8-10cm). Two-thirds (n=23) of cases had a monophasic histology. The 2, 5 and 10-year DSS rates were 97%, 79% and 68%. The 5-year DSS rates for the adult/pediatric cohort were 74%/88%. Recurrence showed significant effect on DSS (p=0.021). There was no significant effect on DSS with age, therapy modality, tumor site, surgical margin, tumor size (⩽5cm vs. >5cm) and histopathologic subtype. Tumor site (i.e. skull base/paranasal sinus region) was associated with local recurrence (p=0.003).ConclusionIn our cohort DSS rate was associated with recurrence. Tumors located in the skull base/paranasal sinus region were associated with a higher rate of local recurrence. Thus appropriate selection of high risk patients who can benefit from multimodality therapies might improve survival.
- Published
- 2016
27. Fanconi Anemia and the Oral Mucosa
- Author
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Jeffrey Eskendri, Bhuvanesh Singh, SaeHee K. Yom, Kant Wu, Cherry L. Estilo, and Jessica Baron
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Gastroenterology ,Pathology and Forensic Medicine ,medicine.anatomical_structure ,Fanconi anemia ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Oral mucosa ,business - Published
- 2018
28. Serum N-Telopeptide and Bone-Specific Alkaline Phosphatase Levels in Patients With Osteonecrosis of the Jaw Receiving Bisphosphonates for Bone Metastases
- Author
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Azeez Farooki, Alison Conlin, Martin Fleisher, Patrick G. Morris, Monica Fornier, Joseph M. Huryn, Serge Cremers, Cherry L. Estilo, Sujata Patil, Maurizio Fazio, Clifford A. Hudis, and Divya Mallam
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Bone Neoplasms ,Breast Neoplasms ,Bone Specific Alkaline Phosphatase ,Gastroenterology ,Bone and Bones ,Collagen Type I ,Bone remodeling ,N-terminal telopeptide ,Internal medicine ,Humans ,Medicine ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,Bone Density Conservation Agents ,Diphosphonates ,business.industry ,Prostatic Neoplasms ,Retrospective cohort study ,Middle Aged ,Alkaline Phosphatase ,Serum samples ,medicine.disease ,Surgery ,Otorhinolaryngology ,Alkaline phosphatase ,Bisphosphonate-Associated Osteonecrosis of the Jaw ,Female ,Oral Surgery ,Peptides ,business ,Osteonecrosis of the jaw ,Biomarkers ,Follow-Up Studies ,Forecasting - Abstract
Purpose Oversuppression of bone turnover can be a critical factor in the pathogenesis of osteonecrosis of the jaw (ONJ). We investigated N-telopeptide of type I collagen (NTX) and bone-specific alkaline phosphatase (BAP) as potential predictors of ONJ onset. Patients and Methods Patients with ONJ and available stored serum were identified retrospectively from the institutional databases. Four approximate points were examined: point of ONJ diagnosis and 12, 6, and 1 month before the diagnosis. NTX and BAP were measured using enzyme-linked immunosorbent assays and examined as possible predictors of ONJ. Results From March 1998 to September 2009, we identified 122 patients with ONJ. Of these, 56 (46%) had one or more serum samples available. Overall, 55 patients (98%) received bisphosphonates. Using the exact dates, no obvious patterns in either NTX or BAP were noted. Similarly, using the ordinal points, no evidence of suppression of NTX or BAP over time was seen. The consecutive median values were as follows: The median NTX values were 8.0 nmol/L (range 3.8 to 32.9) at 12 months before ONJ; 9.5 nmol/L (range 4.7 to 42.7) at 6 months; 9.5 nmol/L (range 4.5 to 24.6) at 1 month, and 10.4 nmol/L (range 4.4 to 32.5) at the ONJ diagnosis. The median BAP values were BAP 18.0 U/L (range 7.0 to 74) at 12 months before ONJ; 18.0 U/L (range 4.0 to 134) at 6 months; 14.0 U/L (range 4.0 to 132) at 1 month, and 18.0 U/L (range 0.7 to 375) at the ONJ diagnosis. Only 2 patients (4%) had NTX and 17 (30%) had BAP below the normal range at the ONJ diagnosis. Conclusions In the present large retrospective study, no trends were seen in the NTX and BAP levels before the ONJ diagnosis.
- Published
- 2012
29. Objective assessment of trismus in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT)
- Author
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SaeHee K. Yom, Joseph M. Huryn, Haley I. Rosenberg, Elyn Riedel, Luciana Maria Pedreira Ramalho, Cherry L. Estilo, Nancy Y. Lee, Esther Drill, Adepitan A. Owosho, and C. Jillian Tsai
- Subjects
Male ,medicine.medical_treatment ,Trismus ,0302 clinical medicine ,Risk Factors ,Intensity-Modulated ,Prevalence ,Medicine ,Stage (cooking) ,Fisher's exact test ,Cancer ,Mouth neoplasm ,Oropharyngeal cancer ,Incidence (epidemiology) ,Oral cancer ,Age Factors ,Middle Aged ,6.5 Radiotherapy and other non-invasive therapies ,Oropharyngeal Neoplasms ,030220 oncology & carcinogenesis ,symbols ,Mouth Neoplasms ,Female ,Oral Surgery ,medicine.symptom ,Adult ,medicine.medical_specialty ,Intensity-modulated radiation therapy ,Clinical Sciences ,Article ,03 medical and health sciences ,symbols.namesake ,Sex Factors ,Clinical Research ,Humans ,Dental/Oral and Craniofacial Disease ,Neoplasm Staging ,Retrospective Studies ,Aged ,Radiotherapy ,business.industry ,Prevention ,Evaluation of treatments and therapeutic interventions ,Retrospective cohort study ,030206 dentistry ,Surgery ,Radiation therapy ,Otorhinolaryngology ,Dentistry ,Radiotherapy, Intensity-Modulated ,business ,Complication - Abstract
PurposeThe aim of this study was to estimate the prevalence of trismus in oral and oropharyngeal cancer patients (OOPC) treated with intensity-modulated radiation therapy (IMRT) and to identify the role of risk factors in patients who developed trismus.Materials and methodsA retrospective cohort study of OOPC treated with IMRT in our institution from 2009 to 2014 was performed. Patients eligible for this study had pre-RT and post-RT maximal inter-incisal opening (MIO) measurements at 6-48 months post-RT, treated with high-dose radiation (≥60Gy) and pre-RT MIO ≥36mm. A descriptive analysis to identify the incidence of trismus, with trismus stated as MIO ≤35mm at or after 6 months post-RT measurement was performed. The role of risk factors such as age, gender, tumor site, tumor size (T), tumor stage, pre-RT MIO measurements and radiation dose to the tumor were assessed using Fisher exact test and the radiation doses to the ipsilateral muscles of mastication in patients who developed trismus were assessed by matching with control (non-trismus) patients using Wilcoxon Signed Rank test.ResultsThe study consisted of 54 patients with a median age of 55 years and 81% were males. The median follow-up time was 10 months. The prevalence of trismus was 14.8%. Patients with pre-RT MIO measurements ≤40mm were at risk of developing trismus (P 
- Published
- 2016
30. The role of parotid gland irradiation in the development of severe hyposalivation (xerostomia) after intensity-modulated radiation therapy for head and neck cancer: Temporal patterns, risk factors, and testing the QUANTEC guidelines
- Author
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Spyridon Varthis, C. Jillian Tsai, Nadeem Riaz, Joseph O. Deasy, Haley I. Rosenberg, Sae Hee K. Yom, Cherry L. Estilo, Adepitan A. Owosho, Jung Hun Oh, Maria Thor, Nancy Y. Lee, and Joseph M. Huryn
- Subjects
Male ,Time Factors ,Severe hyposalivation ,medicine.medical_treatment ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Risk Factors ,Intensity-Modulated ,Parotid Gland ,Head and neck cancer ,Cancer ,Incidence (epidemiology) ,Middle Aged ,6.5 Radiotherapy and other non-invasive therapies ,Parotid gland ,medicine.anatomical_structure ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Carcinoma, Squamous Cell ,Female ,Radiology ,Oral Surgery ,medicine.medical_specialty ,Clinical Sciences ,Xerostomia ,Article ,03 medical and health sciences ,stomatognathic system ,Clinical Research ,medicine ,Humans ,IMRT ,Dental/Oral and Craniofacial Disease ,Retrospective Studies ,Radiotherapy ,business.industry ,Prevention ,Carcinoma ,Evaluation of treatments and therapeutic interventions ,Guideline ,medicine.disease ,Surgery ,Radiation therapy ,stomatognathic diseases ,Squamous Cell ,Otorhinolaryngology ,Dentistry ,Relative risk ,QUANTEC ,Mann–Whitney U test ,Radiotherapy, Intensity-Modulated ,Digestive Diseases ,business - Abstract
BackgroundThe aims of this study were to investigate temporal patterns and potential risk factors for severe hyposalivation (xerostomia) after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and to test the two QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) guidelines.Patients and methodsSixty-three patients treated at the Memorial Sloan Kettering Cancer Center between 2006 and 2015, who had a minimum of three stimulated whole mouth saliva flow measurements (WMSFM) at a median follow-up time of 11 (range: 3-24) months were included. Xerostomia was defined as WMSFM ≤25% compared to relative pre-radiotherapy. Patients were stratified into three follow-up groups: 1
- Published
- 2016
31. Pentoxifylline and tocopherol in the management of cancer patients with medication-related osteonecrosis of the jaw: an observational retrospective study of initial case series
- Author
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Joseph M. Huryn, Cherry L. Estilo, Adepitan A. Owosho, and SaeHee K. Yom
- Subjects
Male ,medicine.medical_specialty ,Bone disease ,Osteoradionecrosis ,Tocopherols ,Bone Neoplasms ,Antioxidants ,Article ,Pathology and Forensic Medicine ,Pentoxifylline ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Multiple myeloma ,Aged ,Retrospective Studies ,Bisphosphonate-associated osteonecrosis of the jaw ,Bone Density Conservation Agents ,business.industry ,Retrospective cohort study ,030206 dentistry ,Free Radical Scavengers ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Bisphosphonate-Associated Osteonecrosis of the Jaw ,Female ,Oral Surgery ,Osteonecrosis of the jaw ,business ,Multiple Myeloma ,medicine.drug - Abstract
Objective Very few studies have evaluated the efficacy of pentoxifylline and tocopherol (PENT-E) in the management of medication-related osteonecrosis of the jaw (MRONJ), although some studies have shown the therapeutic and prophylactic benefit of PENT-E in the management of osteoradionecrosis. We report the outcomes of MRONJ managed with PENT-E in patients with metastatic bone disease or multiple myeloma. Study Design Seven patients diagnosed with established cases of refractory MRONJ caused by antiresorptive medications for the management of metastatic bone tumors or multiple myeloma were administered PENT-E for a mean period of 16.8 months (range 3-48 months). Results At the latest follow-up visit, all patients demonstrated relief of symptoms. There was radiographic evidence of new bone fill of prior radiolucent defect in all patients. Two patients had resolution of exposed bone, two patients had partial resolution, one patient had no change in exposed bone, and one patient with three sites of exposed bone before starting PENT-E had resolution in one site, partial resolution in another site, and no change in the third site. PENT-E was well tolerated in all patients. Conclusions Our case series demonstrated that PENT-E was well tolerated and may be an effective adjunct in the management of MRONJ.
- Published
- 2016
32. Molecular profiling of oral microbiota in jawbone samples of bisphosphonate-related osteonecrosis of the jaw
- Author
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Xi Wei, Smruti Pushalkar, S Doty, Cherry L. Estilo, Monica Fornier, George C. Bohle, Yihong Li, C. Wong, Deepak Saxena, Joseph M. Huryn, and Azeez Farooki
- Subjects
business.industry ,Parvimonas ,Streptococcus ,medicine.medical_treatment ,Osteomyelitis ,Dentistry ,Bisphosphonate ,Biology ,medicine.disease ,biology.organism_classification ,medicine.disease_cause ,Otorhinolaryngology ,Fusobacterium ,medicine ,Eubacterium ,Osteonecrosis of the jaw ,business ,General Dentistry ,Temperature gradient gel electrophoresis - Abstract
Oral Diseases (2012) 18, 602–612 Objective: Infection has been hypothesized as a contributing factor to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ). The objective of this study was to determine the bacterial colonization of jawbone and identify the bacterial phylotypes associated with BRONJ. Materials and methods: Culture-independent 16S rRNA gene-based molecular techniques were used to determine and compare the total bacterial diversity in bone samples collected from 12 patients with cancer (six, BRONJ with history of BP; six, controls without BRONJ, no history of BP but have infection). Results: Denaturing gradient gel electrophoresis profile and Dice coefficient displayed a statistically significant clustering of profiles, indicating different bacterial population in BRONJ subjects and control. The top three genera ranked among the BRONJ group were Streptococcus (29%), Eubacterium (9%), and Pseudoramibacter (8%), while in the control group were Parvimonas (17%), Streptococcus (15%), and Fusobacterium (15%). H&E sections of BRONJ bone revealed layers of bacteria along the surfaces and often are packed into the scalloped edges of the bone. Conclusion: This study using limited sample size indicated that the jawbone associated with BRONJ was heavily colonized by specific oral bacteria and there were apparent differences between the microbiota of BRONJ and controls.
- Published
- 2012
33. Correlation of Osteoradionecrosis and Dental Events With Dosimetric Parameters in Intensity-Modulated Radiation Therapy for Head-and-Neck Cancer
- Author
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James Mechalakos, Richard J. Wong, Michael J. Zelefsky, Ashok R. Shaha, Nancy Y. Lee, Cherry L. Estilo, Jatin P. Shah, Dennis H. Kraus, Daniel R. Gomez, and Suzanne L. Wolden
- Subjects
Larynx ,Cancer Research ,medicine.medical_specialty ,business.product_category ,Osteoradionecrosis ,Radiography ,medicine.medical_treatment ,Dentistry ,Dental Caries ,stomatognathic system ,medicine ,Humans ,Parotid Gland ,Mandibular Diseases ,Radiology, Nuclear Medicine and imaging ,Mouthguard ,Retrospective Studies ,Analysis of Variance ,Univariate analysis ,Radiation ,business.industry ,Head and neck cancer ,Radiotherapy Dosage ,medicine.disease ,Parotid gland ,Radiation therapy ,stomatognathic diseases ,medicine.anatomical_structure ,Oncology ,Head and Neck Neoplasms ,Tooth Extraction ,Radiotherapy, Intensity-Modulated ,Radiology ,business - Abstract
Purpose Osteoradionecrosis (ORN) is a known complication of radiation therapy to the head and neck. However, the incidence of this complication with intensity-modulated radiation therapy (IMRT) and dental sequelae with this technique have not been fully elucidated. Methods and Materials From December 2000 to July 2007, 168 patients from our institution have been previously reported for IMRT of the oral cavity, nasopharynx, larynx/hypopharynx, sinus, and oropharynx. All patients underwent pretreatment dental evaluation, including panoramic radiographs, an aggressive fluoride regimen, and a mouthguard when indicated. The median maximum mandibular dose was 6,798 cGy, and the median mean mandibular dose was 3,845 cGy. Patient visits were retrospectively reviewed for the incidence of ORN, and dental records were reviewed for the development of dental events. Univariate analysis was then used to assess the effect of mandibular and parotid gland dosimetric parameters on dental endpoints. Results With a median clinic follow-up of 37.4 months (range, 0.8–89.6 months), 2 patients, both with oral cavity primaries, experienced ORN. Neither patient had preradiation dental extractions. The maximum mandibular dose and mean mandibular dose of the 2 patients were 7,183 and 6,828 cGy and 5812 and 5335 cGy, respectively. In all, 17% of the patients (n = 29) experienced a dental event. A mean parotid dose of >26 Gy was predictive of a subsequent dental caries, whereas a maximum mandibular dose >70 Gy and a mean mandibular dose >40 Gy were correlated with dental extractions after IMRT. Conclusions ORN is rare after head-and-neck IMRT, but is more common with oral cavity primaries. Our results suggest different mechanisms for radiation-induced caries versus extractions.
- Published
- 2011
34. Comparative Analysis of Mandibular Dosimetric-Distribution of PBRT/IMRT: A Pilot Study
- Author
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Joseph M. Huryn, Nancy Y. Lee, Cherry L. Estilo, SaeHee K. Yom, and Adepitan A. Owosho
- Subjects
Distribution (number theory) ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,business ,Nuclear medicine ,Pathology and Forensic Medicine - Published
- 2016
35. Pentoxifylline with Vitamin E and Laser Therapy For Mronj
- Author
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Leah Bowers, Joseph M. Huryn, SaeHee K. Yom, Neal Lehrman, and Cherry L. Estilo
- Subjects
business.industry ,Vitamin E ,medicine.medical_treatment ,Pharmacology ,Pathology and Forensic Medicine ,Pentoxifylline ,Laser therapy ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,business ,medicine.drug - Published
- 2016
36. Primary Ewing Family of Tumors of the Jaw Has a Better Prognosis Compared to Tumors of Extragnathic Sites
- Author
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Eugene Ko, Haley I. Rosenberg, Joseph M. Huryn, Cristina R. Antonescu, Sae Hee K. Yom, Adepitan A. Owosho, and Cherry L. Estilo
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,CD99 ,Bone Neoplasms ,Sarcoma, Ewing ,Article ,Metastasis ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Ewing family of tumors ,Medicine ,Humans ,Child ,Survival analysis ,Retrospective Studies ,Chemotherapy ,business.industry ,Cancer ,Retrospective cohort study ,030206 dentistry ,medicine.disease ,Prognosis ,Jaw Neoplasms ,Survival Analysis ,Surgery ,Treatment Outcome ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Child, Preschool ,Female ,Sarcoma ,Radiology ,Oral Surgery ,business ,Tomography, X-Ray Computed - Abstract
Purpose Primary Ewing sarcoma of the jaw is rare. The aim of this study was to describe new cases of primary Ewing sarcoma of the jaw and investigate reported prognostic factors of Ewing sarcoma in this series and treatment outcome. Materials and Methods Six patients with primary Ewing sarcoma of the jaw were treated at the Memorial Sloan Kettering Cancer Center (MSKCC) from 1992 through 2013. Clinical data, pathology reports, treatment prescribed, treatment regimens, outcome, and follow-up information were reviewed. Results Five of 6 patients were female and 5 cases were in the mandible. No patient presented with metastatic disease at diagnosis. All cases were positive for CD99, and 3 patients with genetic confirmation were positive for EWS-FLI1 fusion or EWSR1 gene rearrangement. All patients received induction multiagent chemotherapy and surgical resection and 2 patients received adjuvant radiotherapy. Total (grade IV) or nearly total (grade III) tumor necrosis in 3 of 5 patients (60%) assessed for histologic response to chemotherapy indicated intense sensitivity. All patients were alive and free of disease, with no history of local recurrence, at a median follow-up period of 6.5 years. Conclusion Patients with primary Ewing sarcoma of the jaw have a good prognosis and metastasis is an uncommon occurrence at initial presentation.
- Published
- 2015
37. WE-AB-207B-08: Exploring and Refining the QUANTEC Guideline to Reduce Severe Hyposalivation Following IMRT for Head and Neck Cancer
- Author
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Nancy Y. Lee, SaeHee K. Yom, Joseph O. Deasy, Jung Hun Oh, Cherry L. Estilo, Maria Thor, Joseph M. Huryn, Jillian Tsai, Nadeem Riaz, H Rosenburg, and Adepitan A. Owosho
- Subjects
business.industry ,medicine.medical_treatment ,Head and neck cancer ,General Medicine ,Guideline ,Intensity-modulated radiation therapy ,medicine.disease ,Radiation therapy ,stomatognathic diseases ,stomatognathic system ,Cohort ,Medicine ,business ,Nuclear medicine ,Rank correlation - Abstract
Purpose: The aim of this study was to investigate the usefulness of the QUANTEC guideline to prevent xerostomia after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) with respect to follow-up time. In addition, we explored alternative guidelines to further reduce xerostomia. Methods: The QUANTEC guideline suggests a mean dose to the contralateral (Dmeancontra) parotid
- Published
- 2016
38. Effects of Therapy on Dentofacial Development in Long-Term Survivors of Head and Neck Rhabdomyosarcoma: The Memorial Sloan-Kettering Cancer Center Experience
- Author
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Dennis H. Kraus, Suzanne L. Wolden, Cherry L. Estilo, Ian M. Zlotolow, Joseph M. Huryn, Charles A. Sklar, and Leonard H. Wexler
- Subjects
medicine.medical_specialty ,business.industry ,Medical record ,Hematology ,Multimodality Therapy ,medicine.disease ,Trismus ,Hypoplasia ,Surgery ,Oncology ,Agenesis ,Pediatrics, Perinatology and Child Health ,Medicine ,Sarcoma ,medicine.symptom ,business ,Rhabdomyosarcoma ,Facial symmetry - Abstract
Purpose To describe potential effects of multimodality therapy on dental and facial development in long-term survivors of head and neck rhabdomyosarcoma. Patients and methods The medical records of all patients aged 20 years or less presenting between 1985 and 1996 with a diagnosis of rhabdomyosarcoma and treated by protocol were reviewed. Head and neck rhabdomyosarcoma patients who were followed in the Dental Service and were alive and free of disease with at least a 5-year follow-up were included in the review. Ten patients satisfied the inclusion criteria and form the basis of this report. The median age at diagnosis of the 10 patients was 4.3 years (range 10 months to 19.5 years). All patients were treated with chemotherapy, two patients underwent surgery, and all but one patient received external beam radiation therapy. Results Clinical or radiographic dentofacial abnormalities were observed in 8 of the 10 (80%) patients. Abnormalities included enamel defects, bony hypoplasia/facial asymmetry, trismus, velopharyngeal incompetency, tooth/root agenesis, and disturbance in root development. Bony hypoplasia and disturbance in root formation were the most common findings. Conclusions Multimodality therapy for head and neck rhabdomyosarcoma can result in dentofacial abnormalities that affect the patient's quality of life. The care of the long-term survivor requires a multidisciplinary approach, including early involvement of the dental team.
- Published
- 2003
39. Osteonecrosis of the jaw a new complication related to Ipilimumab
- Author
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Cherry L. Estilo, Joseph Randazzo, SaeHee K. Yom, Michael Scordo, Adepitan A. Owosho, Paul B. Chapman, and Joseph M. Huryn
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Bleeding on probing ,Ipilimumab ,Bisphosphonate ,medicine.disease ,Article ,Sequestrum ,Surgery ,Denosumab ,medicine.anatomical_structure ,Oncology ,Tongue ,medicine ,Oral Surgery ,medicine.symptom ,Osteonecrosis of the jaw ,business ,Complication ,medicine.drug - Abstract
A 52-year-old male with history of metastatic melanoma of unknown primary, stage IV with metastases to the left iliac region as well as pancreatic head was diagnosed in early 2014. The metastatic melanoma to the iliac bone presented as a large painful lesion and radiologically as a large lytic lesion. He was treated with palliative radiotherapy, 27 Gy in 3 fractions completed in March 2014 and at about the same time started on Ipilimumab at 3 mg/kg intravenous (230 mg) every 3 weeks for a total of 4 doses, the last one in May 2014. Six days following the second dose of Ipilimumab, the patient presented with a gingival swelling on the lingual aspect of the right mandible. On examination, there was a swelling of the lingual gingiva adjacent to the right mandibular molars, localized bleeding on probing, mild discomfort, and a small amount of purulent discharge was expressed from the gingival sulcus on palpation (Fig. 1A). Panoramic and periapical radiographs showed no obvious radiopaque or radiolucent lesions. The area was irrigated with 0.12% chlorhexidine. He was advised to irrigate the area 3 times per day with chlorhexidine. One week later, he presented for a follow-up, at which time he said “it doesn't feel better”. On examination, the swelling had progressed, a fistula was noted from the lingual area of the right mandibular second molar to the mylohyoid space, and on palpation purulence was expressed from the fistula with slight discomfort. Nevertheless, the patient had excellent oral hygiene. He was prescribed Augmentin 875 mg bid for 7 days. A month later, he presented with a complaint of “my other doctor thought he saw some exposed bone in the area that we have been watching”. He stated that it was asymptomatic; however his tongue noticed something rough. On examination, there was a 2 × 2 mm exposed necrotic-appearing bone on the lingual aspect of the right mandibular second molar (Fig. 1B), there was slight purulence on palpation and the bone was mobile but no tenderness or sensitivity on manipulation. The patient was instructed to continue with the chlorhexidine rinse. In 3 weeks, he returned with the complaint of “the bone is moving around now and bothering my tongue”. There was no history of pain from that area. On examination, an area of exposed necrotic bone measuring 10 × 5 mm was present (Fig. 1C); the bone was very mobile and easily removed with cotton forceps with no associated pain or bleeding on removal. The patient was advised to continue the chlorhexidine rinse. The specimen was submitted for histopathologic evaluation (Fig. 1D), which was reported as a non-vital bone (sequestrum) with bacterial colonies consistent with actinomyces species associated with acute inflammatory cells (Fig. 1E). At his 2 month follow-up examination, the area had fully resolved and healed with no purulent discharge or pain on palpation (Fig. 1F). Fig. 1 Clinical picture at initial presentation showing a gingival swelling (A), clinical picture a month later showing a 2 × 2 mm area of exposed bone (B), clinical picture 3 weeks later showing a 10 × 5 mm area of exposed necrotic bone (C), ... The clinical findings of bone exposure of the jaw with histopathologic diagnosis of sequestrum with actinomyces and neutrophils are similar to osteonecrosis of the jaw (ONJ) in patients treated with anti-resorptive or antiangiogenic agents. With no history of radiation therapy to the jaw or metastasis of the tumor to the jaw, this can be termed medication related osteonecrosis of the jaw (MRONJ) [1]. Since 2003, there has been an increase in ONJ cases related to anti-resorptive medications such as Alendronate (oral bisphosphonate), Pamidronate and Zolendronate (intravenous bisphosphonate), Denosumab (humanized monoclonal antibody) and anti-angiogenic medications such as Sunitinib (tyrosine kinase inhibitor) and Bevacizumab (humanized monoclonal antibody), which targets the vascular endothelial growth factor pathway [[2], [3], [4], [5], [6], [7]]. This patient had not used any of the aforementioned class of medications. Ipilimumab was approved by the US Food and Drug Administration in March 2011 as an immunotherapy for the management of advanced (unresectable or metastatic) melanoma both in naive or post-chemotherapy treated patients. Ipilimumab is a humanized monoclonal antibody against cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4). CTLA-4 is expressed in activated T-cells and in suppressor T-regulatory cells which bind to antigen presenting cells thereby lessening T-cell responses. Blocking the CTLA-4 increases the antitumor responses by activated T-cells. Ipilimumab has demonstrated clinical benefits in the management of melanoma [[8], [9]]. The adverse toxicities of Ipilimumab have been attributed to increased immune-reactivity against normal tissues causing pruritus, diarrhea, vitiligo, hepatitis, and endocrinopathies [10]. Bone necrosis was not reported. We suggest that Ipilimumab may have been involved in the process of bone necrosis in this patient. Ipilimumab increases systemic activated T-cells presence. CTLA4 deficient activated T-cells have been shown to be associated with osteonecrosis, as activated T-cells may elicit osteoclastogenesis via osteoprotegerin ligand resulting in bone loss [11]. Trauma from regular oral activity (chewing or tooth brushing) could increase the demand on this vulnerable bone to mend itself, resulting in localized bone necrosis. To our knowledge, this is the first report of ONJ in a patient treated with Ipilimumab. Thousands of patients have been treated with Ipilimumab. If osteonecrosis is an associated complication, it is probably rare and maybe because patients are treated for a short time. As this is a relatively new medication with great promise for management of melanoma and other advanced-stage malignancy clinicians involved in the care of patients managed with Ipilimumab should be aware of this complication.
- Published
- 2015
40. THE ROLE OF PRE-MEDICATION DENTAL EVALUATION IN THE PREVENTION OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW IN CANCER PATIENTS: THE MEMORIAL SLOAN KETTERING CANCER CENTER EXPERIENCE
- Author
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Joseph M. Huryn, Kant Wu, Haley Freymiller, Adi Z. Sax, Cherry L. Estilo, Adepitan A. Owosho, and SaeHee K. Yom
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Pre-Medication ,Cancer ,Dentistry ,medicine.disease ,Pathology and Forensic Medicine ,DENTAL EVALUATION ,medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Center (algebra and category theory) ,Oral Surgery ,Osteonecrosis of the jaw ,business - Published
- 2017
41. THE RELATIONSHIP BETWEEN RADIOGRAPHIC DENTAL ABNORMALITIES AND AGE AT INITIAL TREATMENT OF PEDIATRIC CANCER
- Author
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Cherry L. Estilo, Haley Freymiller, Adi Z. Sax, Joseph M. Huryn, SaeHee K. Yom, Vera Monica Lim, and Adepitan A. Owosho
- Subjects
medicine.medical_specialty ,business.industry ,Radiography ,Dentistry ,Pediatric cancer ,Pathology and Forensic Medicine ,Medicine ,Initial treatment ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Radiology ,Oral Surgery ,business - Published
- 2017
42. Intraoral angiosarcoma: treatment with a brachytherapy prosthesis
- Author
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Cherry L. Estilo, Evan B. Rosen, Suzanne L. Wolden, Joseph M. Huryn, and Eugene Ko
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Brachytherapy ,Hemangiosarcoma ,Biocompatible Materials ,Oral cavity ,Malignancy ,Prosthesis Design ,Prosthesis ,Patient Care Planning ,Article ,Catheterization ,Clinical report ,Radiation Protection ,medicine ,Humans ,Polymethyl Methacrylate ,Angiosarcoma ,neoplasms ,Radiation oncologist ,Aged ,Palatal Neoplasms ,business.industry ,Soft tissue ,Radiotherapy Dosage ,Prostheses and Implants ,medicine.disease ,digestive system diseases ,Surgery ,Oral Surgery ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Angiosarcomas are rare, malignant neoplasms of vascular origin that account for less than 1% of all soft tissue tumors. Angiosarcomas of the oral cavity are especially rare, and brachytherapy may be prescribed as a localized treatment to manage these malignancies. Intraoral brachytherapy requires collaboration between the radiation oncologist and a dental professional for the fabrication of the brachytherapy delivery prosthesis. The present clinical report describes an intraoral angiosarcoma and the fabrication of an intraoral brachytherapy prosthesis to manage this malignancy.
- Published
- 2014
43. ERDHEIM-CHESTER DISEASE PRESENTING IN THE ORAL CAVITY: REPORT OF TWO CASES AND REVIEW OF LITERATURE
- Author
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S. Kashikar, N. Ozkaya, E. Diamond, Cherry L. Estilo, X. Bin, Z. Gelber, and S. Yom
- Subjects
medicine.medical_specialty ,business.industry ,Erdheim–Chester disease ,medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,medicine.disease ,Oral cavity ,business ,Dermatology ,Pathology and Forensic Medicine - Published
- 2016
44. Comparison of oral microbiota in tumor and non-tumor tissues of patients with oral squamous cell carcinoma
- Author
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Cherry L. Estilo, Smruti Pushalkar, Bhuvanesh Singh, Yihong Li, Xiaojie Ji, Xin Li, Ramanathan Yegnanarayana, and Deepak Saxena
- Subjects
Male ,Microbiology (medical) ,Microbial diversity ,Streptococcus parasanguinis ,lcsh:QR1-502 ,Gemella morbillorum ,Streptococcus intermedius ,Microbiology ,lcsh:Microbiology ,03 medical and health sciences ,0302 clinical medicine ,RNA, Ribosomal, 16S ,Humans ,Cloning, Molecular ,030304 developmental biology ,Mouth neoplasm ,0303 health sciences ,Tumor ,Bacteria ,biology ,Denaturing Gradient Gel Electrophoresis ,Microbiota ,Non-tumor ,Mouth Mucosa ,Streptococcus gordonii ,Bacteroidetes ,Fusobacteria ,Biodiversity ,Sequence Analysis, DNA ,Middle Aged ,biology.organism_classification ,Molecular biology ,3. Good health ,stomatognathic diseases ,Streptococcus salivarius ,Oral squamous cell carcinoma ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Metagenome ,Female ,Mouth Neoplasms ,Research Article - Abstract
Background Bacterial infections have been linked to malignancies due to their ability to induce chronic inflammation. We investigated the association of oral bacteria in oral squamous cell carcinoma (OSCC/tumor) tissues and compared with adjacent non-tumor mucosa sampled 5 cm distant from the same patient (n = 10). By using culture-independent 16S rRNA approaches, denaturing gradient gel electrophoresis (DGGE) and cloning and sequencing, we assessed the total bacterial diversity in these clinical samples. Results DGGE fingerprints showed variations in the band intensity profiles within non-tumor and tumor tissues of the same patient and among the two groups. The clonal analysis indicated that from a total of 1200 sequences characterized, 80 bacterial species/phylotypes were detected representing six phyla, Firmicutes, Bacteroidetes, Proteobacteria, Fusobacteria, Actinobacteria and uncultivated TM7 in non-tumor and tumor libraries. In combined library, 12 classes, 16 order, 26 families and 40 genera were observed. Bacterial species, Streptococcus sp. oral taxon 058, Peptostreptococcus stomatis, Streptococcus salivarius, Streptococcus gordonii, Gemella haemolysans, Gemella morbillorum, Johnsonella ignava and Streptococcus parasanguinis I were highly associated with tumor site where as Granulicatella adiacens was prevalent at non-tumor site. Streptococcus intermedius was present in 70% of both non-tumor and tumor sites. Conclusions The underlying changes in the bacterial diversity in the oral mucosal tissues from non-tumor and tumor sites of OSCC subjects indicated a shift in bacterial colonization. These most prevalent or unique bacterial species/phylotypes present in tumor tissues may be associated with OSCC and needs to be further investigated with a larger sample size.
- Published
- 2012
45. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients
- Author
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Mark M. Schubert, Héliton Spíndola Antunes, Sharon Elad, Rajesh V. Lalla, Cherry L. Estilo, Brian D. Hodgson, Joanne M. Bowen, Ian Hewson, Nilza Nelly Fontana Lopes, and Cesar A. Migliorati
- Subjects
Light therapy ,medicine.medical_specialty ,Infrared Rays ,medicine.medical_treatment ,Neoplasms ,medicine ,Mucositis ,Humans ,Low-Level Light Therapy ,Intensive care medicine ,Stomatitis ,Evidence-Based Medicine ,business.industry ,Head and neck cancer ,Cancer ,Guideline ,Evidence-based medicine ,Total body irradiation ,Phototherapy ,medicine.disease ,Surgery ,Radiation therapy ,Oncology ,Practice Guidelines as Topic ,Lasers, Gas ,Lasers, Semiconductor ,business - Abstract
The aim of this study was to review the available literature and define clinical practice guidelines for the use of laser and other light therapies for the prevention and treatment of oral mucositis. A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible. A new recommendation was made for low-level laser (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm2 (2 s/point)) for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation. A new suggestion was made for low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. No guideline was possible in other populations and for other light sources due to insufficient evidence. The increasing evidence in favor of low-level laser therapy allowed for the development of two new guidelines supporting this modality in the populations listed above. Evidence for other populations was also generally encouraging over a range of wavelengths and intensities. However, additional well-designed research is needed to evaluate the efficacy of laser and other light therapies in various cancer treatment settings.
- Published
- 2012
46. Intravenous bisphosphonate-related osteonecrosis of the jaw: long-term follow-up of 109 patients
- Author
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T. Williams, Cherry L. Estilo, Joseph M. Huryn, Jerry Halpern, Joanne F. Chou, Amber L. Watters, Steven J. Tunick, Elyn Riedel, George C. Bohle, and Heidi J. Hansen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Long term follow up ,medicine.medical_treatment ,Pamidronate ,Comorbidity ,Gastroenterology ,Zoledronic Acid ,Pathology and Forensic Medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Aged ,Aged, 80 and over ,Chi-Square Distribution ,Diphosphonates ,business.industry ,DMF Index ,Significant difference ,Smoking ,Clinical course ,Imidazoles ,Cancer ,Bisphosphonate ,Middle Aged ,medicine.disease ,Surgery ,Zoledronic acid ,Disease Progression ,Bisphosphonate-Associated Osteonecrosis of the Jaw ,Female ,New York City ,Oral Surgery ,business ,Osteonecrosis of the jaw ,medicine.drug ,Follow-Up Studies - Abstract
Objective We report long-term follow-up of patients with intravenous bisphosphonate–related osteonecrosis of the jaw (BRONJ). Study Design Medical and dental histories, including type and duration of bisphosphonate treatment and comorbidities, were analyzed and compared with clinical course of 109 patients with BRONJ at Memorial Sloan-Kettering Cancer Center Dental Service. Results Median onset of BRONJ in months was 21 (zoledronic acid), 30 (pamidronate), and 36 (pamidronate plus zoledronic acid), with a significant difference between the pamidronate plus zoledronic acid and zoledronic acid groups (P = .01; Kruskal-Wallis). The median number of doses for BRONJ onset was significantly less with zoledronic acid (n = 18) than pamidronte plus zoledronic acid (n = 36; P = .001), but not pamidronate alone (n = 29). An association between diabetes (P = .05), decayed-missing-filled teeth (P = .02), and smoking (P = .03) and progression of BRONJ was identified through χ2 test. Conclusions This long-term follow-up of BRONJ cases enhances the literature and contributes to the knowledge of BRONJ clinical course.
- Published
- 2011
47. Dosimetric distribution to the tooth-bearing regions of the mandible following intensity-modulated radiation therapy for base of tongue cancer
- Author
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Joseph M. Huryn, Nancy Y. Lee, George C. Bohle, Beatrice Maritim, Heidi J. Hansen, and Cherry L. Estilo
- Subjects
Molar ,Dose ,Osteoradionecrosis ,medicine.medical_treatment ,Dentistry ,Mandible ,Pathology and Forensic Medicine ,medicine ,Premolar ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Radiation treatment planning ,Radiometry ,Neoplasm Staging ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Dose-Response Relationship, Radiation ,Radiotherapy Dosage ,medicine.disease ,Tongue Neoplasms ,Radiation therapy ,medicine.anatomical_structure ,Tooth Extraction ,Surgery ,Radiotherapy, Intensity-Modulated ,Oral Surgery ,business ,Complication ,Nuclear medicine - Abstract
Objectives Osteoradionecrosis is a significant complication following head and neck radiotherapy. The purpose of this study was to determine the intensity-modulated radiation therapy (IMRT) dosages delivered to the tooth-bearing regions of the mandible. Study Design A total of 28 patients with base of tongue cancer with the following stages: T1-2/N2-3 (n = 10), T3-4/N2-3 (n = 10), and T1-4/N0 (n = 8), treated with IMRT, were included. Average mean and maximum doses were calculated for the anterior, premolar, and molar regions. Results Lower doses were seen in anterior bone with smaller tumors. Large tumors, regardless of laterality, resulted in high doses to the entire mandible, with anterior bone receiving more than 6000 cGy. Conclusions Tumor size is important in preradiation dental treatment planning. This information is important in planning pre- and postradiation dental extractions. Dosimetric analyses correlating mean and maximum point dose with clinical presentation and outcomes are needed to determine the best predictor of osteoradionecrosis risk.
- Published
- 2011
48. CR0404 Mucosal lesions after hematopoietic stem cell transplant
- Author
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Lauren Levi, Cherry L. Estilo, Joseph M. Huryn, Jamie Cohn, and Ronald Ghossein
- Subjects
Pathology ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Mucosal lesions ,Medicine ,Hematopoietic stem cell ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,business ,Pathology and Forensic Medicine - Published
- 2014
49. Prosthetic Reconstruction
- Author
-
Joseph M Huryn, George C Bohle, and Cherry L Estilo
- Published
- 2009
50. Osteonecrosis of the jaw related to bevacizumab
- Author
-
Azeez Farooki, Diane L. Carlson, Cherry L. Estilo, Monica Fornier, George C. Bohle, and Joseph M. Huryn
- Subjects
Cancer Research ,Pathology ,medicine.medical_specialty ,Bevacizumab ,Anticorps monoclonal ,medicine.drug_class ,Angiogenesis Inhibitors ,Breast Neoplasms ,Breast pathology ,Monoclonal antibody ,Antibodies, Monoclonal, Humanized ,medicine ,Carcinoma ,Humans ,biology ,business.industry ,Carcinoma, Ductal, Breast ,Osteonecrosis ,Antibodies, Monoclonal ,Middle Aged ,medicine.disease ,Oncology ,Immunology ,Monoclonal ,biology.protein ,Female ,Antibody ,business ,Osteonecrosis of the jaw ,Jaw Diseases ,medicine.drug - Published
- 2008
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