5-Fluorouracil is Associated with a Decreased Recurrence Risk in Odontogenic Keratocyst Management: A Retrospective Cohort Study

Purpose The antimetabolite drug, 5-fluorouracil (5-FU), has been suggested as an adjunctive treatment to reduce the recurrence rates of odontogenic keratocysts (OKCs). We report on the use of 5-FU in the management of patients with OKCs as a post-enucleation intra-cavity topical dressing. Methods For this retrospective cohort study, we collected all data of sequentially treated cases presenting to the University of Toronto’s hospital clinics for the management of biopsy proven OKCs. Chart reviews were conducted to identify all patients treated with 5-FU cream, and compare them to patients treated with modified Carnoy’s solution (MCS). In the treatment group, all patients were treated in an identical manner with enucleation and peripheral ostectomy followed by the application of 5% 5-FU cream for 24 hours. Pre- and post-operative radiographs were collected to determine the time to recurrence of the disease, and the techniques were compared via a multivariate Cox regression analysis. Results Seventy patients were found to be eligible for inclusion in this study. Of these, 34 patients were treated with 5% topical 5-FU, and 36 patients were managed with MCS. The median follow-up time in the 5-FU group was 22 months (IQR 36), compared to 27 months (IQR 37) for the MCS group (p=0.40). No recurrences were identified in the 5-FU group, compared to 9 recurrences (25%) treated with MCS. 5-FU was shown to be significantly negatively associated with time to disease resolution (p Conclusions Results from this study suggest that when used topically, 5-FU effectively lowers the recurrence rates of OKCs. Further large scale, case-controlled studies are being investigated at our center and are warranted to make definitive conclusions regarding the effectiveness of this novel technique when compared to conventional therapies.