Results of a small Turkish study indicate that laser surgery may be a viable treatment option for cancer patients who experience bisphosphonate-related bone death in their jaws.

Specifically, the study authors found that patients who received laser surgery achieved higher rates of complete healing than patients who received conventional surgery. While the results are suggestive, the study was small and the difference in the rates was not considered significant.

According to Dr. Belir Atalay of Istanbul University in Turkey and lead author of the study, laser surgery may be a better treatment option for these patients than conventional surgery.

“We think that laser-assisted surgery is more effective in wound healing than conventional surgery due to our clinical observations,” Dr. Atalay told The Myeloma Beacon.

However, the study authors acknowledged the need for larger, randomized studies from various clinics in order to better understand the outcomes of different types of therapy for the treatment of bone death in the jaw.

Bisphosphonates, such as Zometa (zoledronic acid) and Aredia (pamidronate), are a class of drugs commonly administered to multiple myeloma patients with bone disease to slow the breakdown of bone and help prevent fractures.

However, bisphosphonates have also been shown to cause the death of jawbone tissue by inhibiting the development of blood vessels in the bone, a condition known as osteonecrosis. Some bisphosphonates may also contribute to bone death more than others. Results of a past study, for instance, showed that patients taking Aredia were four times more likely to develop bone death in the jaw than those taking Zometa (see related Beacon news).

According to the study authors, the proper method of treating bisphosphonate-related bone death of the jaw is still undetermined. Laser surgery has been shown to minimize the risk of cell death and increase healing in patients compared to conventional surgery. Past research has also shown that low-level laser therapy may prevent infections and promote new bone formation, pain relief, wound healing, and nerve regeneration.

In their study, Dr. Atalay and his colleagues sought to compare the effects of laser surgery to conventional surgery on bone and wound healing in patients with bisphosphonate-related bone death in the jaw.

The study included 20 patients with lung, prostate, or breast cancer. All patients had received intravenous Zometa as part of their cancer treatment before developing bone death in the jaw. Seventy percent of patients showed advanced stages of bone death.

All patients received blood tests to evaluate their C-terminal telopeptide (CTX) levels, a marker that identifies the natural rate of bone reformation.

“When we perform a surgery in a healthy person whose CTX level is high, the healing is satisfactory and the risk of infections decreases. But if we perform the operation on a patient whose CTX level is low, the risk of infections and non-healing increases,” explained Dr. Atalay.

Forty percent of patients had CTX levels below 150 pg/ml, while the remaining 60 percent of patients had CTX levels above 150 pg/ml.

Half of the patients were randomly placed into the laser surgery treatment group, and the other half were placed in the conventional surgery treatment group.

Following treatment, patients were assessed for wound healing every other day for the first 10 days, and then every month for the next six months.

After six months, the researchers found that 70 percent of patients who received laser surgery achieved complete healing, which the researchers defined as full covering of the exposed bone with no signs of infection, compared to 40 percent of patients who received conventional surgery. However, the difference was not considered statistically significant.

Similarly, the researchers found that there was no statistical difference between patients whose CTX levels were below 150 pg/ml and those whose CTX levels were above 150 pg/ml.

Patients with advanced bone death in the jaw achieved significantly higher rates of complete healing than patients with minor bone death (71.4 percent versus 16.7 percent). The researchers speculated that this finding could either be the result of a small study population or because patients with advanced bone death have better blood vessel-forming properties in their affected bones than patients with minor bone death.

The researchers recommended that all patients receive complete dental evaluations prior to starting bisphosphonate therapy to prevent bone death in the jaw.

“Completing all the needed dental treatment before starting bisphosphonate treatment and keeping oral hygiene at the highest possible level is the most important way to prevent [bone death in the jaw],” said Dr. Atalay.

For more information, please see the article in Lasers in Medical Science (abstract).