Analysis of SIRT1 Gene SNPs and Clinical Characteristics in Medication-Related Osteonecrosis of the Jaw.

Certain genetic factors, including single-nucleotide polymorphisms (SNPs) in the SIRT1 gene, have been linked to medication-related osteonecrosis of the jaw (MRONJ). This study examined four SNPs in the SIRT1 gene and implemented multivariate statistical analysis to analyze genetic and clinical factors in MRONJ patients. Genomic DNA was isolated from peripheral blood samples of 63 patients of European origin treated for MRONJ, and four SNP genotypes in the gene encoding the SIRT-1 protein were determined by Sanger sequencing. The allele frequencies measured in the MRONJ population were compared with allele frequencies measured in the European population in the National Center for Biotechnology Information Allele Frequency Aggregator (NCBI ALFA) database. Genetic and clinical factors were examined with multivariate statistical analysis. A C:A allele distribution ratio of 77.8:22.2 was measured in the rs932658 SNP. In the ALFA project, a C:A allele distribution ratio of 59.9:40.1 was detected in the European population, which was found to be a significant difference (p = 4.5 × 10-5). Multivariate statistical analysis revealed a positive correlation (0.275) between the genotype of SNP rs932658 and the number of stages improved during appropriate MRONJ therapy. It is concluded that allele A in SNP rs932658 in the SIRT1 gene acts as a protective factor in MRONJ.

Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ).

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. METHODS: Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. RESULTS: Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). CONCLUSIONS: Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

Evaluation of the efficiency of hyaluronic acid, PRP and I-PRF intra-articular injections in the treatment of internal derangement of the temporomandibular joint: A prospective study.

This study aimed to evaluate the clinical effects of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (I-PRF) injections in the internal derangement of the temporomandibular joint. Adult patients who had failed to respond to nonsurgical treatment were were included in the study. The patients were divided into three treatment groups according to the given substance: 1) HA administration three times in a row on a weekly basis, 2) a single dose of PRP, or 3) a single dose of I-PRF. Clinical assessment was performed preoperatively and 6 and 12 months after the treatment, including maximal mouth opening (MMO) and pain level (Visual Analog Scale). Low and high molecular weight (HAL, HAH) hyaluronic acid forms were also compared. 68 adult patients, with a total of 109 joints were included in the study. The mean age was 53 ± 16 years. The statistical analysis showed a significant improvement in MMO in the HA group (p < 0.01). The pain level significantly decreased in all treatment groups (pHA,PRP,I-PRF<0.01). Comparing HAL and HAH forms, no significant difference was found in the evaluation of MMO and VAS values. Within the limitations of the study it seems that due to the similar effects of HA and the autologous blood substances, the platelet concentrates should be preferred in the intra-articular treatment in order to reduce the risk of possible adverse effects.

Relation between medication-related jaw necrosis and blood glucose levels A retrospective epidemiological study / A gyógyszer okozta állcsontnekrózis és a vércukorszint kapcsolata. Retrospektív epidemiológiai vizsgálat

Maslach and Jackson. Results: In the field of examined dimensions of burnout syndrome, the most characteristic was emotional exhaustion, which has occurred with a frequency of nearly 30% and with typically high intensity among professionals working in neonatal intensive care units (N = 278). In addition, one-fifth were characterized by a high frequency and intensity of depersonalization. At the same time, nearly a third of them experienced a decrease in personal effectiveness. Workplace and time spent in healthcare did not show a significant connection with the incidence of burnout syndrome, however, burnout syndrome occurred with a higher frequency and intensity among those working in level III. neonatal intensive care unit. Conclusion: This is the first comprehensive burnout survey among premature and new born intensive care units in

SIRT1 Gene SNP rs932658 Is Associated With Medication-Related Osteonecrosis of the Jaw.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse drug reaction. Our previous whole-exome sequencing study found SIRT1 intronic region single-nucleotide polymorphism (SNP) rs7896005 to be associated with MRONJ in cancer patients treated with intravenous (iv) bisphosphonates (BPs). This study aimed to identify causal variants for this association. In silico analyses identified three SNPs (rs3758391, rs932658, and rs2394443) in the SIRT1 promoter region that are in high linkage disequilibrium (r2 > 0.8) with rs7896005. To validate the association between these SNPs and MRONJ, we genotyped these three SNPs on the germline DNA from 104 cancer patients of European ancestry treated with iv BPs (46 cases and 58 controls). Multivariable logistic regression analysis showed the minor alleles of these three SNPs were associated with lower odds for MRONJ. The odds ratios (95% confidence interval) and p values were 0.351 (0.164-0.751; p = 0.007) for rs3758391, 0.351 (0.164-0.751; p = 0.007) for rs932658, and 0.331 (0.157-0.697; p = 0.0036) for rs2394443, respectively. In the reporter gene assays, constructs containing rs932658 with variant allele A had higher luciferase activity than the reference allele, whereas constructs containing SNP rs3758391 and/or rs2394443 did not significantly affect activity. These results indicate that the promoter SNP rs932658 regulates the expression of SIRT1 and presumably lowers the risk of MRONJ by increasing SIRT1 expression. © 2020 American Society for Bone and Mineral Research (ASBMR).

Risk assessment of bisphosphonate-related osteonecrosis of the jaw based on CBCT scans / A biszfoszfonátkezelés állcsontnekrózist eloidézo kockázatának megítélése CBCT-felvételek alapján.

INTRODUCTION: Bisphosphonate-related osteonecrosis of the jaw is a condition that severely affects the quality of life, therefore an early diagnosis is of utmost importance (both from a general and a surgical point of view), alongside with an accurate assessment of the risk of emergence of the disease. AIM: Estimation of the prognosis is not resolved; among several radiological options those used in dentistry seem the most fit for the purpose, with cone-beam computed tomography (CBCT) being superior in this task. Assessment of the risk of BRONJ developed following orally applied bisphosphonate is unemphatic in most case studies - these focus more on the intravenous application carrying a greater risk of BRONJ. METHOD: In contrast with the studies published so far, we performed our measurements on preoperative CBCT scans, thereby directly studying the possibility of risk assessment. Our measurements were conducted through evaluating CBCT scans. We chose the frontal section in the midline of the mental foramen as the representative area. We measured density and thickness of the cortical bone on several given points; the diameter of the mental foramen was also measured. In the first group, we examined patients suffering from osteoporosis who had developed BRONJ following oral bisphosphonate treatment. In the second group, we looked at patients suffering from osteoporosis, who had received oral bisphosphonate therapy for this condition but did not develop BRONJ after oral surgery. As control group, we chose patients suffering from osteoporosis who had not received any of the medications known to cause BRONJ. RESULTS: Based on our results, it is clear that there is no significant difference in the bone density of those patients who developed BRONJ and those who did not, examining the preoperative CBCT scans. CONCLUSIONS: Using CBCT scans (and thereby submitting the patient to radiation exposure) in order to estimate the possibility of BRONJ following oral bisphosphonate treatment for osteoporosis is not recommended. It is important not to expose patients to more radiation than strictly necessary to predict BRONJ following oral bisphosphonate treatment in accordance with the ALARA (as low as reasonably achievable) principle. Orv Hetil. 2020; 161(21): 867-872.

[Prognostic factors of the medication-related osteonecrosis of the jaw]. / A gyógyszer okozta állcsontnekrózis prognózisát befolyásoló faktorok.

Introduction: The potential risk factors of the medication-related osteonecrosis of the jaw remain the subject of research because of the different results of the studies. Aim: In our study, we examined the potential prognostic factors of the medication-related osteonecrosis of the jaw. Method: Patients with medication-related osteonecrosis of the jaw presenting between June 2006 and November 2013 were included in this study. Prognosis was examined, based on stage improvement, healing and the rate of relapse. The minimum follow-up time was 5 years. Statistical analysis: The results were evaluated by Fisher's exact test, Mann-Whitney test, Kruskal-Wallis probe and chi-square test. The outcomes were accepted as significant when the p value was <0.05. Results: The stage stated at the first check-up indicated poor prognosis (p = 0.009). The relapse rate of patients with non-insulin-dependent diabetes mellitus was significantly higher than the relapse rate of those without diabetes mellitus (p = 0.050). Regarding the relapse rate, the relationship between patients receiving anti-estrogen therapy and those without hormonal therapy was significant (p = 0.036). The prognosis of mandibular necrosis was significantly worse (p = 0.003) than the prognosis of maxillary necrosis. We did not find significant connection between prognosis and gender, age, administration route of bisphosphonate, invasive procedures preceding the necrosis, chemotherapeutic and steroid treatment. Conclusion: Of the factors studied here, the stage stated at the first check-up, the localization of the necrotic bone parts, diabetes mellitus and anti-estrogen therapy used simultaneously with the antiresorptive therapy affected the prognosis of the medication-related osteonecrosis of the jaw. Orv Hetil. 2020; 161(8): 283-289.

Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population.

Objective: Bisphosphonate-related osteonecrosis of the jaws is considered to be a rare but severe complication of bisphosphonate therapy. To understand this condition better, data collection is essential. Although the number of scientific papers about this subject is large, to date only a few multicenter reports have been published. Study design: We present a novel cloud-based data collection system for the evaluation of the risk factors of bisphosphonate-related osteonecrosis of the jaws. Web-based questionnaire and database have been set up and made available to voluntary researchers and clinicians in oral and maxillofacial surgery in Hungary and Slovakia. Results: To date, fifteen colleagues from eight maxillofacial units have joined the study. Data of 180 patients have been recorded. Collected data were statistically analysed and evaluated from an epidemiological point of view. Conclusions: Authors consider cloud-based multicenter data collection a useful tool that allows for real-time collaboration between users, facilitates fast data entry and analysis, and thus considerably contributes to widening our knowledge of bisphosphonate-related osteonecrosis of the jaws.

The Effect of Platelet-Rich Fibrin Membrane in Surgical Therapy of Medication-Related Osteonecrosis of the Jaw.

PURPOSE: We examined the effect of the membranous form of platelet-rich fibrin (PRF) on patients with medication-related osteonecrosis of the jaw. MATERIALS AND METHODS: Our study included patients who underwent an operation because of second- or third-stage osteonecrosis of the jaw induced by antiresorptive therapy. The diagnosis of medication-related osteonecrosis of the jaw was based on the 2009 and 2014 recommendations of the American Association of Oral and Maxillofacial Surgeons. On the basis of the duration of treatment, we divided our patients into 2 groups. Patients in the first group (Gr1) underwent traditional surgical therapy between 2009 and 2014, whereas patients in the second group (Gr2) underwent PRF membrane-supplemented operations between 2015 and 2017. Outcomes were assessed based on patient recovery, stage improvement, and relapse rate. The follow-up period was a minimum of 1 year. RESULTS: Our study included 101 patients: 73 in Gr1 and 28 in Gr2. The results in Gr2 were significantly better than those in Gr1: recovery (P = .022), stage improvement (P = .005), and relapse rate (P < .001). CONCLUSIONS: In Gr2, significantly better results were achieved in terms of stage improvement, recovery, and relapse rate than in Gr1.

Database analysis of the risk factors of bisphosphonate-related osteonecrosis of the jaw in Hungarian patients.

OBJECTIVE: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but serious side effect of bisphosphonates (BPs). Since this disease has no independent code in either of the diseases' or in the medical procedures' classifications, it is hard to estimate how many BP patients are affected. DESIGN: A retrospective observational epidemiological registry-based study was carried out, using the data of the national service of Hungary on the incidence of BRONJ and related factors. SETTING: A data analysis was performed, which is relevant for the whole Hungarian population from 2010 to 2014. The socioeconomic and medication data of 236 207 BP patients were analysed, and a method was worked out to define BRONJ patients from the Hungarian BP population. PRIMARY AND SECONDARY OUTCOME MEASURES: The incidences of BRONJ were analysed according to genders and the types of the BP drugs administered. The marginal interdependence between the types of BP drugs, modes of administration and main indication was calculated. RESULTS: 340 BP patients (0.1%) developed BRONJ. The incidence of BRONJ in Hungary in the malignant indication of BPs is 0.9%, and 0.1% in the non-malignant indication, and the OR to develop BRONJ was OR=9.7 (95% CI 7.8 to 12.1) between them. Although more women developed BRONJ, the proportion of men was significantly higher than that of women. Steroids increase the risk of jaw osteonecrosis, and differences were also found between the BP drugs. CONCLUSIONS: Oncology indicated, intravenously administered and steroid comedicated BP therapies pose a high risk of developing BRONJ in the Hungarian population.

[Intra-articular steroid and hyaluronic acid treatment of internal derangement of the temporomandibular joint]. / Az állkapocsízületi károsodás kezelése szteroiddal, illetve hialuronsavval.

INTRODUCTION: Derangement of the temporomandibular joint complicates everyday life, due to the masticatory malfunction and the continuous pain sensation of the head and facial region. The therapy is multidisciplinary and varying. In case of the inefficiency of conservative therapy, minimally invasive intervention is needed with intraarticular injection. AIM: The aim of our study was to examine whether hyaluronic acid injection is more beneficial compared to corticosteroid in 37 joints. We also examined whether the efficacy of the therapy is influenced by hyaluronic acid molecular weight and the used protocol. METHOD: Wilkes stage, maximal mouth opening and the Visual Analogue Scale were determined pre-operatively and 6 months later. Corticosteroid application was performed once, hyaluronic acid was injected on a weekly bases 3 times in a row, by use of low (6-10 × 105 dalton) or high molecular weight (24-36 × 105 dalton) preparations. RESULTS: The medical state of the patients treated with corticosteroid temporarily improved, but the symptoms returned. Due to hyaluronic acid treatment, significant improvement was revealed in all parameters (pwilkes<0.0001; pmouth-opening = 0.0002; pVAS<0.0001). There was no significant relapse (T = 2.05). The third administration of hyaluronic acid resulted in a significant improvement of the Visual Analogue Scale compared to the first and second injection (T3.-1. = 20.37; T3.-2. = 9.57). CONCLUSIONS: Comparing the two agents we can state that hyaluronic acid was significantly more effective and its application for three times seems to be the most effective treatment decreasing the symptoms. The high molecular weight solution was more effective in increasing mouth opening. In contrast to hyaluronic acid, corticosteroid had no prolonged effect in higher Wilkes stages. Orv Hetil. 2018; 159(36): 1475-1482.

[Incidence of type 2 diabetes among oral cancer patients in Hungary]. / A 2-es típusú diabetes mellitus prevalenciájának változása szájüregi carcinomás betegek körében.

INTRODUCTION: Data proves that Hungary has a leading role in the statistics of oral cancer and patients living with type 2 diabetes. AIM: Our aim was to understand the statistical correlation between oral cancer and metabolic disorder (diabetes mellitus and impaired fasting glucose) due to the valuable data from the Semmelweis University. METHOD: We analyzed the data of 835 patients diagnosed with malignant oral cancer and 587 tumor-free control patients. We investigated the incidence and location of oral cancer among patients living with diabetes, and compared these datasets with our previous data from 14 years earlier. RESULTS: We found that in oral cancer patients, 26.1% had diabetes and 20.8% had impaired fasting glucose; in the control group these ratios were 10.8% and 11.1%. This difference is significant (p<0.05). 14 years ago in the tumor group 14.6%, in the control group 5.6% had diabetes, while 9.7% and 5.5% had impaired fasting glucose. Lip cancer had the biggest incidence. CONCLUSIONS: The rise of type 2 diabetes in the tumor group was significant. This could be a burden for the health care system. We want to highlight the importance of interdisciplinary cooperation between health care professionals. Orv Hetil. 2018; 159(20): 803-807.

SIRT1/HERC4 Locus Associated With Bisphosphonate-Induced Osteonecrosis of the Jaw: An Exome-Wide Association Analysis.

Osteonecrosis of the jaw (ONJ) is a rare, but serious drug side effect, mainly associated with the use of intravenous (iv) bisphosphonates (BPs). The purpose of this study was to identify genetic variants associated with ONJ in patients of European ancestry treated with iv BPs using whole-exome sequencing (WES). The WES phase 1 included 44 multiple myeloma patients (22 ONJ cases and 22 controls) and WES phase 2 included 17 ONJ patients with solid tumors. Multivariable logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CI), adjusting for age, sex, and principal components for ancestry. Meta-analysis of WES phase 1 and 2 was performed to estimate the combined ORs. In silico analyses were then performed to identify expression quantitative loci (eQTL) single-nucleotide polymorphisms (SNPs) that are in high linkage disequilibrium (LD) with the top SNPs. The associations of the potentially functional SNPs were replicated and validated in an independent case-control study of 48 patients of European ancestry treated with iv BPs (19 ONJ cases and 29 controls). The top SNPs in the exome-wide association meta-analysis were two SNPs on chromosome 10: SIRT1 SNP rs7896005 and HERC4 SNP rs3758392 with identical OR of 0.07 (0.01-0.46; p = 3.83 × 10-5 ). In the in silico functional analyses, two promoter region SNPs (rs7894483 and rs3758391) were identified to be in high LD with the index SNPs and are eQTLs for SIRT1 gene in whole blood in the GTEx database. The ORs were 0.30 (0.10-0.88), 0.26 (0.12-0.55), and 0.26 (0.12-0.55) for the WES top SNP rs7896005 and two promoter SNPs rs7894483 and rs3758391, respectively, in the replication sample. In summary, we identified the SIRT1/HERC4 locus on chromosome 10 to be associated with iv BP-induced ONJ and two promoter SNPs that might be the potential genetic markers for this association. © 2017 The Authors.Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

Potential significance of antiestrogen therapy in the development of bisphosphonate related osteonecrosis of the jaw.

OBJECTIVES: There are known risk factors and established treatment protocols for bisphosphonate-related osteonecrosis of the jaw (BRONJ), but it remains a difficult disease to treat, with the risk of relapses. This study investigates whether or not there is a relationship between antiestrogen therapy and BRONJ. PATIENTS AND METHODS: In our prospective study, we followed up 93 patients with BRONJ who were seen at our clinic between 2006 and 2011. RESULTS: We found that breast cancer patients had a significantly worse prognosis than patients with other underlying illnesses (p < 0.01), which might indicate the role of antiestrogen therapy (p < 0.001) as a causative factor. CONCLUSION: The dominance of the female gender among BRONJ patients as well as our new findings related to antiestrogen therapy of breast cancer raise the possibility that estrogen deficiency might be a newly discovered risk factor for BRONJ.

[Dentigerous cyst associated with a wisdom tooth in the maxillary sinus. Case reports, review of the literature]. / Arcüreg felé attöro, follikuláris cisztával körülvett bölcsességfogak. Esetismertetés, irodalmi attekintés.

Wisdom teeth are often impacted or in an ectopic position. One rather special localisation is the maxillary sinus. Usually these teeth are associated with dentigerous cysts, which can occupy the maxillary sinus partially or totally and can be the cause of various symptoms. We can find it at routine radiographic examination or the patient could have typical, sinus-related symptoms. This signs can be swelling, pain of the cheek, headeache and nasolacrimal obstruction. We report four cases (one of them detailed) with review of the literature where the upper wisdom tooth is situated in the maxillary sinus.

[A rare case of fatal outcome due to extensive facial trauma caused by dogbite]. / Kiterjedt arcsérüléssel járó, halálos kimenetelu kutyatámadás ritka esete.

Statistically 10% of head and neek trauma is caused by animal bite, more often inflicted by dogs. More than 50% of victims are infants and small children. Generally, the result of dogbite is superficial trauma but there are cases of deep soft tissue defects with amputation and multiple bone fractures. In case described in this article, an elderly woman suffered a dog attack, wich resulted in extensive face and head injuries. In spite of receiving proper treatment, the patient passed away. It is highly probable that underlying Syncumar therapy caused complications which contributed to the fatal outcome. Because of it's unusual nature we found this case to be of interest for publication.

[Osteonecrosis of the jaws by using bisphosphonates]. / Biszfoszfonátok alkalmazása következtében kialakuló osteonecrosis az allcsontokban.

The new generation of bisphosphonates are often used in the treatment of osteoporosis or for certain tumors with bone defects. Between the period of September 2005 and May 2006 we have treated 8 patients at our clinic with a bisphosphonate-induced osteonecrosis in the maxillofacial region. All of these patients went through intravenous bisphosphonate treatment earlier. We have chosen two cases, where the appearance of side effects can be named as typical. Based upon the increasing number of international articles reporting and our own experiences in this matter, we would like to draw attention to the importance of prevention in treating these patients. In case of symptoms, if temporary suspension of the bisphosphonate therapy does not have severe consequences, combination of surgical and long-term antibiotic therapy could be the solution.

Overall survival of oropharyngeal cancer patients treated with different treatment modalities.

Therapeutic modalities of use in tumor therapy can be applied in various combinations to treat malignant lesions of the mesopharynx. A study was made of the overall survival of patients with mesopharyngeal carcinoma treated with different modalities in our institution in the period 1995-2000. In this retrospective study, a total of 66 patients were divided into 4 groups: Patients who took part in 1) intra-arterial chemotherapy and subsequent irradiation; 2) intra-arterial chemotherapy and surgical care; 3) only surgical care; or 4) only irradiation or palliative treatment. In each group, the five-year survival rate was examined, as a function of the age of the patient, the initial tumor size, the lymph node status and the clinical stage. The five-year overall survival rate in group 1 was 28.57%, in both group 2 and group 3 was 66.66%, and in group 4 was 20%. For all of the 66 patients, it was 43.93%. For groups 2 and 3, the Kendall rank correction test did not reveal a significant effect of the lymph node state or the clinical stage on the survival, whereas the effects of the age and the initial tumor size did prove to be significant. The Cox regression test showed the latter of these two effects to be the stronger. As 64 of the 66 patients examined were treated for tumors in clinical stages III or IV, the five-year survival rate of 43.93% may be said to be good. The comparison of groups 2 and 3 revealed that (in spite of the poorer initial prognosis in group 2) the survival rates were the same, i.e. the neoadjuvant intra-arterial chemotherapy improved the prognosis.

[Survival prospects of mesopharyngeal carcinoma patients treated primarily with intraarterial chemotherapy. A retrospective study]. / Elsodlegesen intraarteriális kemoterápiával kezelt mesopharynx-carcinomás betegek túlélési kilátásai. Retrospektív vizsgálat.

BACKGROUND: The radical removal of mesopharyngeal tumors necessitates very extensive, aggressive surgery. In certain cases, therefore, they strive to ensure the quality of life of these patients by means of two other possibilities in the complex treatment: chemotherapy and irradiation; in this way, over radicality can be avoided. AIM: One of the elements of the complex therapy may be intraarterial chemotherapy. The present work relates to a study of the effects and side-effects of primary intraarterial chemotherapy administrated in the period 1995-2000, and the overall survival of the patients. PATIENTS AND METHOD: Remission was attained in a total of 30 patients who participated in primary intraarterial chemotherapy. The degree of severity of any complications that occurred was studied, as was the duration of survival. Treatment was performed by retrograde cannulation of the external carotid artery and the administration of a relatively low dose of drug for a relatively long time (5-14 days). The intra-arterial chemotherapy was supplemented with other modes of treatment. RESULTS: A clinically observable degree of tumor regression was detected in 83.3% of the cases after the intraarterial treatment. The 5-year survival rate was approximately 30%. CONCLUSIONS: The overall survival rate for oropharyngeal carcinoma patients treated with combined procedures is reported to range between 32% and 83%. Since our patients (with 2 exceptions) were in stage III or IV, and in many cases were inoperable, our 5-year survival rate of approximately 30% may be stated to be acceptable, while the quality of life of the patients was much more favourable than following the primary radical operation.