ESTRO 2024 - Abstract Book

S1191

Clinical - Head & neck

ESTRO 2024

During the last decade, based on pathophysiological concepts and PENTOCLO favorable therapeutic results [1], a retrospective study was realized on all inoperable patients with advanced-fractured ORN, treated at Hôpital Saint Louis, single-center setting.

Material/Methods:

Eighty patients, 64 ±9 years old, presented an advanced ORN within 7 ±10 years after RT, bilateral in 31 (39%). Mandibular bone was exposed (mean 22 ±13 mm) with mandibular fracture (Epstein stage IIIB) without healing for 15 ±16 months, despite usual care with short antibiotherapy, local curettage and/or hyperbaric oxygen. The mandibular fracture site was the body and angle in 71% (57/80) of cases. It occurred after mechanical trauma (large sequestration, forced trismus, repeated surgeries), tooth extraction, acute step on chronic infection (cellulitis, abscess, purulence) and/or hypo-vascularization (carotid).

All patients received a 6-week "DISINFILTRATING treatment" (phase 1) combining prednisone 20mg- amoxicillin/clavulanate 2g - ciprofloxacin 1g - fluconazole 50mg.

A PENTOCLO combination (Pentoxifylline 800mg- Tocopherol 1000mg- Clodronate 1600mg) was further introduced (phase 2) until mucosal healing, helped until purulence control, if any, by a continuous clindamycin (300-600mg/day) prescription. Then, a maintenance TRICO treatment (clodronate 1600mg - colchicine 1mg) with cholecalciferol supplementation, was administered (phase 3), as a relay, in order to obtain superficial (avoid rebound effect by insufficient duration of treatment) and bone (strength of the callus) consolidation.

Results:

Treatments were tolerated.

Symptomatic improvement was observed in all patients after phase 1.

A complete mucosal healing was progressively achieved using PENTOCLO in a median time of 15 ±7 months: (a) most patients underwent “spontaneous” removal of a bulky sequestra (mean 19 ±11 mm) during phase 2 follow up; (b) objective response combined a reduction then cessation of analgesics, discontinuation of antibiotic therapy (mean 7 ±4 months), and closed skin fistulae. Then, phase 3 TRICO helped to improve or achieve bone healing : a progressive radiological consolidation of the fracture in 18-42 months for 90% of patients with unexpected delayed and solid bone callus (except for surgical catch-up for mobility, carcinologic evolution, or death).

Conclusion:

Advanced-fracture mandibular ORN may be conservatively and successfully managed in a curative intent. This cohort of 80 fragile patients, the largest ever described, has made it possible to define an innovative and effective therapeutic sequence, in real life, using "DESINFILTRANT- PENTOCLO -TRICO" combinations, whenever radical surgery was not an option.