Regenerative Surgery for the Rehabilitation of a Patient after Surgery and Radiation Therapy for Head and Neck Cancer: A Case Report

M. Scala, A. Orsi, A. Rattaro, M. Trapasso, Susanna Polotto, F. Spagnolo, P. Mereu, P. L. Santi

Department of Plastic Surgery, I.R.C.C.S. Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.

DOI: 10.4236/jbise.2014.76038                

Abstract

Oral cancer is usually treated combining surgery, radiation therapy and chemotherapy, following effective therapeutic protocols. Severe maxillary and mandibular bone atrophy resulting after therapies are usually treated with autologous bone grafting procedures even though these techniques often present a significant risk of postoperative complications and disadvantages. We describe the case of a 59-year-old woman presenting severe bone defect after being treated with surgery and radiotherapy for recurrent oral verrucous squamous cell carcinoma. We performed bone regeneration using Platelet-Derived Growth Factors (PDGF) in combination with autologous bone chips. Our procedure of bone regeneration allowed the placement of dental implants and the achievement of a good aesthetic and functional result. Regenerative surgery may enable the regeneration of substantial bone defects. Moreover, PDGF application decreases the risk of implant failure in irradiated patients.

Keywords

Regenerative Surgery, Radiation Therapy, Head and Neck, Squamous Cell Carcinoma, Platelet-Derived Growth Factors, Bone Chips

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Farré-Guasch, E., Prins, H.J., Overman, J.R., Ten Bruggenkate, C.M., Schulten, E.A., Helder, M.N. and Klein-Nulend, J. (2012) Human Maxillary Sinus Floor Elevation as a Model for Bone Regeneration. Enabling the Application of One-Step Surgical Procedures. Tissue Engineering Part B Review.
[2]	Schmitt, C., Karasholi, T., Lutz, R., Wiltfang, J., Neukam, F.W. and Schlegel, K.A. (2012) Long-Term Changes in Graft Height after Maxillary Sinus Augmentation, Onlay Bone Grafting, and Combination of Both Techniques: A Long-Term Retrospective Cohort Study. Clinical Oral Implants Research.
[3]	De Oliveira, E., Silva, M., Pelegrine, A.A., Alves Pinheiro da Silva, A., Manhães Júnior, L.R., de Mello, E., Oliveira, R., Gaiba França, S., Aloise, A.C. and Ferreira, L.M. (2012) Xenograft Enriched with Autologous Bone Marrow in Inlay Reconstructions: A Tomographic and Histomorphometric Study in Rabbit Calvaria. International Journal of Biomaterials. http://dx.doi.org/10.1155/2012/170520
[4]	Carini, F., Pisapia, V., Monai, D., Barbano, L. and Porcaro, G. (2012) Implant Rehabilitation in Patients Irradiated for Head and Neck Cancer: Role of Intensity-Moduled Radiotherapy (IMRT) in Planning the Insertion Site. Annali di Stomatologia (Roma), 3, 8-20.
[5]	Alsaadi, G., Quirynen, M., Komarek, A. and van Steenberghe, D. (2008) Impact of Local and Systemic Factors on the Incidence of Late Oral Implant Loss. Clinical Oral Implants Research, 19, 670-676.
[6]	Tanaka, T.I., Chan, H.L., Tindle, D.I., MacEachern, M. and Oh, T.J. (2012) Updated Clinical Considerations for Dental Implant Therapy in Irradiated Head and Neck Cancer Patients. Journal of Prosthodontics, 22, 432-438. http://dx.doi.org/10.1111/jopr.12028
[7]	Chen, H., Liu, N., Xu, X., Qu, X. and Lu, E. (2013) Smoking, Radiotherapy, Diabetes and Osteoporosis as Risk Factors for Dental Implant Failure: A Meta-Analysis. PloS One, 8, 8.
[8]	De Girolamo, L., Sartori, M.F., Arrigoni, E., Rimondini, L., Albisetti, W., Weinstein, R.L. and Brini, A.T. (2008) Human Adipose-Derived Stem Cells as Future Tools in Tissue Regeneration: Osteogenic Differentiation and Cell-Scaffold Interaction. International Journal of Artif Organs, 31, 467-479.
[9]	Scala, M., Gipponi, M.,Pasetti, S., Dellachà, E., Ligorio, M., Villa, G., Margarino, G., Giannini, G. and Strada, P. (2007) Clinical Applications of Autologous Cryoplatelet Gel for the Reconstruction of the Maxillary Sinus. A New Approach for the Treatment of Chronic Orosinusal Fistula. In Vivo, 21, 541-547.
[10]	Dominiak, M., Lysiak-Drwal, K., Solski, L., Zywicka, B., Rybak, Z. and Gedrange, T. (2012) Evaluation of Healing Processes of Intraosseous Defects with and without Guided Bone Regeneration and Platelet Rich Plasma. An Animal Study. Annals of Anatomy, 194, 549-555.
[11]	Scala, M., Spagnolo, F., Trapasso, M., Strada, P., Moresco, L. and Santi, P.L. (2012) Association of Vacuum-Assisted Closure and Platelet Gel for the Definitive Surgical Repair of an Enterocutaneous Fistula: A Case Report. In Vivo, 26, 147-150.
[12]	Müller, A.M., Mehrkens, A., Schäfer, D.J., Jaquiery, C., Güven, S., Lehmicke, M., Martinetti, R., Farhadi, I., Jakob, M., Scherberich, A. and Martin, I. (2010) Towards an Intraoperative Engineering of Osteogenic and Vasculogenic Grafts from the Stromal Vascular Fraction of Human Adipose Tissue. European Cells and Materials, 19, 127-135.
[13]	Oliveira, K.G., Von Zeidler, S.V., Podestà, J.R.V., Sena, A., Souza, E.D., Lenzi, J., Bissoli, N.S. and Gouvea, S.A. (2014) Influence of Pain Severity on the Quality of Life in Patients with Head and Neck Cancer before Antineoplastic Therapy. BMC Cancer, 14, 39. http://dx.doi.org/10.1186/1471-2407-14-39
[14]	Ramshankar, V. and Krishnamurthy, A. (2012) Human Papilloma Virus in Head and Neck Cancers-Role and Relevance in Clinical Management. Indian Journal of Surgical Oncology, 4, 59-66. http://dx.doi.org/10.1007/s13193-012-0196-5
[15]	Deeken, J.F., Newkirk, K., Harter, K.W., Marshall, M.B., Banovac, F., Johnson, L., Wang, H., Wang, Y., Zhuang, T., Jay, A.K., Berkowitz, F., Esposito, G., Kallakury, B. and Davidson, B. (2014) Multimodality Treatment for Patients with Metastatic/Recurrent HPV-Positive Head and Neck Squamous Cell Carcinoma May Lead to Significant Improvement in Overall Survival.
[16]	Balermpas, P., Bauer, C., Fraunholz, I., Ottinger, A., Wagenblast, J., Stöver, T., Seitz, O., Fokas, E., Rödel, C. and Weiss, C. (2014) Concomitant Chemoradiotherapy versus Induction Chemotherapy Followed by Radiotherapy as Definitive, First Line Treatment of Squamous Cell Carcinoma of the Head and Neck. Strahlentherapie und Onkologie.
[17]	Mak, M.P. and Glisson, B.S. (2014) Is There Still a Role for Induction Chemotherapy in Locally Advanced Head and Neck Cancer? Current Opinion in Oncology, 26.
[18]	Schlumpf, M., Fischer, C., Naehrig, D., Rochlitz, C. and Buess, M. (2013) Results of Concurrent Radio-Chemotherapy for the Treatment of Head and Neck Squamous Cell Carcinoma in Everyday Clinical Practice with Special Reference to Early Mortality. BMC Cancer, 13, 610. http://dx.doi.org/10.1186/1471-2407-13-610
[19]	Klein, J., Livergant, J. and Ringash, J. (2014) Health Related Quality of Life in Head and Neck Cancer Treated with Radiation Therapy with or without Chemotherapy. A Systematic Review. Oral Oncology, 50, 254-262. http://dx.doi.org/10.1016/j.oraloncology.2014.01.015
[20]	Dandekar, V., Morgan, T., Turian, J., Fidler, M.J., Showel, J., Nielsen, T., Coleman, J., Diaz, A. and Sher, D.J. (2014) Patterns-of-Failure after Helical Tomotherapy-Based Chemoradiotherapy for Head and Neck Cancer: Implications for CTV Margin, Elective Nodal Dose and Bilateral Parotid Sparing. Oral Oncology, in Press. http://dx.doi.org/10.1016/j.oraloncology.2014.02.009
[21]	Yokota, T. (2013) Is Biomarker Research Advancing in the Era of Personalized Medicine for Head and Neck Cancer? International Journal of Oncology, 19, 211-219.
[22]	Fujii, M. (2014) Recent Multidisciplinary Approach with Molecular Targeted Drugs for Advanced Head and Neck Cancer. International Journal of Oncology, 19, 220-229.
[23]	Zafereo, M. (2014) Surgical Salvage of Recurrent Cancer of the Head and Neck. Current Oncology Reports, 16, 386. http://dx.doi.org/10.1007/s11912-014-0386-0