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Fitzgerald KT, Lyons C, England A, McEntee MF, Devine A, O'Donovan T, O'Sullivan E. Risk factors associated with the development of osteoradionecrosis (ORN) in Head and Neck cancer patients in Ireland: A 10-year retrospective review. Radiother Oncol 2024; 196:110286. [PMID: 38641259 DOI: 10.1016/j.radonc.2024.110286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND AND PURPOSES To assess osteoradionecrosis (ORN) incidence in a population of Irish Head and Neck cancer (HNC) patients, and assess precipitating factors that may contribute to ORN development to aid prevention. MATERIALS AND METHODS Review of 1050 HNC patients attending the Dental Oncology Clinic, CUDSH between 2010 and 2021 identified 47 cases of ORN. Medical, dental and radiotherapy records of these forty-seven patients were retrospectively reviewed. Patient-, tumour-, and treatment-related variables were investigated in association with osteoradionecrosis development. Analysis conducted using SPSS, Pearson's Chi-square test (p < 0.05), and ordinal regression model. RESULTS ORN incidence was 4.4 %. Median time from radiotherapy (RT) to ORN development was 9.5 months (range 1-98.5 months). ORN development within the mandibular surgical site was significant (p <.001), presenting at a higher Notani grade (p =.002), in mid-mandibular body region (p =.028), at radiation doses ≥ 60 Gy (p =.035), due to induced causes (p =.029), and without resolution (p =.019). CONCLUSION This is the first retrospective study of ORN in HNC patients in Ireland over 10-year period. ORN incidence was extremely low (4.4%). As patients reported high smoking/alcohol use and poor dental attendance pre-diagnosis, this suggests intensive dental intervention pre/post-diagnosis contributed to low ORN rates. Mandibular surgery pre-RT increased risk of developing ORN at the surgical site. Therefore, we recommend future treatment planning should contour the surgical site, designating it an organ at risk (OAR), assigning a dose constraint, where oncologically possible, with emphasis on reducing the hot-spot to this region; findings reinforce importance of life-long expert dental care to reduce ORN incidence.
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Affiliation(s)
| | - Ciara Lyons
- Radiation Therapy Dept., Glandore Centre, Cork University Hospital, Cork, Ireland
| | - Andrew England
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Mark F McEntee
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Annemarie Devine
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Theresa O'Donovan
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Eleanor O'Sullivan
- Radiation Therapy Dept., Glandore Centre, Cork University Hospital, Cork, Ireland; ENTO Research Unit, Cork University Dental School & Hospital, Cork, Ireland.
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2
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de Almeida-Silva LA, Lupp JDS, Sobral-Silva LA, Dos Santos LAR, Marques TO, da Silva DBR, Caneppele TMF, Bianchi-de-Moraes M. The incidence of osteoradionecrosis of the jaws in oral cavity cancer patients treated with intensity-modulated radiotherapy: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:66-78. [PMID: 38772792 DOI: 10.1016/j.oooo.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE A systematic review with meta-analysis was conducted to define the incidence of osteoradionecrosis (ORN) in patients with oral cavity cancer (OCC) treated with intensity-modulated radiotherapy (IMRT), and to identify the risk factors influencing its development. STUDY DESIGN Six databases were searched systematically. A meta-analysis was performed to determine overall, spontaneous, and dental extraction-attributed incidences of ORN. The Grading of Recommendations Assessment, Development, and Evaluation tool evaluated evidence certainty. RESULTS Out of 11 eligible studies, 6 underwent meta-analysis for the overall aggregated ORN incidence in OCC patients receiving IMRT, resulting in an incidence rate of 8% (95% CI: 6%-11%). Regarding development reasons, 2 studies were assessed, revealing an incidence of 36% (95% CI: 1%-98%) for spontaneous ORN, and 17% (95% CI: 5%-44%) ensued from dental extraction exclusively pre-RT. All rates had very low certainty of evidence. Factors significantly correlated with ORN development included postoperative RT use (78%), employment of therapeutic doses above 50 Gy, and mandibular involvement (80.5%). CONCLUSION The findings suggest that IMRT alone is not sufficient to decrease ORN rates in OCC patients, underscoring the importance of precisely identifying the involved risk factors. However, further detailed primary studies will be necessary.
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Affiliation(s)
- Luis Augusto de Almeida-Silva
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil.
| | - Juliana Dos Santos Lupp
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Leonardo Alvares Sobral-Silva
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Luiz Augusto Rodrigues Dos Santos
- Department of Surgery and Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Thays Oliveira Marques
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Danillo Babinskas Ribeiro da Silva
- Department of Surgery and Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Taciana Marco Ferraz Caneppele
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Michelle Bianchi-de-Moraes
- Department of Surgery and Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
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3
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Yang F, Wong RJ, Zakeri K, Singh A, Estilo CL, Lee NY. Osteoradionecrosis Rates After Head and Neck Radiation Therapy: Beyond the Numbers. Pract Radiat Oncol 2024; 14:e264-e275. [PMID: 38649030 DOI: 10.1016/j.prro.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Osteoradionecrosis (ORN) is a severe late complication of head and neck radiation therapy shown to have profound negative effect on the quality of life of cancer survivors. Over the past few decades, improvements in radiation delivery techniques have resulted in a decrease in the incidence of ORN. However, even with modern radiation therapy techniques, ORN remains an important clinical concern. In recent literature, there is a wide range of reported ORN rates from 0% to as high as 20%. With such a high level of variability in the reported incidence of ORN, oncologists often encounter difficulties estimating the risk of this serious radiation therapy toxicity. METHODS AND MATERIALS In this review, the authors present a summary of the factors that contribute to the high level of variability in the reported incidence of ORN. RESULTS Variable definition, variable grading, and heterogeneity of both study inclusion criteria and treatment parameters can each significantly influence the reporting of ORN rates. CONCLUSIONS Given numerous factors can affect the reported incidence of ORN, a thorough understanding of the clinical context behind the reported ORN rates is needed to comprehend the true risk of this important radiation therapy toxicity.
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Affiliation(s)
- Fan Yang
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Departments of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaveh Zakeri
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annu Singh
- Departments of Dentistry, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cherry L Estilo
- Departments of Dentistry, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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4
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Carsuzaa F, Dore M, Falek S, Delpon G, Drouet J, Thariat J. [Prevention, diagnosis and management of osteoradionecrosis: Where do we stand?]. Bull Cancer 2024; 111:525-536. [PMID: 38480057 DOI: 10.1016/j.bulcan.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 05/13/2024]
Abstract
Osteoradionecrosis (ORN) is a late secondary iatrogenic complication of external radiotherapy for cancers of the upper aero-digestive tract. Despite the systematization of intensity-modulated radiotherapy and its potential for preserving salivary secretion and limiting the dose delivered to the supporting bone, ORN remains a feared and frequent complication. The objective of this literature review was to provide an overview of the management of ORN and to determine the key points that would make it possible to improve patient care. The diagnosis of ORN requires to eliminate tumor recurrence then is based on clinical arguments and imaging by CT or Cone Beam evolving in a chronic mode (more than 3-6 months). The harmonization of its classifications aims to offer comprehensive and multidisciplinary care as early as possible. Primary prevention is based on pre-therapeutic oral and dental preparation, then associated with fluoroprophylaxis if salivary recovery is insufficient and requires supervision of invasive dental care and prosthetic rehabilitation. Semi-automatic contouring tools make it possible to identify doses delivered to dental sectors and guide dental care with personalized dosimetric mapping. Conservative medical treatment is offered at an early stage where innovative medical treatments, highlighted by early studies, could be of interest in the future. In the event of advanced ORN, a non-conservative treatment is then proposed and frequently consists of interruptive mandibulectomy associated with reconstruction by bony free flap, the conditions of implantation remaining to be defined with the support of prospective clinical trials.
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Affiliation(s)
- Florent Carsuzaa
- Service d'ORL et chirurgie cervico-faciale, centre hospitalo-universitaire de Poitiers, Poitiers, France.
| | - Mélanie Dore
- Service de radiothérapie, institut de cancérologie de l'Ouest, Nantes, France
| | - Sabah Falek
- Service de chirurgie maxillofaciale et stomatologie, centre François-Baclesse, Caen, France
| | - Grégory Delpon
- Service de radiothérapie, institut de cancérologie de l'Ouest, Nantes, France
| | - Julien Drouet
- Service de chirurgie maxillofaciale et stomatologie, centre François-Baclesse, Caen, France
| | - Juliette Thariat
- Service de radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie université, Caen, France; GORTEC, Intergroupe ORL France, France
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5
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Rupe C, Gioco G, Massaccesi M, Tagliaferri L, Pastore F, Micciché F, Galli J, Mele D, Specchia ML, Cassano A, Cordaro M, Lajolo C. Osteoradionecrosis incidence in pre-radiation teeth extractions: A prospective study. Oral Dis 2024. [PMID: 38591808 DOI: 10.1111/odi.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
AIMS To evaluate osteoradionecrosis (ORN) incidence in a cohort of patients undergoing tooth extraction (TE) before radiotherapy (RT) for head and neck cancers. METHODS The study protocol was approved by the Ethics Committee of Università Cattolica del Sacro Cuore (ID-2132) and registered at clinicaltrials.gov (ID: NCT04009161). TE was performed in case of signs of pericoronitis, periapical lesions, restorative impossibility, severe periodontitis. ORN was defined as exposed bone at an unhealed post-extraction socket in the absence of oncological recurrence. The RT plans were reviewed, and each post-extractive socket was contoured to calculate the received radiation dose. RESULTS In total, 156 patients with 610 TE were enrolled. The mean follow-up was 567 days. ORN was diagnosed in four patients (2.6% of patients and 0.7% of TE). Need for osteotomy and radiation dose at the extraction site were associated with ORN (OR for osteotomy: 21.9, 95% CI: 2.17-222.2, p = 0.009; OR for RT dose: 1.1, 95% CI: 1-1.15, p = 0.05). CONCLUSIONS TE appears to be a significant risk factor for ORN, particularly when osteotomy is required, and post-extraction sockets receive a high RT dosage. This study proposes a decision-making algorithm for TE and outlines a straightforward surgical protocol.
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Affiliation(s)
- C Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Gioco
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Tagliaferri
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Pastore
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Micciché
- Oncologic Radiotherapy, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy
| | - J Galli
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Mele
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Cassano
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Cordaro
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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7
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Naseer A, Goode F, Doyle T. Osteoradionecrosis - an old problem with new consequences. Curr Opin Support Palliat Care 2024; 18:39-46. [PMID: 38170197 DOI: 10.1097/spc.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Osteoradionecrosis (ORN) is a devasting complication of radiation therapy (RT), especially in head and neck cancers (HNC), and is still poorly understood. The aim of this review is to report its incidence and consider the risk factors associated with ORN to highlight prevention strategies to decrease its incidence. RECENT FINDINGS The average incidence of ORN is between 2% and 23%, with incidence decreasing in more recent years with the introduction of modern RT technology and better oral health care. Smoking, diabetes mellitus, oropharyngeal and oral cavity cancers, pre- and post-RT dental extractions and a total radiation dose of over 60 Gy were all identified as risk factors for ORN. In prevention, strategies were mainly structured around minimising risk factors or targeting possible mechanisms of ORN's pathophysiology. SUMMARY At present, the controversy surrounding the risk factors and pathogenesis of ORN makes it difficult to establish a set of prevention guidelines for its incidence. In order to achieve this, more research examining its aetiology must be conducted as well as a universal staging system within which ORN may be classified.
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Affiliation(s)
- Amara Naseer
- School of Medicine, Discipline of Radiation Therapy, Trinity College Dublin, The University of Dublin
| | - Fiona Goode
- Trinity College: The University of Dublin Trinity College, Dublin, Republic of Ireland
| | - Tia Doyle
- Trinity College: The University of Dublin Trinity College, Dublin, Republic of Ireland
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Wang X, Zheng L, Zhang J, Zhang J. Evaluation of outcomes after conservative mandibular surgery in patients with oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2023; 52:1111-1119. [PMID: 37271626 DOI: 10.1016/j.ijom.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
This study aimed to assess preoperative radiological and clinical examinations for identifying bone status and to evaluate survival outcomes in patients undergoing marginal mandibulectomy for the primary treatment of oral squamous cell carcinoma. The medical records, enhanced computed tomography (CT) scans, and pathological specimens of these patients were reviewed. Disease-free (DFS), local recurrence-free (LRFS), and osteoradionecrosis-free (ORNFS) survival were analysed. The study included 104 patients. The preoperative CT and clinical examinations achieved a sensitivity of 45.8% and specificity of 100% for judging bone condition. LRFS was 79.6% and DFS was 68.8%. Pathological bone invasion in significantly affected DFS (P = 0.597), while DFS was significantly higher for those with a lower clinical tumour stage (1/2 vs 3/4; P = 0.005) and postoperative radiotherapy (P = 0.011). Among 39 patients receiving postoperative radiotherapy, ORNFS was 75.2%. Postoperative chemotherapy significantly decreased ORNFS (P = 0.009). Tumour subsite (P = 0.003) and the resection site (P = 0.035) significantly affected the remaining bone height. The results indicate that CT and clinical examinations cannot precisely identify superficial bone damage, but work well in selecting patients for marginal resection. Adhering to current indications, this resection approach can guarantee safe bone margins in terms of survival outcomes.
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Affiliation(s)
- X Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - L Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.
| | - J Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - J Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
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9
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Alberga JM, Meijer J, Raghoebar GM, Langendijk JA, Korfage A, Steenbakkers RJHM, Meijer TWH, Reintsema H, Vissink A, Witjes MJH. Planned dose of intensity modulated proton beam therapy versus volumetric modulated arch therapy to tooth-bearing regions. Oral Oncol 2023; 140:106392. [PMID: 37084567 DOI: 10.1016/j.oraloncology.2023.106392] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Intensity modulated proton beam therapy (IMPT) for head and neck cancer offers dosimetric benefits for the organs at risk when compared to photon-based volumetric modulated arch therapy (VMAT). However, limited data exists about the potential benefits of IMPT for tooth-bearing regions. The aim of this study was to compare the IMPT and VMAT radiation dosimetrics of the tooth-bearing regions in head and neck cancer patients. Also, we aimed to identify prognostic factors for a cumulative radiation dose of ≥40 Gy on the tooth-bearing areas, which is considered the threshold dose for prophylactic dental extractions. METHODS A total of 121 head and neck cancer patients were included in this retrospective analysis of prospectively collected data. We compared the average Dmean values of IMPT versus VMAT of multiple tooth-bearing regions in the same patients. Multivariate logistic regression analysis was performed for receiving a cumulative radiation dose of ≥40 Gy to the tooth-bearing regions (primary endpoint) in both VMAT and IMPT. RESULTS A lower Dmean was seen after applying IMPT to the tooth-bearing tumour regions (p < 0.001). Regarding VMAT, oral cavity tumours, T3-T4 tumours, molar regions in the mandible, and regions ipsilateral to the tumour were risk factors for receiving a cumulative radiation dose of ≥40 Gy. CONCLUSIONS IMPT significantly reduces the radiation dose to the tooth-bearing regions.
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Affiliation(s)
- J M Alberga
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - J Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J A Langendijk
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Korfage
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R J H M Steenbakkers
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - T W H Meijer
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H Reintsema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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10
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Wu SS, Hong H, Fritz M, Ku J, Prendes B, Silver N, Genther DJ, Ciolek P, Byrne P, Brauer P, Reddy CA, Woody N, Campbell S, Koyfman SA, Lamarre ED. Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity-modulated radiotherapy era. Head Neck 2023; 45:890-899. [PMID: 36808674 DOI: 10.1002/hed.27310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Resected oral cavity carcinoma defects are often reconstructed with osteocutaneous or soft-tissue free flaps, but risk of osteoradionecrosis (ORN) is unknown. METHODS This retrospective study included oral cavity carcinoma treated with free-tissue reconstruction and postoperative IMRT between 2000 and 2019. Risk-regression assessed risk factors for grade ≥2 ORN. RESULTS One hundred fifty-five patients (51% male, 28% current smokers, mean age 62 ± 11 years) were included. Median follow-up was 32.6 months (range, 1.0-190.6). Thirty-eight (25%) patients had fibular free flap for mandibular reconstruction, whereas 117 (76%) had soft-tissue reconstruction. Grade ≥2 ORN occurred in 14 (9.0%) patients, at a median 9.8 months (range, 2.4-61.5) after IMRT. Post-radiation teeth extraction was significantly associated with ORN. One-year and 10-year ORN rates were 5.2% and 10%, respectively. CONCLUSIONS ORN risk was comparable between osteocutaneous and soft-tissue reconstruction for resected oral cavity carcinoma. Osteocutaneous flaps can be safely performed with no excess concern for mandibular ORN.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner, College of Medicine, Cleveland, Ohio, USA
| | - Hanna Hong
- Cleveland Clinic Lerner, College of Medicine, Cleveland, Ohio, USA
| | - Michael Fritz
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Jamie Ku
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Brandon Prendes
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Natalie Silver
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Dane J Genther
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Peter Ciolek
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Patrick Byrne
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Philip Brauer
- Case Western Reserve, University School of Medicine, Cleveland, Ohio, USA
| | - Chandana A Reddy
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Neil Woody
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shauna Campbell
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shlomo A Koyfman
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Eric D Lamarre
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
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11
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Liao PH, Lin C, Huang JY, Lin HM, Kuo TJ. Association between tooth extraction during radiotherapy and the risk of osteoradionecrosis in patients with head and neck cancers. Eur Arch Otorhinolaryngol 2023; 280:2945-2952. [PMID: 36892614 DOI: 10.1007/s00405-023-07885-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE It is commonly recommended that tooth extraction should be performed prior to radiotherapy (RT) in patients with head neck cancer to prevent osteoradionecrosis (ORN). However, doctors still occasionally encounter patients who require tooth extraction during RT. This study aimed to determine the risk of ORN in patients who undergo tooth extraction during RT. METHODS Data were collected from Taiwan's National Health Insurance Research Database. We retrospectively enrolled 24,412 patients with head and neck cancer treated with radiotherapy between 2011 and 2017. The associations between ORN and demographic characteristics, timing of tooth extraction, and treatments were examined using univariate and multivariable Cox proportional hazards regression models. RESULTS A total of 24,412 head and neck cancer patients were enrolled; 133 patients underwent tooth extraction during RT and 24,279 patients did not undergo tooth extraction during RT. Tooth extraction during RT was not associated with a significantly higher risk of ORN (hazard ratio [HR] = 1.303, P = 0.4862). Tumor site, RT dose ≥ 60 Gy, age < 55 y/o, mandibulectomy, chronic periodontitis, and chemotherapy were significantly associated with a higher risk of ORN. CONCLUSION The risk of ORN in head and neck cancer is not significantly different between patients who undergo tooth extraction during RT and patients who do not undergo tooth extraction during RT.
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Affiliation(s)
- Pei-Hsun Liao
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Che Lin
- Department of Orthopaedic, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsin-Mei Lin
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Jen Kuo
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan.
- School of Dentistry, Chung Shan Medical University, 110, Sec. 1, Chien-Kuo N. Rd., Taichung, Taiwan.
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Eternal Dental Clinic, Taichung, Taiwan.
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12
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Yilmaz B, Somay E, Topkan E. Comments on Dinnoo et al., 2021: ''18F-FDG PET/CT for early response assessment of jaw osteoradionecrosis after the PENTOCLO protocol: A promising imaging modality''. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101317. [PMID: 36280112 DOI: 10.1016/j.jormas.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Busra Yilmaz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey.
| | - Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
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13
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Osteoradionecrosis of the Jaw-Comparison between Bone and Soft Tissue Injury and Their Influence on Surgical Outcomes-A Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13030366. [PMID: 36766471 PMCID: PMC9914009 DOI: 10.3390/diagnostics13030366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Surgical therapy of osteoradionecrosis of the jaw (ORN) is challenging and requires treatment of the affected hard and soft tissue. To understand how tissue injury after irradiation influences surgical outcomes, the objective of this study was to find out whether (a) bone-related, (b) soft tissue-related, and (c) treatment-related parameters influence the surgical success of patients with ORN. A total of 175 patients (324 lesions) were included in this retrospective, single-center study. All patients were diagnosed with ORN and underwent surgical therapy. The primary outcome was complete soft tissue recovery (mucosa/skin) and the absence of symptoms 3 months after surgery. At the time of follow-up, 58% of patients (189 of 324 lesions) had intact intraoral or extraoral soft tissue. The extent of bone destruction had no effect on treatment success, whereas soft tissue injury due to fibrosis (OR: 0.344; CI 0.142-0.834; p = 0.01818) and xerostomia (OR: 0.163; CI 0.064-0.419; p = 0.00016) increased the probability of treatment failure. Soft tissue reconstruction with a microvascular graft improved therapeutic success compared to local wound closure (OR: 2.998; CI 1.371-6.555; p = 0.006). Thus, for the treatment of ORN, it is extremely important to pay attention not only to the extent of bone destruction but especially to soft tissue defects. Because the extent of soft tissue injury is a predictor for therapeutic success, it should influence the choice of surgical treatment.
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14
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Amina BS, Anshul S, Sharan TK, Anusha RS, Lewis S, Umesh V, Priyanka A, Tarun G. Radiation Therapy Treatment Outcomes for Patients with Head and Neck Cancer: a Tertiary Care Centre Experience in a Tier Three Town. Indian J Otolaryngol Head Neck Surg 2022; 74:6146-6150. [PMID: 36742778 PMCID: PMC9895132 DOI: 10.1007/s12070-021-02810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/08/2021] [Indexed: 02/07/2023] Open
Abstract
To report the outcomes of patients with head and neck squamous cell cancers (HNSCC) who received radiotherapy as a part of their first line treatment. All patients treated with radiotherapy for HNSCC between 2013 and 2017 were retrospectively identified from the department records. Patients with follow-up of less than 3 months following primary treatment were excluded. The demographic, disease and outcome details were retrieved from the patients' hospital records. The disease free survival (DFS) was estimated with Kaplan-Meier analysis, and effect of different variables on DFS were compared using log-rank test. The late toxicities of treatment were also recorded and reported. A total of 311 patients were found to be eligible. Most patients were males (82%), and oral cavity cancers predominated (45.3%). 237 patients (76.2%) had locally advanced disease at presentation. Radiotherapy was used as definitive treatment for 152 patients (48.9%). At a median follow up of 14.8 months (range: 3-85.2 months), the estimated Disease-Free Survival (DFS) was 52.7 months (95%CI: 37.7-67.7 months). Locally advanced disease correlated with a significantly lower median DFS (61.2 vs. 32.8 months; p = 0.01), but other factors, including gender, use of concurrent chemotherapy and adjuvant vs definitive radiotherapy appeared to have no statistical association with DFS. 181 (58.2%) patients had chronic RT-related toxicities at last follow-up, but most were generally mild, most frequently subcutaneous fibrosis (48.6%, which occurred significantly more frequently in patients receiving adjuvant RT following surgery- 40.8% versus 57.2%; p = 0.03) and xerostomia (32.4%). Radiation induced osteoradionecrosis was rare, occurring in only three (1%).Most HNSCC patients present with locally advanced disease, where disease control remains poor. Though there is substantial toxicity following treatment, the risk of severe toxicities with modern radiotherapy is low.
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Affiliation(s)
- B. S. Amina
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - S. Anshul
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - T. K. Sharan
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - R. S. Anusha
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - V. Umesh
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - A. Priyanka
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
| | - G. Tarun
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
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15
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Ngeow WC, Tan CC, Goh YC, Deliberador TM, Cheah CW. A Narrative Review on Means to Promote Oxygenation and Angiogenesis in Oral Wound Healing. Bioengineering (Basel) 2022; 9:636. [PMID: 36354548 PMCID: PMC9688034 DOI: 10.3390/bioengineering9110636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/19/2022] [Accepted: 10/29/2022] [Indexed: 08/22/2023] Open
Abstract
Oral mucosa serves as the primary barrier against pathogen invasions, mechanical stresses, and physical trauma. Although it is generally composed of keratinocytes and held in place by desmosomes, it shows variation in tissue elasticity and surface keratinization at different sites of the oral cavity. Wound healing undergoes four stages of tissue change sequences, namely haemostasis, inflammation, proliferation, and remodelling. The wound healing of oral hard tissue and soft tissue is largely dependent on the inflammatory response and vascular response, which are the targets of many research. Because of a less-robust inflammatory response, favourable saliva properties, a unique oral environment, and the presence of mesenchymal stem cells, oral wounds are reported to demonstrate rapid healing, less scar formation, and fewer inflammatory reactions. However, delayed oral wound healing is a major concern in certain populations with autoimmune disorders or underlying medical issues, or those subjected to surgically inflicted injuries. Various means of approach have been adopted to improve wound tissue proliferation without causing excessive scarring. This narrative review reappraises the current literature on the use of light, sound, mechanical, biological, and chemical means to enhance oxygen delivery to wounds. The current literature includes the use of hyperbaric oxygen and topical oxygen therapy, ultrasounds, lasers, platelet-rich plasma (PRP)/platelet-rich fibrin (PRF), and various chemical agents such as hyaluronic acid, astaxanthin, and Centella asiatica to promote angiogenesis in oral wound healing during the proliferation process. The arrival of a proprietary oral gel that is reported to improve oxygenation is highlighted.
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Affiliation(s)
- Wei Cheong Ngeow
- Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Chuey Chuan Tan
- Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Yet Ching Goh
- Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Chia Wei Cheah
- Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
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Humbert-Vidan L, Hansen CR, Fuller CD, Petit S, van der Schaaf A, van Dijk LV, Verduijn GM, Langendijk H, Muñoz-Montplet C, Heemsbergen W, Witjes M, Mohamed ASR, Khan AA, Marruecos Querol J, Oliveras Cancio I, Patel V, King AP, Johansen J, Guerrero Urbano T. Protocol Letter: A multi-institutional retrospective case-control cohort investigating PREDiction models for mandibular OsteoRadioNecrosis in head and neck cancer (PREDMORN). Radiother Oncol 2022; 176:99-100. [PMID: 36179801 PMCID: PMC9727320 DOI: 10.1016/j.radonc.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Laia Humbert-Vidan
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, Comprehensive Cancer Centre, King's College London, London, UK.
| | - Christian R Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Centre, Houston, TX, United States
| | - Steven Petit
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Gerda M Verduijn
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hans Langendijk
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Carles Muñoz-Montplet
- Department of Medical Physics and Radiation Protection, Catalan Institute of Oncology, Girona, Spain; Department of Medical Sciences, University of Girona, Girona, Spain
| | - Wilma Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Max Witjes
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Centre, Houston, TX, United States
| | - Abdul A Khan
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Jordi Marruecos Querol
- Department of Medical Sciences, University of Girona, Girona, Spain; Department of Radiation Oncology, Catalan Institute of Oncology, Girona, Spain
| | | | - Vinod Patel
- Department of Oral Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew P King
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
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17
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Osteoradionecrosis after postoperative radiotherapy for oral cavity cancer: A retrospective cohort study. Oral Oncol 2022; 133:106056. [PMID: 35933938 DOI: 10.1016/j.oraloncology.2022.106056] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Osteoradionecrosis (ORN) is a severe late complication after radiotherapy but current knowledge on ORN risks in the setting of postoperative radiotherapy (PORT) is limited. We studied the incidence and risk factors of ORN in patients with oral cavity cancers (OCC, treated with PORT. PATIENTS AND METHODS A retrospective cohort study was conducted including OCC patients (mainly squamous cell) treated with postoperative intensity modulated radiotherapy between 2010 and 2018 with > 1 year disease-free survival. Cumulative incidences of ORN were computed using the Kaplan Meier method. Clinical and dosimetric risk factors for mandibular ORN were evaluated using Cox regression models. RESULTS Within our cohort (N = 227, median follow-up 49 months) we observed 46 cases of ORN, mainly in the mandible (n = 41). The cumulative incidence of mandibular ORN was 15.9 % (SE 2.5 %) at three years and 19.8 % (SE 3.0 %) at five years. At univariable analysis, smoking, mandibular mandibulotomy or segment resection, mean dose to the mandible, and mandible volume (%) ≥ 60 Gy (V60) were significantly associated with increased ORN risks. At multivariable analysis, smoking (HR 2.13, 95 %CI 1.12-4.06) and V60 (HR 1.02 per 1 % increase, 95 %CI 1.01-1.04) remained predictive factors. For active smokers with a high V60 ≥ 40 % we observed rapid ORN development with a 1-year incidence of 29 % vs 6 % for others (p < 0.01). CONCLUSION OCC Patients treated with PORT are at high risk for mandibular ORN. We identified the mandibular volume receiving ≥ 60 Gy as the dominant risk factor, especially in active smokers. Limiting high-dose volumes at treatment planning may decrease ORN risks.
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18
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Hoffmann L, Marschner SN, Kakoschke TK, Hickel R, Sabbagh H, Wölfle UC. Dental management before radiotherapy of the head and neck region: 4-year single-center experience. Clin Exp Dent Res 2022; 8:1478-1486. [PMID: 36089654 PMCID: PMC9760134 DOI: 10.1002/cre2.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/18/2022] [Accepted: 08/27/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To review our experience with a standardized dental management approach in patients with planned radiotherapy of the head and neck region based on preradiation and follow-up data. MATERIAL AND METHODS Records of patients who underwent radiotherapy between June 2016 and November 2020 were reviewed. Data on dental findings and therapeutic recommendations were extracted from a prospectively managed database. Hospital records were used to obtain follow-up data. RESULTS Two hundred eighty-one patient records were identified. After the exclusion of 81 patients because of incomplete data, 200 patients were included in the study. Dental findings relevant to radiotherapy were found in 144 cases (72.0%). Teeth extractions were recommended in 112 (56.0%) patients. Follow-up data were available for 172 (86.0%) patients (mean follow-up: 16.8 ± 10.7 months). Radiodermatitis was the most frequently observed sequela of radiotherapy (42.4%), followed by dysphagia (38.4%) and stomatitis (36.6%). Osteoradionecrosis was observed in only 2.3% of the patients. CONCLUSION Dental findings relevant to planned radiotherapy were frequent and in many cases resulted in recommendations for teeth extraction. Based on our standardized dental management protocol, we observed low rates of late oral complications after radiotherapy of the head and neck region.
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Affiliation(s)
- Lea Hoffmann
- Department of Conservative Dentistry and Periodontology, University HospitalLMU MunichMunichGermany,Department of Orthodontics and Dentofacial Orthopedics, University HospitalLMU MunichMunichGermany
| | - Sebastian N. Marschner
- Department of Radiation Oncology, University HospitalLMU MunichMunichGermany,German Cancer Consortium (DKTK)Partner Site MunichMunichGermany
| | - Tamara K. Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University HospitalLMU MunichMunichGermany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University HospitalLMU MunichMunichGermany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University HospitalLMU MunichMunichGermany
| | - Uta C. Wölfle
- Department of Conservative Dentistry and Periodontology, University HospitalLMU MunichMunichGermany
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Comment on: Osteoradionecrosis after postoperative radiotherapy for oral cavity cancer: A retrospective cohort study. Oral Oncol 2022; 134:106098. [PMID: 36041356 DOI: 10.1016/j.oraloncology.2022.106098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022]
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20
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Singh A, Huryn JM, Kronstadt KL, Yom SK, Randazzo JR, Estilo CL. Osteoradionecrosis of the jaw: A mini review. FRONTIERS IN ORAL HEALTH 2022; 3:980786. [PMID: 35967463 PMCID: PMC9366306 DOI: 10.3389/froh.2022.980786] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022] Open
Abstract
Osteoradionecrosis (ORN) of the jaw is one of the most dreaded complications of head and neck radiation therapy. Despite the evolution of radiation treatment modalities, ORN continues to remain a therapeutic challenge and its etiopathogenesis still remains unclear. It is clinically characterized by exposed necrotic bone within the head and neck radiation field. Over the past years, several studies have reported on the definition, staging, incidence, etiology, and management of this oral complication. In this review, we summarize the literature on ORN and discuss our institutional experience and management strategies that aim to predict and mitigate risk for ORN.
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21
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Agarwal R, Freeman TE, Li MM, Naik AN, Philips RW, Kang SY, Ozer E, Agrawal A, Carrau RL, Rocco JW, Old MO, Seim NB. Outcomes with culture-directed antibiotics following microvascular free tissue reconstruction for osteonecrosis of the jaw. Oral Oncol 2022; 130:105878. [DOI: 10.1016/j.oraloncology.2022.105878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
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22
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Contrera KJ, Chinn SB, Weber RS, Roberts D, Myers JN, Lai SY, Lewis CM, Hessel AC, Gillenwater AM, Mulcahy CF, Yu P, Hanasono MM, Fuller CD, Chambers MS, Zafereo ME. Outcomes after definitive surgery for mandibular osteoradionecrosis. Head Neck 2022; 44:1313-1323. [PMID: 35238096 PMCID: PMC9081223 DOI: 10.1002/hed.27024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). MATERIALS AND METHODS Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. RESULTS Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01-19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19-30.29) and smoking (OR 5.91, 95% CI 1.69-20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16-12.17) and preoperative swallow (OR 3.42, 95% CI 1.23-9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43-8.94). CONCLUSIONS Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.
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Affiliation(s)
- Kevin J. Contrera
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- Department of Plastic and Reconstructive Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven B. Chinn
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan, USA
| | - Randal S. Weber
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Dianna Roberts
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffery N. Myers
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol M. Lewis
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy C. Hessel
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ann M. Gillenwater
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Collin F. Mulcahy
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Peirong Yu
- Department of Plastic and Reconstructive Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew M. Hanasono
- Department of Plastic and Reconstructive Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark S. Chambers
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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Kang Z, Jin T, Li X, Wang Y, Xu T, Wang Y, Huang Z, Huang Z. Progression and postoperative complications of osteoradionecrosis of the jaw: a 20-year retrospective study of 124 non-nasopharyngeal cancer cases and meta-analysis. BMC Oral Health 2022; 22:213. [PMID: 35643546 PMCID: PMC9148447 DOI: 10.1186/s12903-022-02244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To assess the contributing risk factors for the progression of, and the postoperative poor prognosis associated with, osteoradionecrosis of jaw (ORNJ) following non-nasopharyngeal cancer treatment in head and neck. METHODS A retrospective study of 124 non-nasopharyngeal carcinoma patients in head and neck treated at one institution between 2001 and 2020 was conducted. A cumulative meta-analysis was conducted according to PRISMA protocol and the electronic search was performed on the following search engines: PubMed, Embase, and Web of Science. After assessing surgery with jaw lesions as a risk factor for the occurrence of ORNJ, 124 cases were categorized into two groups according to the "BS" classification, after which jaw lesions, chemotherapy, flap reconstruction and onset time of ORNJ were analyzed through the chi-square test and t-test to demonstrate the potential association between them and the progression of ORNJ. Postoperative outcomes of wound healing, occlusal disorders, and nerve injury were statistically analyzed. RESULTS With the statistically significant results of the meta-analysis (odds ratio = 3.07, 95% CI: 1.84-5.13, p < 0.0001), the chi-square test and t-test were used to validate our hypotheses and identified that surgery with jaw lesions could aggravate the progression and accelerate the appearance of ORNJ. Patients who underwent chemotherapy tended to suffer from severe-to-advanced osteonecrosis but did not shorten the onset time of ORNJ. Flap reconstruction presented obvious advantages in wound healing (p < 0.001) and disordered occlusion (p < 0.005). The mean onset time of ORNJ in non-nasopharyngeal cancer patients (4.5 years) was less than that in patients with nasopharyngeal cancer (NPC) (6.8 years). CONCLUSIONS Iatrogenic jaw lesions are evaluated as a significant risk factor in the occurrence and progression of ORNJ in non-nasopharyngeal carcinoma patients who tend to have more severe and earlier osteonecrosis after radiotherapy than NPC patients. Flap reconstruction is a better choice for protecting the remaining bone tissue and reducing postoperative complications of ORNJ.
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Affiliation(s)
- Ziqin Kang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Tingting Jin
- Department of Stomatology, Longgang District Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Xueer Li
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, Guangdong, China
| | - Yuepeng Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Tianshu Xu
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Zixian Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China.
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China.
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Unforeseen Outcomes Post Treatment for Radiation Induced Trismus: A Case Report. MEDICINES 2022; 9:medicines9050031. [PMID: 35622070 PMCID: PMC9147736 DOI: 10.3390/medicines9050031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022]
Abstract
Post radiotherapy radiation trismus presents significant concerns for a patient’s quality of life and for the clinical monitoring for recurrence of head and neck oncology. Current treatments include scar band release surgery that has been shown to be safe and effective. We present a case with a rare, post-operative complication of difficulty of mouth closure that can pose a significant impact on quality of life that should be considered.
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Yong CW, Robinson A, Hong C. Dental Evaluation Prior to Cancer Therapy. FRONTIERS IN ORAL HEALTH 2022; 3:876941. [PMID: 35510226 PMCID: PMC9058061 DOI: 10.3389/froh.2022.876941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
A comprehensive oral examination and dental care prior to the start of cancer therapy is the standard of care in many cancer centers. This is because good oral health will likely minimize the undesirable complications such as opportunistic infections during cancer therapy. As the considerations differ between anti-neoplastic regimens, this chapter discusses the indications and rationale when planning and executing a treatment plan for patients undergoing various cancer therapies.
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Affiliation(s)
- Chee Weng Yong
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Andrew Robinson
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Catherine Hong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Lang K, Held T, Meixner E, Tonndorf-Martini E, Ristow O, Moratin J, Bougatf N, Freudlsperger C, Debus J, Adeberg S. Frequency of osteoradionecrosis of the lower jaw after radiotherapy of oral cancer patients correlated with dosimetric parameters and other risk factors. Head Face Med 2022; 18:7. [PMID: 35219324 PMCID: PMC8881856 DOI: 10.1186/s13005-022-00311-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Osteoradionecrosis (ORN) of the lower jaw is a serious late complication after radiotherapy in patients with oral cavity cancer. The aim of this study is to generate more insight into which patient- and treatment-related factors are associated with the development of ORN in oral cavity cancer patients undergoing postoperative radiotherapy. Material and methods Retrospective evaluation and comparison of 44 patients with ORN (event group 1) matched according to 45 patients without ORN (control group 2) who received postoperative radiotherapy of oral cavity squamous cell carcinoma at our institution between 2012 and 2020. Dosimetric factors that favor the occurrence of ORN should be detected. The cumulative occurrence rate of ORN was calculated according to the Kaplan–Meier method and analyzed by Cox regression and log-rank test. Results The median time to develop ORN was 18 months (3–93 months) after radiotherapy. Dental status before radiotherapy (RT) treatment (HR 4.5; 1.8–11.5) and dosimetric parameters including Dmean > 45 Gy (HR 2.4; 1.0–5.7), Dmax > 60 Gy (HR 1.3; 1.1–2.8) and planning target volume (PTV) proportion > 40% intersection with the lower jaw (HR 1.1; 1.0–1.1) were significantly associated with ORN. Conclusion The results of this retrospective study reveal that oral cavity cancer patients who underwent pre-RT dental surgery as well as dosimetric parameters using Dmax > 60 Gy, higher mean doses > 45 Gy and more than 40% PTV intersection with the lower jaw bone are independent risk factors for ORN. These findings can assist in the management of patients undergoing RT for head and neck cancer regarding ORN prevention. Clinical relevance Poor oral hygiene and desolate dental status as well as high radiation doses to the mandibular bone significantly increase the risk of developing osteoradionecrosis. Before irradiating a patient with oral cavity cancer, an appointment with the dentist should be made and teeth sanitized if necessary. Likewise, maximum radiation doses to the lower jaw should be minimized.
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Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany.
| | - Thomas Held
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany
| | - Eric Tonndorf-Martini
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Treister NS, Brennan MT, Sollecito TP, Schmidt BL, Patton LL, Mitchell R, Haddad RI, Tishler RB, Shadick R, Hodges JS, Lalla RV, Lalla RV. Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad). Cancer 2022; 128:487-496. [PMID: 34665873 PMCID: PMC8776577 DOI: 10.1002/cncr.33948] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) treated with radiation therapy (RT) are at risk for jaw osteoradionecrosis (ORN), which is largely characterized by the presence of exposed necrotic bone. This report describes the incidence and clinical course of and risk factors for exposed intraoral bone in the multicenter Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad) cohort. METHODS Participants were evaluated before RT and at 6, 12, 18, and 24 months after RT. Exposed bone was characterized by location, sequestrum formation, and other associated features. The radiation dose to the affected area was determined, and the history of treatment for exposed bone was recorded. RESULTS The study enrolled 572 participants; 35 (6.1%) were diagnosed with incident exposed bone at 6 (47% of reports), 12 (24%), 18 (20%), and 24 months (8%), with 60% being sequestrum and with 7 cases (20%) persisting for >6 months. The average maximum RT dose to the affected area of exposed bone was 5456 cGy (SD, 1768 cGy); the most frequent associated primary RT sites were the oropharynx (42.9%) and oral cavity (31.4%), and 76% of episodes occurred in the mandible. The diagnosis of ORN was confirmed in 18 participants for an incidence rate of 3.1% (18 of 572). Risk factors included pre-RT extractions (P = .008), a higher RT dose (P = .039), and tobacco use (P = .048). CONCLUSIONS The 2-year incidence of exposed bone in the OraRad cohort was 6.1%; the incidence of confirmed ORN was 3.1%. Exposed bone after RT for HNC is relatively uncommon and, in most cases, is a short-term complication, not a recurring or persistent one.
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Affiliation(s)
- Nathaniel S. Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, 1620 Tremont Street, 3 Floor, Boston, MA 02120, USA. Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Michael T. Brennan
- Department of Oral Medicine, Atrium Health’s Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, USA
| | - Thomas P. Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA. Division of Oral Medicine, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Brian L. Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, New York 10010, USA
| | - Lauren L. Patton
- Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, CB 7450, Chapel Hill, NC, USA
| | - Rebecca Mitchell
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN 55414, USA
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women’s Hospital, 450 Brookline Ave, Boston, MA 02215, United States
| | - Ryann Shadick
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA 02120, USA
| | - James S. Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN 55414, USA
| | - Rajesh V. Lalla
- Section of Oral Medicine, MC3912, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030-3912, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut Health, Farmington, Connecticut
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Balermpas P, van Timmeren JE, Knierim DJ, Guckenberger M, Ciernik IF. Dental extraction, intensity-modulated radiotherapy of head and neck cancer, and osteoradionecrosis : A systematic review and meta-analysis. Strahlenther Onkol 2022; 198:219-228. [PMID: 35029717 PMCID: PMC8863691 DOI: 10.1007/s00066-021-01896-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Abstract
Objective To seek evidence for osteoradionecrosis (ORN) after dental extractions before or after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC). Methods Medline/PubMed, Embase, and Cochrane Library were searched from 2000 until 2020. Articles on HNC patients treated with IMRT and dental extractions were analyzed by two independent reviewers. The risk ratios (RR) and odds ratios (OR) for ORN related to extractions were calculated using Fisher’s exact test. A one-sample proportion test was used to assess the proportion of pre- versus post-IMRT extractions. Forest plots were used for the pooled RR and OR using a random-effects model. Results Seven of 630 publications with 875 patients were eligible. A total of 437 (49.9%) patients were treated with extractions before and 92 (10.5%) after IMRT. 28 (3.2%) suffered from ORN after IMRT. ORN was associated with extractions in 15 (53.6%) patients, eight related to extractions prior to and seven cases related to extractions after IMRT. The risk and odds for ORN favored pre-IMRT extractions (RR = 0.18, 95% CI: 0.04–0.74, p = 0.031, I2 = 0%, OR = 0.16, 95% CI: 0.03–0.99, p = 0.049, I2 = 0%). However, the prediction interval of the expected range of 95% of true effects included 1 for RR and OR. Conclusion Tooth extraction before IMRT is more common than after IMRT, but dental extractions before compared to extractions after IMRT have not been proven to reduce the incidence of ORN. Extractions of teeth before IMRT have to be balanced with any potential delay in initiating cancer therapy. Supplementary Information The online version of this article (10.1007/s00066-021-01896-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Panagiotis Balermpas
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland.
- Medical School, University of Zürich, Zürich, Switzerland.
| | - Janita E van Timmeren
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland
- Medical School, University of Zürich, Zürich, Switzerland
| | - David J Knierim
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland
- Medical School, University of Zürich, Zürich, Switzerland
- Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland
- Medical School, University of Zürich, Zürich, Switzerland
| | - Ilja F Ciernik
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland
- Medical School, University of Zürich, Zürich, Switzerland
- Center of Dental Medicine, University of Zürich, Zürich, Switzerland
- Department of Radiotherapy and Radiation Oncology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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GIRARDI FM, WAGNER VP, MARTINS MD, ABENTROTH AL, HAUTH LA, KRAETHER NETO L, MERGEN C, MATIELLO J. Risk factors for jaw osteoradionecrosis: a case control study. Braz Oral Res 2022; 36:e132. [DOI: 10.1590/1807-3107bor-2022.vol36.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/21/2022] [Indexed: 12/23/2022] Open
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Li Y, Wang X, Pang Y, Wang S, Luo M, Huang B. The Potential Therapeutic Role of Mesenchymal Stem Cells-Derived Exosomes in Osteoradionecrosis. JOURNAL OF ONCOLOGY 2021; 2021:4758364. [PMID: 34899907 PMCID: PMC8660232 DOI: 10.1155/2021/4758364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
As one of the most serious complications of radiotherapy, osteoradionecrosis (ORN) seriously affects the quality of life of patients and even leads to death. Vascular injury and immune disorders are the main causes of bone lesions. The traditional conservative treatment of ORN has a low cure rate and high recurrent. Exosomes are a type of extracellular bilayer lipid vesicles secreted by almost all cell types. It contains cytokines, proteins, mRNA, miRNA, and other bioactive cargos, which contribute to several distinct processes. The favorable biological functions of mesenchymal stem cells-derived exosomes (MSC exosomes) include angiogenesis, immunomodulation, bone regeneration, and ferroptosis regulation. Exploring the characteristic of ORN and MSC exosomes can promote bone regeneration therapies. In this review, we summarized the current knowledge of ORN and MSC exosomes and highlighted the potential application of MSC exosomes in ORN treatment.
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Affiliation(s)
- Yuetian Li
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xinyue Wang
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yu Pang
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shuangcheng Wang
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Meng Luo
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Bo Huang
- State Key Laboratory of Oral Diseases, and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. Radiother Oncol 2021; 166:137-144. [PMID: 34843843 DOI: 10.1016/j.radonc.2021.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials. METHODS AND MATERIALS Patients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Primary outcome was healing of ORN one year after surgery evaluated by a clinically adjusted version of the Common Toxicity Criteria of Adverse Events (CTCAE) v 3.0. Secondary outcomes included xerostomia, unstimulated and stimulated whole salivation rates, trismus, dysphagia, pain, Activities of Daily Living (ADL) and quality of life according to EORTC. Data were combined from two separate trials. Ninety-seven were enrolled and 65 were eligible for the intent-to-treat analysis. The 33% drop-out was equally distributed between groups. RESULTS In group 1, 70% (21/30) healed compared to 51% (18/35) in group 2. HBO was associated with an increased chance of healing independent of baseline ORN grade or smoking status as well as improved xerostomia, unstimulated whole salivary flow rate, and dysphagia. Due to insufficient recruitment, none of the endpoints reached a statistically significant difference between groups. ADL data could only be obtained from 50 patients. CONCLUSION Hyperbaric oxygen did not significantly improve the healing outcome of osteoradionecrosis after surgical removal of necrotic bone as compared to standard care (70% vs. 51%). This effect is not statistically significant due to the fact that the study was underpowered and is therefore prone to type II error.
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Hato H, Sakata KI, Sato J, Satoh A, Hayashi T, Kitagawa Y. Clinical study of treatment methods and associated factors in mandibular osteoradionecrosis. J Oral Sci 2021; 63:289-291. [PMID: 34092776 DOI: 10.2334/josnusd.21-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study aimed to determine the appropriate treatment methods and evaluate associated factors by comparing nonoperative treatment alone with a combination of both nonoperative and surgical treatment in 34 patients with mandibular osteoradionecrosis (mORN). The associated cure factors were analyzed by Cox regression. Propensity scores were calculated from factors that were not significant in the univariate analysis and used as covariates in the multivariate analysis. The cure rate among patients who received nonoperative and surgical treatment was higher than that observed with nonoperative treatment alone. Only the treatment method was associated with cure in both univariate and multivariate analyses.
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Affiliation(s)
- Hiroyuki Hato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
| | - Ken-Ichiro Sakata
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
| | - Jun Sato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
| | - Akira Satoh
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
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Dutheil F, Guillemin F, Biau J, Pham-Dang N, Saroul N, Clavère P, Lapeyre M. [Predictive factors for mandibular osteoradionecrosis after irradiation of head and neck cancers]. Cancer Radiother 2021; 25:484-493. [PMID: 33836955 DOI: 10.1016/j.canrad.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
The identification of the different risk factors for mandibular osteoradionecrosis (ORN) must be done before and after the management of patients with head and neck cancer. Various clinical criteria for this severe radiation-induced complication are related to the patient (intrinsic radiosensitivity, malnutrition associated with thin weight loss, active smoking intoxication, microcapillary involvement, precarious oral status, hyposalivation) and/or related to the disease (oral cavity, large tumor size, tumor mandibular invasion). Therapeutic risk factors are also associated with a higher risk of ORN (primary tumor surgery, concomitant radio-chemotherapy, post-irradiation dental avulsion, preventive non-observance with the absence of stomatological follow-up and daily installation of gutters fluoride and, non-observance curative healing treatments). Finally, various dosimetric studies have specified the parameters in order to target the dose values distributed in the mandible, which increases the risk of ORN. An mean mandibular dose greater than 48-54Gy and high percentages of mandibular volume receiving 40 to 60Gy appear to be discriminating in the risk of developing an ORN.
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Affiliation(s)
- F Dutheil
- Département d'oncologie radiothérapie du CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France; Département d'oncologie radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - F Guillemin
- Département d'oncologie radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - J Biau
- Département d'oncologie radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - N Pham-Dang
- Département de chirurgie maxillo-faciale, CHU Estaing, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - N Saroul
- Département de chirurgie ORL, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Clavère
- Département d'oncologie radiothérapie du CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - M Lapeyre
- Département d'oncologie radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
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Humbert-Vidan L, Patel V, Oksuz I, King AP, Guerrero Urbano T. Comparison of machine learning methods for prediction of osteoradionecrosis incidence in patients with head and neck cancer. Br J Radiol 2021; 94:20200026. [PMID: 33684314 PMCID: PMC8010531 DOI: 10.1259/bjr.20200026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 12/16/2020] [Accepted: 01/25/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Mandible osteoradionecrosis (ORN) is one of the most severe toxicities in patients with head and neck cancer (HNC) undergoing radiotherapy (RT). The existing literature focuses on the correlation of mandible ORN and clinical and dosimetric factors. This study proposes the use of machine learning (ML) methods as prediction models for mandible ORN incidence. METHODS A total of 96 patients (ORN incidence ratio of 1:1) treated between 2011 and 2015 were selected from the local HNC toxicity database. Demographic, clinical and dosimetric data (based on the mandible dose-volume histogram) were considered as model variables. Prediction accuracy (measured using a stratified fivefold nested cross-validation), sensitivity, specificity, precision and negative predictive value were used to evaluate the prediction performance of a multivariate logistic regression (LR) model, a support vector machine (SVM) model, a random forest (RF) model, an adaptive boosting (AdaBoost) model and an artificial neural network (ANN) model. The different models were compared based on their prediction accuracy and using the McNemar's hypothesis test. RESULTS The ANN model (77% accuracy), closely followed by the SVM (76%), AdaBoost (75%) and LR (75%) models, showed the highest overall prediction accuracy. The RF model (71%) showed the lowest prediction accuracy. However, based on the McNemar's test applied to all model pair combinations, no statistically significant difference between the models was found. CONCLUSION Based on our results, we encourage the use of ML-based prediction models for ORN incidence as has already been done for other HNC toxicity end points. ADVANCES IN KNOWLEDGE This research opens a new path towards personalised RT for HNC using ML to predict mandible ORN incidence.
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Affiliation(s)
| | - Vinod Patel
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | | | - Andrew Peter King
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
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Saito I, Hasegawa T, Kawashita Y, Kato S, Yamada SI, Kojima Y, Ueda N, Umeda M, Shibuya Y, Kurita H, Kirita T, Akashi M. Association between dental extraction after radiotherapy and osteoradionecrosis: A multi-centre retrospective study. Oral Dis 2021; 28:1181-1187. [PMID: 33650256 DOI: 10.1111/odi.13826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Radiotherapy (RT) carries a substantial risk for the development of osteoradionecrosis (ORN) of the jaw. This study was performed to investigate the relationship between dental extractions after RT and the development of ORN. MATERIAL AND METHODS Thirty-two patients with head and neck cancer who underwent tooth extraction after RT were investigated for correlations between the development of ORN and various factors. RESULTS Postextraction ORN was diagnosed in 12 (12.1%) teeth of 9 patients. The RT dose against the site of tooth extraction was 62.0 and 37.4 Gy in the ORN and Non-ORN groups, respectively (p < .001). The duration from RT to tooth extraction was 41.2 and 28.2 months in the ORN and Non-ORN groups, respectively (p = .025). Tooth extraction was significantly associated with ORN in patients with a high RT dose against the site (odds ratio = 1.231) and a longer duration of time from RT (odds ratio = 1.084). CONCLUSIONS Extraction of non-restorable teeth and those with a poor prognosis should not necessarily be postponed even when patients are undergoing RT. However, clinicians should pay special attention to postoperative management after tooth extraction in patients with a high RT dose and longer time from RT.
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Affiliation(s)
- Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yumiko Kawashita
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Shinichiro Kato
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuka Kojima
- Department of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Yasuyuki Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Kubota H, Miyawaki D, Mukumoto N, Ishihara T, Matsumura M, Hasegawa T, Akashi M, Kiyota N, Shinomiya H, Teshima M, Nibu KI, Sasaki R. Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma. Radiat Oncol 2021; 16:1. [PMID: 33402192 PMCID: PMC7786900 DOI: 10.1186/s13014-020-01701-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters. METHODS We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation. RESULTS Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). CONCLUSIONS V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.
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Affiliation(s)
- Hikaru Kubota
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Naritoshi Mukumoto
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Megumi Matsumura
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomi Kiyota
- Kobe University Hospital Cancer Center, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan.
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Frankart AJ, Frankart MJ, Cervenka B, Tang AL, Krishnan DG, Takiar V. Osteoradionecrosis: Exposing the Evidence Not the Bone. Int J Radiat Oncol Biol Phys 2021; 109:1206-1218. [PMID: 33412258 DOI: 10.1016/j.ijrobp.2020.12.043] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 12/25/2022]
Abstract
Osteoradionecrosis is a relatively rare but potentially morbid and costly complication of radiation therapy for head and neck cancer. Multidisciplinary diagnosis and treatment are essential. Despite evidence guiding individual aspects of care for osteoradionecrosis, there is a lack of broad consensus on the overall diagnosis and management of this condition. This study comprehensively reviews the literature, with a focus on the past 10 years, to guide evaluation and treatment.
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Affiliation(s)
- Andrew J Frankart
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Deepak G Krishnan
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio; Cincinnati VA Medical Center, Cincinnati, Ohio.
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O'Connell JE, Brown JS, Rogers SN, Bekiroglu F, Schache A, Shaw RJ. Outcomes of microvascular composite reconstruction for mandibular osteoradionecrosis. Br J Oral Maxillofac Surg 2020; 59:1031-1035. [PMID: 34531074 DOI: 10.1016/j.bjoms.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022]
Abstract
The aim of this retrospective study was to compare outcomes and reconstruction-related complications in patients receiving a composite free flap reconstruction of the mandible for ORN with those reconstructed for other indications. The records of all patients who underwent composite reconstruction of a mandibular defect at Aintree University Hospital, Liverpool, were reviewed and analysed. Based on radiotherapy exposure and ORN history, the study cohort was divided into three separate case-matched groups. Local wound healing issues were markedly more common in the ORN setting, as was infection and subsequent osteosynthesis plate(s) removal. Free flap survival was similar among all three case-matched groups. Advanced mandibular ORN may be safely and predictably reconstructed with composite free flaps, and that while the rate of local complications is greater than non-irradiated, and non-ORN case-matched controls, the free flap survival rate compares favourably.
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Affiliation(s)
- J E O'Connell
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL.
| | - J S Brown
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL
| | - S N Rogers
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - F Bekiroglu
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL
| | - A Schache
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Liverpool Head & Neck Centre, University of Liverpool Cancer Research Centre, 200 London Road Liverpool L3 9TA
| | - R J Shaw
- Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Liverpool Head & Neck Centre, University of Liverpool Cancer Research Centre, 200 London Road Liverpool L3 9TA
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Lajolo C, Gioco G, Rupe C, Troiano G, Cordaro M, Lucchese A, Paludetti G, Giuliani M. Tooth extraction before radiotherapy is a risk factor for developing osteoradionecrosis of the jaws: A systematic review. Oral Dis 2020; 27:1595-1605. [PMID: 32531873 DOI: 10.1111/odi.13485] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this systematic review was to estimate the osteoradionecrosis rate in patients with head and neck cancer due to teeth extraction performed before radiotherapy and to identify possible risk factors. MATERIAL AND METHODS PRISMA protocol was used to evaluate and present the results. PubMed, Scopus and Web of Science were used as search engines: English full-length papers of clinical studies, in peer-reviewed journals, were investigated. Cumulative meta-analysis was performed with a random effects model (PROSPERO registration code: CRD42018079986). RESULTS Among 2,020 records screened, 8 were included in this review. Sixteen of 494 patients who underwent tooth extraction before radiotherapy developed osteoradionecrosis, with an osteoradionecrosis incidence of 2.2% (95% Confidence of Interval = 0.6-3.9, p < .185, I2 = 3,044%). All cases were reported in the mandible. No other clinical risk factor for osteoradionecrosis was detected. CONCLUSIONS Even if it is generally recommended to remove oral foci before radiotherapy, this systematic review confirmed that teeth extractions before radiotherapy represent a risk factor for osteoradionecrosis; the considerable amount of missing data prevented us from identifying other possible risk factors for osteoradionecrosis onset. Major efforts should be done to perform sounder methodological clinical investigations.
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Affiliation(s)
- Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gioele Gioco
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Cordaro
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - Gaetano Paludetti
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Giuliani
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Piotrowski SL, Wilson L, Maldonado KL, Tailor R, Hill LR, Bankson JA, Lai S, Kasper FK, Young S. Effect of Radiation on DCE-MRI Pharmacokinetic Parameters in a Rabbit Model of Compromised Maxillofacial Wound Healing: A Pilot Study. J Oral Maxillofac Surg 2020; 78:1034.e1-1034.e10. [PMID: 32147226 DOI: 10.1016/j.joms.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Osteoradionecrosis (ORN), a potentially debilitating complication of maxillofacial radiation, continues to present a challenging clinical scenario, with limited treatment options that often fail. Translational animal models that can accurately mimic the human characteristics of the condition are lacking. In the present pilot study, we aimed to characterize the effects of radiation on the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) pharmacokinetic parameters in a rabbit model of compromised maxillofacial wound healing to determine its potential as a translational model of ORN. MATERIALS AND METHODS An experimental group underwent fractionated radiation of the mandible totaling 36 Gy. At 4 weeks after irradiation, the experimental and control groups (n = 8 rabbits each) underwent a surgical procedure to create a critical size defect in the mandibular bone. DCE-MRI scans were acquired 1 week after arrival (baseline; time point 1), 4 weeks after completion of irradiation in the experimental group (just before surgery, time point 2), and 4 weeks after surgery (time point 3). RESULTS No differences in the analyzed DCE-MRI parameters were noted within the experimental or control group between the baseline values (time point 1) and those after irradiation (time point 2). The whole blood volume fraction (vb) in the experimental group was increased compared with that in the control group after irradiation (time point 2; P < .05). After surgery (time point 3), both the forward flux rate of contrast from blood plasma and the extracellular extravascular space and the vb were increased in the control group compared with the experimental group (P < .05). CONCLUSIONS The results of the present study suggest that DCE-MRI of a rabbit model of compromised maxillofacial wound healing could reflect the DCE-MRI characteristics of human patients with ORN and those at risk of developing the condition. Future studies will focus on further characterization of this rabbit model as a translational preclinical model of ORN.
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Affiliation(s)
- Stacey L Piotrowski
- Anatomic Pathology Resident and PhD Student, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN; and Molecular Pathology Fellow, National Institutes of Health Comparative Biomedical Scientist Training Program, Bethesda, MD
| | - Lindsay Wilson
- Research Assistant III, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Kiersten L Maldonado
- Imaging Research Technician, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ramesh Tailor
- Associate Professor, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lori R Hill
- Associate Professor, Department of Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James A Bankson
- Professor, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen Lai
- Professor, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - F Kurtis Kasper
- Associate Professor, Department of Orthodontics, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX
| | - Simon Young
- Assistant Professor, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX.
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Willaert R, Nevens D, Laenen A, Batstone M, Politis C, Nuyts S. Does intensity-modulated radiation therapy lower the risk of osteoradionecrosis of the jaw? A long-term comparative analysis. Int J Oral Maxillofac Surg 2019; 48:1387-1393. [DOI: 10.1016/j.ijom.2019.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/05/2019] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
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Muraki Y, Akashi M, Ejima Y, Hasegawa T, Miyawaki D, Shinomiya H, Nishii M, Otsuki N, Sasaki R, Nibu KI, Komori T. Dental intervention against osteoradionecrosis of the jaws in irradiated patients with head and neck malignancy: a single-arm prospective study. Oral Maxillofac Surg 2019; 23:297-305. [PMID: 31172389 DOI: 10.1007/s10006-019-00783-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effectiveness of dental intervention before and after radiation therapy (RT) for head and neck malignancy on prevention of osteoradionecrosis (ORN) of the jaws. METHODS This is a single-arm prospective study according to intervention protocol of prophylactic dental extraction before RT and routine follow-up after RT. The primary endpoint was the occurrence of jawbone exposure during the first 2 years after RT. RESULTS Sixty-seven patients were assessed. Before RT, 144 teeth among 39 patients (58%) were prophylactically extracted. The occurrence of transient jawbone exposure during the first 2 years after RT was 7%. Because those jawbone exposures healed with intervention after RT, no jawbone exposure was found at 2 years after RT. CONCLUSIONS Dental intervention both before and after RT seemed to be important to prevent ORN development. Further studies in larger cohorts are necessary.
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Affiliation(s)
- Yumi Muraki
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yasuo Ejima
- Department of Radiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mika Nishii
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Miniello TG, Araújo JP, Silva MLG, Paulo Kowalski L, Rocha AC, Jaguar GC, Abreu Alves F. Influence of bisphosphonates on clinical features of osteoradionecrosis of the maxilla and mandible. Oral Dis 2019; 25:1344-1351. [DOI: 10.1111/odi.13081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Juliane Pirágine Araújo
- Stomatology Department, School of Dentistry São Paulo University São Paulo Brazil
- Stomatology Department A.C. Camargo Cancer Center São Paulo Brazil
| | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department A.C. Camargo Cancer Center São Paulo Brazil
| | | | | | - Fábio Abreu Alves
- Stomatology Department, School of Dentistry São Paulo University São Paulo Brazil
- Stomatology Department A.C. Camargo Cancer Center São Paulo Brazil
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Renda L, Tsai TY, Huang JJ, Ito R, Hsieh WC, Kao HK, Hung SY, Huang Y, Huang YC, Chang YL, Cheng MH, Chang KP. A nomogram to predict osteoradionecrosis in oral cancer after marginal mandibulectomy and radiotherapy. Laryngoscope 2019; 130:101-107. [PMID: 30786034 DOI: 10.1002/lary.27870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/15/2019] [Accepted: 01/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE There is no useful tool to clinically predict the occurrence of osteoradionecrosis (ORN) of the mandible quantitatively. The aim was to investigate the risk factors, including different modalities of radiotherapy, for developing mandibular ORN in patients undergoing marginal mandibulectomy and postoperative radiotherapy. METHODS Between January 2006 and December 2012, 167 subjects who underwent marginal mandibulectomy and postoperative radiotherapy with different modalities were enrolled. The association of ORN with mandibular bone measurements and patient variables was analyzed, and a nomogram was established. RESULTS Fifteen (8.98%) of the 167 patients developed ORN during the follow-up period, and ORN was significantly associated with diabetes mellitus (DM), body mass index (BMI), remaining bone height, remaining bone height to original bone height ratio, resected bone height to original bone height ratio, and mandibular dose (P: < 0.001, 0.004, 0.042, 0.018, 0.010, 0.020, respectively). Interestingly, the risk of ORN had no significant difference between conformal and intensity modulation radiation therapy (P = 0.407). Multivariate analysis revealed that DM and resected bone height to original bone height ratio ≥ 50% were independent risk factors for postoperative ORN. A nomogram consisting of BMI, DM, resected bone height to original bone height ratio, mandibulotomy, and mandibular dose for predicting the ORN-free probability was established; and the c-index of the nomogram for ORN status was 0.803. CONCLUSION A nomogram based on the risk factors was plotted to strengthen the prediction of ORN quantitatively. Surgeons should be more discrete regarding the treatment plan for patients with higher probability of ORN. LEVEL OF EVIDENCE 3b Laryngoscope, 130:101-107, 2020.
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Affiliation(s)
- Levent Renda
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey
| | - Tsung-You Tsai
- Department of Pathology, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Jung-Ju Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ran Ito
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Wei-Chuan Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Yenlin Huang
- Department of Pathology, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Yu-Chen Huang
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Yu-Liang Chang
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Ming-Huei Cheng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Magremanne M. Successful treatment of grade III osteoradionecrosis with mandibular fracture with pentoxifylline, tocopherol and clodronate. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:518-522. [PMID: 29936237 DOI: 10.1016/j.jormas.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/17/2018] [Indexed: 11/16/2022]
Abstract
Osteoradionecrosis (ORN) is one of the most severe complications after head and neck radiotherapy. Once established, ORN is difficult to manage and is traditionally considered to be irreversible. Since the recent understanding of the pathophysiology of ORN is based on the concept of radiation-induced fibrosis, a new therapeutic medical regimen has been proposed comprising the combination of pentoxifylline, tocopherol and clodronate (PENTOCLO). A 55-year-old woman presented with grade III ORN with large intraoral bone exposure, a fracture of the left posterior horizontal branch and an orocutaneous fistula. Because she refused surgery, medical treatment with PENTOCLO was proposed. After 55months of treatment, there was complete mucosal coverage and complete consolidation of the fracture site around the orocutaneous fistula. PENTOCLO treatment can help some patients with grade III disease, as in this case. Further prospective randomized controlled trials are needed to confirm this result.
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Affiliation(s)
- M Magremanne
- Department of oral and maxillofacial surgery, institut Roi Albert II, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Brussels, Belgium.
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Foster CC, Melotek JM, Brisson RJ, Seiwert TY, Cohen EEW, Stenson KM, Blair EA, Portugal L, Gooi Z, Agrawal N, Vokes EE, Haraf DJ. Definitive chemoradiation for locally-advanced oral cavity cancer: A 20-year experience. Oral Oncol 2018; 80:16-22. [PMID: 29706184 DOI: 10.1016/j.oraloncology.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/14/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. MATERIALS AND METHODS Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70-75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. RESULTS 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. CONCLUSION Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.
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Affiliation(s)
- Corey C Foster
- Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Avenue, M/C 9006, Chicago, IL 60637, USA
| | - James M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Avenue, M/C 9006, Chicago, IL 60637, USA
| | - Ryan J Brisson
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309, USA
| | - Tanguy Y Seiwert
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Kerstin M Stenson
- Department of Otolaryngology, Rush University, 1611 W. Harrison Street, Suite 550, Chicago, IL 60612, USA
| | - Elizabeth A Blair
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Louis Portugal
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Zhen Gooi
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Nishant Agrawal
- Department of Otolaryngology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Everett E Vokes
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Daniel J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, 5758 S. Maryland Avenue, M/C 9006, Chicago, IL 60637, USA.
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Akashi M, Wanifuchi S, Iwata E, Takeda D, Kusumoto J, Furudoi S, Komori T. Differences between osteoradionecrosis and medication-related osteonecrosis of the jaw. Oral Maxillofac Surg 2018; 22:59-63. [PMID: 29224060 DOI: 10.1007/s10006-017-0667-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/05/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The appearance of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) is similar, but clinically important differences between ORN and MRONJ exist. The aim of this study was to compare the clinical data between ORN and MRONJ and to reveal the critical differences between these diseases. METHODS We retrospectively reviewed the epidemiological data, clinical findings, and treatment in 27 ORN and 61 MRONJ patients. Radiographic signs before the initiation of treatment were also assessed. RESULTS The median age (P = 0.0474) and the ratio of female to male patients (P < 0.0001) were significantly higher in MRONJ patients. There were significantly more MRONJ patients who reported a history of pain when compared with ORN patients (P = 0.0263). As an aetiological factor, tooth extraction was significantly more relevant to MRONJ than ORN (P = 0.0352). When assessing the radiographic signs on computed tomographic images, periosteal reaction was found only in MRONJ patients (P = 0.0158). Minimal debridement was performed significantly more frequently for MRONJ (P = 0.0093), and by contrast, surgical resection was performed more frequently for ORN (P = 0.0002). CONCLUSIONS Understanding the clinical and underlying pathological differences between ORN and MRONJ probably contributes to the selection of appropriate treatment for each patient.
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Affiliation(s)
- Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan.
| | - Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
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50
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Sampath S, Vora N, Zumsteg Z. Radiation Therapy for the Head and Neck Patient: Advances, Challenges, and Perspectives. Cancer Treat Res 2018; 174:145-162. [PMID: 29435841 DOI: 10.1007/978-3-319-65421-8_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Radiation therapy for head and neck malignancies has made remarkable advances in treatment technology, resulting in improved clinical and functional outcomes. It is necessary for the radiation oncologist to have a complex understanding of the patient's tumor and its relationship to the surrounding normal anatomy, in order to safely limit dose to normal tissues. Complications following radiation can be managed with timely intervention, usually on an outpatient basis. This chapter will discuss the technological advances in the field, the impact of human papillomavirus (HPV)-mediated disease on radiation treatment, efforts to limit dose to critical salivary and swallowing structures, and management of certain radiation-related toxicities.
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Affiliation(s)
- Sagus Sampath
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, USA.
| | - Nayana Vora
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, USA
| | - Zachary Zumsteg
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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