Biology of radiation-induced mandibular necrosis and the therapeutical perspectives for melatonin

Coram Guevara, Luis Herrera, Ricardo Cárdenas, Freddy Mestre, Heberto Suarez-Roca


Radiation therapy is one of the most widely used therapeutic alternatives in the treatment of different types of orofacial cancer. Some anatomical areas in the oral cavity, including jaw bones and salivary glands, are exposed to high doses of radiation, resulting in adverse radiation-induced reactions. One of the most severe radiation-induced reactions is osteoradionecrosis (ORN), which is associated with high morbidity and a significant decrease in the patient’s quality of life. Thus, preventive and therapeutic strategies need to be implemented as to reduce its occurrence. Melatonin, a hormone produced by the pineal gland has anti-tumor, -apoptotic, -oxidant, and anti-inflammatory properties, and has been shown to improve radiation-induced lesions in several organs. Melatonin, when administered preventively, reduces the overproduction of free radicals in peripheral blood cells and apoptosis of normal cells. It also leads to over-expression of pro-inflammatory (DAMPs and TNF) and tolerogenic (TGF-β) mediators that occurs following radiation, thereby modulating the oxidative, necrotic, and fibrotic changes of ORN. Melatonin might be an effective drug for the preventive treatment of ORN.

Keywords: Radiotherapy, Ionizing radiation, Osteoradionecrosis, Melatonin

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