Saved … the jaws destroyed by radiotherapy

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People with debilitating jaw fractures caused by cancer treatment can be spared risky surgeries by a breakthrough drug combination that heals damaged bone.

Radiotherapy to the head and neck, given in cancer of the tongue, throat and nose, can lead to problems with the blood vessels connected to the lower jaw. This can cause bone infections and, in extreme cases, fractures of the jaw.

Known as osteoradionecrosis, the condition can affect one in ten patients undergoing radiotherapy for head and neck cancer, impacting as many as 1,000 Britons per year.

Until recently, surgery was the only remedy. This can include partial jaw removal or bone rebuilding of a leg – an intensive procedure, especially for patients who already have cancer treatment, and one that doesn’t work in many cases.

Now a groundbreaking study has shown that giving patients two commonly used drugs, pentoxifylline and tocopherol, not only stops bone deterioration, but reverses it for more than half of patients.

Radiotherapy to the head and neck, given for tongue, throat and nose cancers, can lead to problems with blood vessels connected to the lower jaw

Radiotherapy to the head and neck, given for tongue, throat and nose cancers, can lead to problems with blood vessels connected to the lower jaw

Have you ever wondered why … some people ‘pick up’ the accents of others?

The explanation lies in specialized brain cells called mirror neurons, which are an evolutionary tool to help us fit in with a particular group.

Mirror neurons run along normal brain pathways and unconsciously direct certain behavioral elements to match those around us.

Mirror neurons also fire when we see someone in pain, or when we see someone smile – which is why we can ‘feel’ someone else’s discomfort when they stub their toe, or notice that our mood is lifted by the happiness of others.

Dr. Vinod Patel, a consultant oral surgeon with Guy’s and St Thomas’ NHS Foundation Trust, led the study and said he hoped the findings would motivate other cancer specialists to take the treatment. He added, “We’ve seen broken jaw bones healed without surgery.”

Head and neck cancer affects more than 12,000 Britons a year. Most are successfully treated with radiotherapy and chemotherapy. Those affected by osteoradionecrosis often first notice that something is wrong when pieces of bone in the mouth begin to protrude as the gums recede due to a lack of blood supply.

The uncovered bone can then become infected. Professor Mark McGurk, an oral surgeon at University College London Hospital, said, “The quality of life for people with this condition is appalling.”

Doctors often prescribe antibiotics to treat the infections, but this cannot stop the bone breakdown. Surgery is offered, but in one case in five it fails to stop the damage.

Medicines pentoxifylline and tocopherol have been proven to stimulate blood flow. Prof McGurk said, “This condition is caused by blood loss to the bone, so by improving blood flow to the area, we give the bone the tools it needs to repair itself.”

In December 2020, Dr. Patel published the largest study to date on the use of Pentoclo in osteoradionecrosis. The study of more than 100 patients taking the drug found that more than 80 percent of them had their bone deterioration halted.

Dr. Vinod Patel, a consultant oral surgeon with Guy's and St Thomas' NHS Foundation Trust, led the study and said he hoped the findings would motivate other cancer specialists to take the treatment.

Dr. Vinod Patel, a consultant oral surgeon with Guy's and St Thomas' NHS Foundation Trust, led the study and said he hoped the findings would motivate other cancer specialists to take the treatment.

Dr. Vinod Patel, a consultant oral surgeon with Guy’s and St Thomas’ NHS Foundation Trust, led the study and said he hoped the findings would motivate other cancer specialists to take the treatment.

What’s the difference … between palpitations and arrhythmias?

Palpitations are the realization of the beating of the heart. Triggers are broad, from stress to consuming too much alcohol.

In most cases they are harmless. However, they can also be a symptom of a group of conditions known as arrhythmias, where the heart beats abnormally due to nerve problems.

Damage to the heart from a heart attack can cause arrhythmias, and some types have been linked to an increased risk of fatal cardiac arrest.

Amazingly, 56 percent of the damage was reversed, as a renewed supply of blood allowed the bone to heal and regain structure. In some cases, completely broken jawbones were restored.

One patient who can benefit from this is Alex Cosgrove, 46, from Kent. She was diagnosed with stage three throat cancer in 2016 after finding a lump in her left lymph node and was given a six-week course of radiotherapy and chemotherapy, which was effective in the fight against the cancer, but a ‘dire ordeal’ for the mother. -of two.

She said, “I got severe radiation burns in my throat. I couldn’t eat solids for months and was on incredibly strong painkillers. ‘

Months after her cancer treatment, Alex, a marketing standards official, saw shards of bone sticking out of her gums. The doctors shaved off the pieces of bone, but they kept popping up. Then I started having terrible infections. My face was constantly sore and I had a hard time eating or even functioning. ‘

She was referred to Guy’s and St Thomas’ and started the drug combination in March 2018. Over the past two years, she has seen a steady improvement. “The infections were becoming less and less common, and scans of my face showed the bone was healing,” she says.

“ The last time I had an infection was in 2019, and I’m already eating my favorite foods, like chocolate, which I couldn’t eat for a long time. ”

Alex added: ‘When I was first diagnosed I was told the bone damage would slowly eat away at my face. So to know that healing has changed my life. ‘

Dr. Patel is in the process of setting up a larger clinical trial and hopes the results will convince NHS regulators to make the treatment part of the standard of care for people suffering from osteoradionecrosis.

He added, “We are even investigating whether patients can use it once they have stopped radiotherapy to anticipate the disease before it even starts.”