Saved… the jaws that are wrecked by radiotherapy


People with debilitating jaw fractures caused by cancer treatment could be spared risky surgery by a breakthrough drug combo that heals damaged bone.

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. This can trigger infections in the bone and, in extreme cases, jaw fractures.

Known as osteoradionecrosis, the condition can affect one in ten patients who undergo radiotherapy for head and neck cancers, impacting up to 1,000 Britons every year.

Until recently, surgery has been the only remedy. This can include partial removal of the jaw or rebuilding it using bone from a leg – an intensive procedure, particularly for patients already coping with cancer treatment, and one that does not work in many cases.

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

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

Ever wonder why… some people ‘pick up’ others’ accents? 

The explanation lies with specialist brain cells, called mirror neurons, which are an evolutionary tool to help us fit in with any given group.

Mirror neurons run alongside the normal brain pathways and subconsciously control certain elements of behaviour so it matches those around us.

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

Dr Vinod Patel, a consultant oral surgeon at Guy’s and St Thomas’ NHS Foundation Trust, led the study and said he hoped the findings would motivate other cancer specialists to take on the treatment. He added: ‘We’ve seen broken jaw bones that have healed with no surgical input.’

Head and neck cancers affect more than 12,000 Britons a year. Most are successfully treated with radiotherapy and chemotherapy. Those struck by osteoradionecrosis often first notice something is wrong when bits of bone begin to protrude in the mouth as the gum recedes due to lack of blood supply. 

The uncovered bone can then become infected. Professor Mark McGurk, oral surgeon at University College London Hospital, said: ‘The quality of life for those with this condition is terrible.’

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

Drugs pentoxifylline and tocopherol are both proven to boost blood flow. Prof McGurk said: ‘This condition is caused by a loss of blood to the bone, so by improving blood supply to the area we are giving the bone the tools it needs to repair itself.’

In December 2020, Dr Patel published the largest study yet into the use of Pentoclo for osteoradionecrosis. The study of more than 100 patients on the drug found that in over 80 per cent of them, bone deterioration was halted. 

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

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

What’s the difference… between palpitations and arrhythmias? 

A palpitation is the awareness of the heart beating. Triggers are wide-ranging, from stress to consuming too much alcohol.

In most cases they’re harmless. However, they can also be a symptom of a group of conditions known as arrhythmias, when the heart beats in an abnormal way due to nerve problems.

Damage to the heart from a heart attack can trigger arrhythmias, and some types are linked to a raised risk of fatal cardiac arrest.

Stunningly, for 56 per cent the damage was reversed, as a renewed supply of blood allowed the bone to heal and regain structure. In some cases, jaw bones that had completely broken off were restored.

One patient to benefit is Alex Cosgrove, 46, from Kent. Diagnosed with stage three throat cancer in 2016 after finding a lump on her left lymph node, she was put on a six-week course of radiotherapy and chemotherapy, which was effective at fighting the cancer, but was a ‘nasty ordeal’ for the mother-of-two. 

She said: ‘I suffered 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 trading standards officer – noticed shards of bone sticking out of her gums. ‘The doctors shaved off the bits of bone but they kept popping up. Then I started to get horrible infections. My face was constantly sore and I struggled to eat or even just function.’

She was referred to Guy’s and St Thomas’ and started on the drug combo in March 2018. For the past two years she has seen steady improvement. ‘The infections started happening less and less frequently, 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 back to eating all my favourite foods now, like chocolate, which I couldn’t eat for a long time.’

Alex added: ‘When I was first diagnosed I was told the bone damage was going to slowly eat away at my face. So to know it’s now healing has changed my life.’

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

He added: ‘We’re even exploring whether patients can take it once they come off radiotherapy to pre-empt the disease before it even starts.’

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