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 postenucleation intracavity topical dressing.
Methods: For this retrospective cohort study, we collected all data of sequentially treated cases present-
ing to the University of Toronto’s hospital clinics for the management of biopsy-proven OKCs. Chart re-
views 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 iden-
tical manner with enucleation and peripheral ostectomy followed by the application of 5% 5-FU cream for
24 hours. Preoperative and postoperative 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 (interquartile range, 36), compared with 27 months (interquartile range, 37) for
the MCS group (P = .40). No recurrences were identified in the 5-FU group, compared with 9 recurrences
(25%) in patients treated with MCS. 5-FU was shown to be significantly negatively associated with time to
disease resolution (P < .01).
Conclusions: Results from this study suggest that when used topically, 5-FU effectively lowers the recur-
rence 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 with conventional therapies.
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