Survival of metastatic cancer and myeloma patients after diagnosis of Osteonecrosis of Jaws (ONJ). Potential impact on ONJ treatment strategies.

Survival of cancer and myeloma patients after diagnosis of medication-related Osteonecrosis of Jaws (ONJ) has not adequately been reported. ONJ is not rare in patients with bone metastatic cancer and myeloma patients, occurring mostly after prolonged treatment with antiresorptive drugs (zoledronic acid and other bisphosphonates, and/or denosumab). On the other hand, expected residual survival can influence the choice of ONJ treatment strategies (surgical versus conservative). We reviewed survival data after ONJ diagnosis time of 609 patients registered in the regional database of a cancer network in North-Western Italy (Rete Oncologica di Piemonte e Valle d’Aosta).  Main characteristics. Disease:  metastatic breast cancer 43%; myeloma 24.1%; prostate cancer 19.2%; lung cancer 5.7.% renal cancer 3.2% other cancer types 4.8%. Sex: 237 M, 372 F. Median age 69 (32-90) years. Main treatment: 79.1% zoledronic acid, 4.8% denosumab; 16.1 % other drugs or drug sequences.  Observed actuarial median survival after the registered ONJ diagnosis time was 29 (95% CI 26-35) months for breast cancer patients, 31 (95% CI 28-43) months for myeloma patients, 19 (95% CI 15-26) months for prostate cancer patients, 11 (95% CI 5-19) months for lung cancer patients, 30 (95% CI 13-57) months for renal cancer patients, 53 (95% CI 17-84) months for other cancer patients.  Two, three and four-year actuarial survival were respectively: 57.6%, 42.2%, 33.9% for breast cancer patients, 64.6%, 44.9%, 36% for myeloma patients, 42.7%, 27.3%, 19.6% for prostate patients; 28.5%, 14.3%, 11.4% for lung cancer patients; 57.8%, 36.8%, 26.3% for renal cancer patients; 62%, 58.6%, 58.6% for others cancer types.  In conclusion, expected survival after ONJ diagnosis is not really short (less than one year) in most of ONJ patients. Our data do not support generalized exclusion of jawbone surgery in ONJ patients due to expected short survival.