Two studies are ongoing that promise
Two studies are ongoing that promise to be paramount in the prescription of dexamethasone in the prophylaxis of pain flare. NCIC CTG is currently investigating the use of 8mg dexamethasone daily on the day of treatment and four days post-treatment versus placebo of the same duration (NCT01248585) . The primary outcome of this study is the incidence of pain flare, with secondary outcomes including changes in pain scores, analgesic use, and QOL. The results of this study may be able to help identify those patients who will not benefit from prophylactic dexamethasone. Similarly, Westhoff et al.  are collaborating with twelve radiotherapy departments in the Netherlands to investigate placebo for four days versus 8mg dexamethasone for one day with placebo for three days, versus 8mg dexamethasone for four days (NCT01669499). Again, the primary outcome is the incidence of pain flare, with secondary outcomes including pain scores, QOL, and side effects. Similar studies should be undertaken in a stereotactic body radiation therapy setting, in order to confirm the findings by Khan et al. .
Conflict of Interest statement
Acknowledgments We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.
Introduction Primary tumors of jaw bone are uncommon . Osteoid-producing primary bone tumors are encountered in gnathic apparatus, albeit far less in incidence as compared to their skeletal counterparts. The neoplasms covered in this review are those in which the osteoid or bone formation and its progenitor MLN 8237 Supplier are responsible for the primary pathology . Osteoid is the homogenously eosinophilic organic nonmineralised matrix of bone, produced by osteoblasts. The main constituent, type 1 collagen determines by its alignment whether the bone is lamellar or woven. The fiber arrangement is parallel to one another in lamellar bone and randomly distributed in woven. Association of reactive elements like giant cells, hemorrhage and edematous non-atypical spindle cell stroma is indicative of secondary repair or fracture callus. In reactive conditions, the bone formation is focal; progressively maturing and the osteoid islands are parallel to one another . Bone producing lesions have overlapping histological features. The term “borderline” has been used throughout the literature for denoting these overlapping features seen in gnathic bone tumors . Their distinct clinical and radiographic characterisitcs are used to provide an accurate diagnosis. Osseous tumors are defined by the World Health Organization (WHO) as neoplasms that produce an osseous matrix. These lesions are divided into benign and malignant on the basis of their biological behavior . Lesions that are included are the benign tumors—osteoma, exostosis, osteoid osteoma, osteoblastoma, giant cell tumor as well as the malignant neoplasm, osteosarcoma [1,6]. Fibro-osseous lesions like juvenile ossifying fibroma, ossifying fibroma and fibrous dysplasia are excluded from the discussion as they are essentially fibrogenic in origin. Computed tomography imaging shows a benign bone tumor as a well circumscribed lesion with the matrix of the tumor; characteristics such as cortical breakthrough, bone destruction, a permeative pattern and associated soft-tissue masses suggest a malignant bone neoplasm .
Torus Exostosis or tori are described simply as bony overgrowths. On the palate, the exostosis occurs posterior to midline and tends to be noticeable only by the third decade. In case of the torus mandibularis, the tumor presents itself in the lingual aspect of mandible opposite the mental foramen. Torus palatinus and torus mandibularis are essentially composed of compact bone with larger specimens associated with cancellous core. Tori are removed only if they are large enough to interfere with speech or denture stability .