Ameloblastoma medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Treatment decisions for ameloblastoma are based on the following factors: | |||
*Anatomical location | |||
*Clinical behavior of the tumor | |||
*Age | |||
*General state of health of the patient | |||
*Size | |||
*Histologic variant | |||
*Clinicoradiologic variant | |||
Management of ameloblastoma has been controversial because of the unique biological behavior of this disease as a slow-growing, locally invasive tumor with a high rate of recurrence.[12–17] Recurrence rates of ameloblastoma are reportedly as high as 15-25% after radical treatment[13–15] and 75-90% after conservative treatment.[13–17] Therefore, wide resection of the jaw in accordance with the treatment of malignant tumors is usually recommended for ameloblastomas. Recent advancements in understanding the biological behaviors of ameloblastoma have led to more rational surgical approaches. | Management of ameloblastoma has been controversial because of the unique biological behavior of this disease as a slow-growing, locally invasive tumor with a high rate of recurrence.[12–17] Recurrence rates of ameloblastoma are reportedly as high as 15-25% after radical treatment[13–15] and 75-90% after conservative treatment.[13–17] Therefore, wide resection of the jaw in accordance with the treatment of malignant tumors is usually recommended for ameloblastomas. Recent advancements in understanding the biological behaviors of ameloblastoma have led to more rational surgical approaches. | ||
Treatment of mandibular ameloblastoma continues to be controversial. It can change with clinicoradiologic variant, anatomic location and clinical behaviour of the tumour.5 | Treatment of mandibular ameloblastoma continues to be controversial. It can change with clinicoradiologic variant, anatomic location and clinical behaviour of the tumour.5 | ||
Also, the age and the general state of health of the patient are important factors. Treatment consists of wide resection, curettage and enucleation.6,10 Rates of recurrence may be as high as 15% to 25% after radical treatment and 75% to 90% after conservative treatment.10 The aim of this article is to describe conservative treatment of ameloblastoma by enucleation and bone curettage in cases where the lower border of the mandible is not affected by the tumour. | Also, the age and the general state of health of the patient are important factors. Treatment consists of wide resection, curettage and enucleation.6,10 Rates of recurrence may be as high as 15% to 25% after radical treatment and 75% to 90% after conservative treatment.10 The aim of this article is to describe conservative treatment of ameloblastoma by enucleation and bone curettage in cases where the lower border of the mandible is not affected by the tumour. | ||
Treatment modalities are dictated by size [4, 5], anatomical location (Table 1) [6], histologic variant, and anatomical involvement [7]. On the one hand, there is a school advocating major segmental or en bloc resection for ameloblastoma with a requirement of 1–1.5 cm of clinically and radiographically normal bone and uninvolved margins. On the other hand, there is a school advocating a more conservative surgical management by enucleation with adjacent bone | Treatment modalities are dictated by size [4, 5], anatomical location (Table 1) [6], histologic variant, and anatomical involvement [7]. On the one hand, there is a school advocating major segmental or en bloc resection for ameloblastoma with a requirement of 1–1.5 cm of clinically and radiographically normal bone and uninvolved margins. On the other hand, there is a school advocating a more conservative surgical management by enucleation with adjacent bone | ||
Revision as of 16:35, 27 December 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
The mainstay of therapy for ameloblastoma is surgery. The predominant therapy for ameloblastoma is surgical resection. Adjunctive chemotherapy/radiation/chemoradiation may be required.
Medical Therapy
Treatment decisions for ameloblastoma are based on the following factors:
- Anatomical location
- Clinical behavior of the tumor
- Age
- General state of health of the patient
- Size
- Histologic variant
- Clinicoradiologic variant
Management of ameloblastoma has been controversial because of the unique biological behavior of this disease as a slow-growing, locally invasive tumor with a high rate of recurrence.[12–17] Recurrence rates of ameloblastoma are reportedly as high as 15-25% after radical treatment[13–15] and 75-90% after conservative treatment.[13–17] Therefore, wide resection of the jaw in accordance with the treatment of malignant tumors is usually recommended for ameloblastomas. Recent advancements in understanding the biological behaviors of ameloblastoma have led to more rational surgical approaches. Treatment of mandibular ameloblastoma continues to be controversial. It can change with clinicoradiologic variant, anatomic location and clinical behaviour of the tumour.5 Also, the age and the general state of health of the patient are important factors. Treatment consists of wide resection, curettage and enucleation.6,10 Rates of recurrence may be as high as 15% to 25% after radical treatment and 75% to 90% after conservative treatment.10 The aim of this article is to describe conservative treatment of ameloblastoma by enucleation and bone curettage in cases where the lower border of the mandible is not affected by the tumour.
Treatment modalities are dictated by size [4, 5], anatomical location (Table 1) [6], histologic variant, and anatomical involvement [7]. On the one hand, there is a school advocating major segmental or en bloc resection for ameloblastoma with a requirement of 1–1.5 cm of clinically and radiographically normal bone and uninvolved margins. On the other hand, there is a school advocating a more conservative surgical management by enucleation with adjacent bone
- Surgery is the most common treatment of this tumor. Excision of normal tissue near the tumor margin is often required, because of the invasive nature of the growth. ameloblastoma has tendency to spread to adjacent bony and sometimes soft tissues without metastasizing.
- Although ameloblastoma is not a cancer that actually invades adjacent tissues, it is suspected to spread to adjacent areas of the jaw bone via marrow space. Thus, wide surgical margins that are clear of disease are required for a good prognosis. This is very much like surgical treatment of cancer.
- Often, treatment requires excision of entire portions of the jaw. Surgery is the only effective method for removing the excess tissue growth. A wide surgical excision is often required; in majority of cases, a part of the bone beneath the growth must be removed as well. Surgical curettage of the bone tumor is another treatment modality- although, there is a higher chance of recurrence with this treatment method.
- Since, surgery is a highly effective method to treat ameloblastoma, in most situations, chemotherapy and radiation treatment is not preferred. Facial reconstructive surgeries may be required, after removal of the tumor. Radiation is ineffective in many cases of ameloblastoma. There have also been reports of sarcoma being induced as the result of using radiation to treat ameloblastoma. Chemotherapy is also often ineffective. However, there is some controversy regarding this and some indication that some ameloblastomas might be more responsive to radiation that previously thought.