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Tatsuno S, Doi H, Inada M, Uehara T, Wada Y, Ishikawa K, Tanaka K, Kitano M, Nishimura Y. Clinical outcomes and failure patterns after postoperative radiotherapy for oral cavity squamous cell carcinoma. Strahlenther Onkol 2024; 200:389-399. [PMID: 37999789 DOI: 10.1007/s00066-023-02171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/10/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE This study aimed to assess recurrence patterns and identify the optimal dose and target volumes of postoperative radiotherapy (PORT) in patients with oral cavity squamous cell carcinoma (OSCC). METHODS Data of 111 patients who received PORT for OSCC between January 2010 and April 2020 were retrospectively reviewed. The median age was 68 years (range 19-88). PORT was administered as initial treatment to 63 patients and as salvage treatment for recurrent tumors to 48 patients. The median prescribed dose was 60 Gy (range 50-66) administered in 30 fractions (range 25-33). RESULTS Median follow-up time was 73 months (range 24-147). Overall survival (OS), progression-free survival (PFS), local control (LC), and locoregional control (LRC) at 3 years were 55.6%, 45.6%, 74.6%, and 63.1%, respectively. There were no significant differences in OS, PFS, LC, and LRC between the initially diagnosed and postoperative recurrent cases. Of 22 patients (20%) who developed regional nodal recurrences, 17 (15%) and 11 (10%) had in-field and out-of-field recurrences, respectively. Of 105 patients who received irradiation to the primary tumor bed, 24 (23%) developed recurrence at the primary site. The PFS and LC rates were significantly worse in patients receiving ≤ 56 Gy to the primary site than those receiving > 56 Gy (p = 0.016 and p = 0.032, respectively). CONCLUSION PORT was effective for postoperative recurrences as well as for initially diagnosed oral cavity cancer. Doses greater than 56 Gy to the primary site may be required in PORT for OSCC.
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Affiliation(s)
- Saori Tatsuno
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan.
| | - Masahiro Inada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan
| | - Takuya Uehara
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan
| | - Yutaro Wada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan
| | - Kazuki Ishikawa
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-Higashi, Osaka-Sayama, Japan
| | - Mutsukazu Kitano
- Department of Otolaryngology-Head and Neck Surgery, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-Higashi, Osaka-Sayama, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Osaka, Ohno-higashi, Osaka-Sayama, Japan
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Tsur N, Segal E, Kurman N, Tzelnick S, Wiesel O, Wilk L, Hamzany Y, Bachar G, Shoffel-Havakuk H. Post-radiotherapy osteomyelitis of the cervical spine in head and neck cancer patients. BJR Open 2023; 5:20230001. [PMID: 37942493 PMCID: PMC10630972 DOI: 10.1259/bjro.20230001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To evaluate patient characteristics, risk factors, disease course, and management of cervical vertebral osteomyelitis in patients who had radiation for head and neck cancers. Methods A retrospective cohort study (case series) of patients diagnosed with post-radiation osteomyelitis of the cervical spine between 2012 and 2021. Data were collected from the patient's medical files. Results Seven patients (71% male) with post-radiation cervical osteomyelitis were reviewed. The median patient age was 64 years. The mean interval between diagnosis of osteomyelitis and the first and last radiotherapy course was 8.3 and 4.0 years, respectively. A medical or surgical event preceded the diagnosis in four patients (57%) by a mean of 46.25 days. Common imaging findings were free air within the cervical structures and fluid collection. Four patients recovered from osteomyelitis during the follow-up within an average of 65 days. Conclusion Post-radiation osteomyelitis is characterized by a subtle presentation, challenging diagnosis, prolonged treatment, and poor outcome. Clinicians should maintain a high index of suspicion for the long-term after radiotherapy. Multidisciplinary evaluation and management are warranted. Advances in knowledge The study describes post-radiotherapy osteomyelitis of the cervical spine, a rare and devastating complication. Literature data regarding this complication are sparse.
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Affiliation(s)
| | - Ella Segal
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
| | | | | | | | - Lior Wilk
- Division of Diagnostic and Interventional Imaging, Soroka, University Medical Center, Beer-Sheva, Israel
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Tufano-Sugarman AM, Wang KY, Kohn N, Ghaly M, Parashar B, Frank D, Kamdar D, Pereira L, Fantasia J, Seetharamu N. Osteoradionecrosis versus Cancer Recurrence: An Unresolved Clinical Dilemma. ORL J Otorhinolaryngol Relat Spec 2022; 85:28-35. [PMID: 36455537 DOI: 10.1159/000527261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/05/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Osteoradionecrosis is a rare and debilitating risk of definitive chemoradiotherapy for head and neck squamous cell carcinoma. It is difficult to distinguish between osteoradionecrosis and recurrent or progressive disease, as clinical and radiologic features may be similar. Our aim was to compare the clinical presentation and radiologic features of osteonecrosis with those of recurrent or progressive cancer. METHODS We conducted a single-center case series of 19 patients with head and neck squamous cell carcinoma diagnosed between 2011 and 2019 who subsequently developed clinical and/or radiological suspicion of osteoradionecrosis. The population was a referred sample from head and neck cancer physicians at Northwell Health Cancer Institute. Clinician notes and imaging reports were reviewed to assign a final diagnosis of either cancer, osteonecrosis, or indeterminate. RESULTS No differences were found in the clinical presentation or radiologic features between groups. Median time between treatment and development of symptoms was longer in patients with a final diagnosis of osteoradionecrosis than recurrent or progressive disease (5 vs. 3 months), but this difference was not statistically significant. Radiation dose and type were not associated with diagnosis. Mean standard uptake value maximums on positron emission tomography/computed tomography were significantly higher in the cancer group (median 14.8 vs. 9.1, p < 0.0152). At 1 year after first suspicion of osteoradionecrosis, 100% of osteoradionecrosis patients were alive, versus 28.6% of cancer patients. DISCUSSION/CONCLUSION There is significant overlap in clinical and radiologic features of osteoradionecrosis and cancer. Standard uptake maximums may be helpful in predicting diagnosis. Occurrence of symptoms within 6 months of completing chemoradiotherapy should raise the concern for malignancy.
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Affiliation(s)
- Andrea M Tufano-Sugarman
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Kevin Y Wang
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Nina Kohn
- Biostatistics Department, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Maged Ghaly
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Bhupesh Parashar
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Douglas Frank
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Dev Kamdar
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Lucio Pereira
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - John Fantasia
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Nagashree Seetharamu
- Department of Hematology Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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Tassone P, Clookey S, Topf M, Galloway T, Dooley L, Zitsch R. Quality of life after segmental mandibulectomy and free flap for mandibular osteonecrosis: Systematic review. Am J Otolaryngol 2022; 43:103586. [PMID: 35961223 DOI: 10.1016/j.amjoto.2022.103586] [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: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Review QOL outcomes among patients undergoing segmental mandibulectomy and bony free flap reconstruction for ONJ. DATA SOURCES PubMed was searched for MeSH terms "Quality of life," "Osteonecrosis," "Osteoradionecrosis," "Bisphosphonate-associated osteonecrosis of the jaw," "Free tissue flaps," and "Mandibular reconstruction." REVIEW METHODS English language studies with QOL outcomes data for patients undergoing free flap reconstruction for advanced ONJ were included. 197 records were initially screened; 18 full texts assessed; 10 full texts included. PRISMA guidelines were followed. RESULTS Ten studies were included in this systematic review: six retrospective, three retrospective with comparison groups, and one prospective. In studies with comparison groups, ONJ patients have worse self-reported QOL than the general population as well as head and neck cancer patients without ONJ. Nearly all patients with QOL measurements (220/235 patients) had ONJ from prior radiation. Segmental mandibulectomy and bony free flap improved overall QOL in over half of patients, as well as pain associated with ONJ in 70-75 % of patients. Surgery did not improve long-term effects of radiation such as chewing, swallowing, and salivary production. Donor site morbidity rarely affects QOL. CONCLUSIONS Osteonecrosis of the jaw (ONJ) worsens quality-of-life, and advanced disease often requires segmental mandibulectomy and bony free flap reconstruction. Patients and surgeons may expect improvement in some, but not all, domains of patient-reported QOL by the use of segmental mandibulectomy and reconstruction for advanced ONJ.
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Affiliation(s)
- Patrick Tassone
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Michael Topf
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tabitha Galloway
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Laura Dooley
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Robert Zitsch
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
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Huang YF, Lin KC, Liu SP, Chang CT, Muo CH, Chang PJ, Tsai CH, Wu CZ. The association between the severity of periodontitis and osteonecrosis of the jaw in patients with different cancer locations: a nationwide population-based study. Clin Oral Investig 2022; 26:3843-3852. [PMID: 35482084 DOI: 10.1007/s00784-021-04175-1] [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: 05/24/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the relation between the severity of periodontitis and osteonecrosis of the jaw (ONJ) occurrence among different cancer locations and estimate the effect of dental care on ONJ prevention in cancer patients. MATERIALS AND METHODS This population-based cross-sectional study was conducted through the Longitudinal Health Insurance Database, Taiwan. Patients with malignancies were collected and subdivided into groups according to their different cancer locations, the severity of periodontitis, and dental care. Multivariable logistic regression analysis was performed to assess the associations between ONJ and ONJ-related factors. RESULTS A total of 8,234 ONJ patients and 32,912 control patients were investigated. Lip, oral cavity, and pharynx malignancies had the highest ONJ risk among all cancer locations (OR from 3.07 to 9.56, P < 0.01). There is a linear relationship between different severities of periodontitis and ONJ. Patients with radiotherapy and severe periodontitis had the highest ONJ risk (adjusted OR, 9.56; 95% CI, 5.34-17.1). Patients with good dental care had a lower ONJ risk. CONCLUSIONS The periodontal condition and cancer location showed a significant impact on the risk of developing ONJ after adjusting for bisphosphonate use. Good dental care could decrease the risk of ONJ in cancer patients. The severity of periodontitis might be a target to predict the potency of ONJ. CLINICAL RELEVANCE Dentists must be vigilant about the increased risk of ONJ in cancer patients with periodontitis, especially in the head and neck cancer population. Good dental care is advised for cancer patients with severe periodontitis.
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Affiliation(s)
- Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Kuan-Chou Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, 11696, Taiwan
| | - Shih-Ping Liu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, 40402, Taiwan
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, 40402, Taiwan
- Department of Social Work, Asia University, Taichung, 41354, Taiwan
| | - Chung-Ta Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, 22056, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Po-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
| | - Chun-Hao Tsai
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, 40402, Taiwan
- Department of Orthopedics, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Ching-Zong Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan.
- Department of Dentistry, Taipei Medical University Hospital, Taipei, 11031, Taiwan.
- Department of Dentistry, Lotung Poh-Ai Hospital, Yilan, 26546, Taiwan.
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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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van Dijk LV, Abusaif AA, Rigert J, Naser MA, Hutcheson KA, Lai SY, Fuller CD, Mohamed ASR. Normal Tissue Complication Probability (NTCP) Prediction Model for Osteoradionecrosis of the Mandible in Patients With Head and Neck Cancer After Radiation Therapy: Large-Scale Observational Cohort. Int J Radiat Oncol Biol Phys 2021; 111:549-558. [PMID: 33965514 PMCID: PMC8906058 DOI: 10.1016/j.ijrobp.2021.04.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Osteoradionecrosis (ORN) of the mandible represents a severe, debilitating complication of radiation therapy (RT) for head and neck cancer (HNC). At present, no normal tissue complication probability (NTCP) models for risk of ORN exist. The aim of this study was to develop a multivariable clinical/dose-based NTCP model for the prediction of ORN any grade (ORNI-IV) and grade IV (ORNIV) after RT (±chemotherapy) in patients with HNC. METHODS AND MATERIALS Included patients with HNC were treated with (chemo-)RT between 2005 and 2015. Mandible bone radiation dose-volume parameters and clinical variables (ie, age, sex, tumor site, pre-RT dental extractions, chemotherapy history, postoperative RT, and smoking status) were considered as potential predictors. The patient cohort was randomly divided into a training (70%) and independent test (30%) cohort. Bootstrapped forward variable selection was performed in the training cohort to select the predictors for the NTCP models. Final NTCP model(s) were validated on the holdback test subset. RESULTS Of 1259 included patients with HNC, 13.7% (n = 173 patients) developed any grade ORN (ORNI-IV primary endpoint) and 5% (n = 65) ORNIV (secondary endpoint). All dose and volume parameters of the mandible bone were significantly associated with the development of ORN in univariable models. Multivariable analyses identified D30% and pre-RT dental extraction as independent predictors for both ORNI-IV and ORNIV best-performing NTCP models with an area under the curve (AUC) of 0.78 (AUCvalidation = 0.75 [0.69-0.82]) and 0.81 (AUCvalidation = 0.82 [0.74-0.89]), respectively. CONCLUSIONS This study presented NTCP models based on mandible bone D30% and pre-RT dental extraction that predict ORNI-IV and ORNIV (ie, needing invasive surgical intervention) after HNC RT. Our results suggest that less than 30% of the mandible should receive a dose of 35 Gy or more for an ORNI-IV risk lower than 5%. These NTCP models can improve ORN prevention and management by identifying patients at risk of ORN.
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Affiliation(s)
- Lisanne V van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, NL.
| | - Abdelrahman A Abusaif
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jillian Rigert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katherine A Hutcheson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Shaikh N, Makary CA, Ryan L, Reyes C. Treatment Outcomes for Osteoradionecrosis of the Central Skull Base: A Systematic Review. J Neurol Surg B Skull Base 2021; 83:e521-e529. [PMID: 35832934 DOI: 10.1055/s-0041-1733973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objective Osteoradionecrosis (ORN) of the skull base can have catastrophic consequences if not detected early and managed appropriately. This is a systematic review of the different treatment modalities for skull base ORN and their outcomes.
Study Design This study is a systematic review.
Materials and Methods Two researchers extracted information including patient population, surgical technique, outcomes of interest, and study design. A computerized search of Medline, Embase, and the Cochrane library (January 1990–June 2020) looked for several papers on the subject of skull base ORN.
Results A total of 29 studies had met inclusion criteria, including data from 333 patients. Nasopharyngeal carcinoma was the most common primary tumor (85%). Average age at diagnosis of ORN was 55.9 years (range = 15–80 years) and 72.3% of patients were males. The average time to diagnosis of ORN after radiation therapy was 77 months with an average radiation dose of 76.2 Gy (range = 46–202 Gy). Nighty-eight patients (29.4%) also had chemotherapy as part of their treatment regimen. Although all parts of the central skull base were reported to be involved, the clivus and sphenoid bone were the most commonly reported subsites. Trial of medical treatment had a success rate of 41.1%. About 66% of patients needed surgical treatment, either primarily or after failing medical treatment. Success rate was 77.3%. Overall, the surgical treatment was superior to medical treatment (p < 0.0001).
Conclusion ORN is a rare complication of the treatment of skull base tumors. Most cases require surgical treatment, including endoscopic debridement or free flap reconstruction, which has a high success rate.
Level of Evidence Level 3 evidence as a systematic review of case studies, case reports, retrospective, and prospective trials with no blinding or controls.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, United States
| | - Chadi A. Makary
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, United States
| | - Lindsey Ryan
- Department of Otolaryngology, Augusta University, Augusta, Georgia, United States
| | - Camilo Reyes
- Department of Otolaryngology, Augusta University, Augusta, Georgia, United States
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Sweeny L, Mayland E, Swendseid BP, Curry JM, Kejner AE, Thomas CM, Kain JJ, Cannady SB, Tasche K, Rosenthal EL, DiLeo M, Luginbuhl AJ, Theeuwen H, Sarwary JR, Petrisor D, Wax MK. Microvascular Reconstruction of Osteonecrosis: Assessment of Long-term Quality of Life. Otolaryngol Head Neck Surg 2021; 165:636-646. [PMID: 33618563 DOI: 10.1177/0194599821990682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. STUDY DESIGN Retrospective multi-institutional review. SETTING Tertiary care centers. METHODS Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. RESULTS Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). CONCLUSION The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.
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Affiliation(s)
- Larissa Sweeny
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Erica Mayland
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Brian P Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Carissa M Thomas
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua J Kain
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steve B Cannady
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kendall Tasche
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Michael DiLeo
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Adam J Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Juliana R Sarwary
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel Petrisor
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Mark K Wax
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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van Baar GJC, Leeuwrik L, Lodders JN, Liberton NPTJ, Karagozoglu KH, Forouzanfar T, Leusink FKJ. A Novel Treatment Concept for Advanced Stage Mandibular Osteoradionecrosis Combining Isodose Curve Visualization and Nerve Preservation: A Prospective Pilot Study. Front Oncol 2021; 11:630123. [PMID: 33692960 PMCID: PMC7937888 DOI: 10.3389/fonc.2021.630123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Osteoradionecrosis (ORN) of the mandible is a severe complication of radiation therapy in head and neck cancer patients. Treatment of advanced stage mandibular osteoradionecrosis may consist of segmental resection and osseous reconstruction, often sacrificing the inferior alveolar nerve (IAN). New computer-assisted surgery (CAS) techniques can be used for guided IAN preservation and 3D radiotherapy isodose curve visualization for patient specific mandibular resection margins. This study introduces a novel treatment concept combining these CAS techniques for treatment of advanced stage ORN. Methods Our advanced stage ORN treatment concept includes consecutively: 1) determination of the mandibular resection margins using a 3D 50 Gy isodose curve visualization, 2) segmental mandibular resection with preservation of the IAN with a two-step cutting guide, and 3) 3D planned mandibular reconstruction using a hand-bent patient specific reconstruction plate. Postoperative accuracy of the mandibular reconstruction was evaluated using a guideline. Objective and subjective IAN sensory function was tested for a period of 12 months postoperatively. Results Five patients with advanced stage ORN were treated with our ORN treatment concept using the fibula free flap. A total of seven IANs were salvaged in two men and three women. No complications occurred and all reconstructions healed properly. Neither non-union nor recurrence of ORN was observed. Sensory function of all IANs recovered after resection up to 100 percent, including the patients with a pathologic fracture due to ORN. The accuracy evaluation showed angle deviations limited to 3.78 degrees. Two deviations of 6.42° and 7.47° were found. After an average of 11,6 months all patients received dental implants to complete oral rehabilitation. Conclusions Our novel ORN treatment concept shows promising results for implementation of 3D radiotherapy isodose curve visualization and IAN preservation. Sensory function of all IANs recovered after segmental mandibular resection.
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Affiliation(s)
- Gustaaf J C van Baar
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands
| | - Lars Leeuwrik
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands
| | - Johannes N Lodders
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands
| | - Niels P T J Liberton
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Technology, 3D Innovation Lab, Amsterdam, Netherlands
| | - K Hakki Karagozoglu
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands
| | - Tymour Forouzanfar
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands
| | - Frank K J Leusink
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands
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11
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Zadik Y, Ganor Y, Rimon O, Bersudski E, Meirovitz A. Assessment of jaw osteonecrosis diagnostic criteria in cancer patients with a history of radiation therapy and exposure to bone-modifying agents. Radiother Oncol 2020; 156:275-280. [PMID: 33373641 DOI: 10.1016/j.radonc.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the jaw is currently defined by the development of osteonecrosis in head/neck irradiated patients, regardless of lesion exposure. To diagnose medication-related osteonecrosis of the jaw (MRONJ), a history of any radiation therapy to the jaw region must be ruled out. The aim of this study was to assess the accuracy of current osteonecrosis criteria, while introducing new modifications for improved diagnosis and treatment. METHODS One hundred and forty-one necrotic lesions were analyzed from patients exposed to bone-modifying agents (BMAs) and/or received head and neck regional radiation therapy, where the maximal dose of radiation exposure to the jaw osteonecrosis site was calculated. Modified diagnostic criteria were used to reassess all cases and a comparison of outcomes was performed using Pearson's Chi-Square/Fisher's exact test. RESULTS Only in patients with primary head and neck carcinomas did the maximal mean radiation dose in the necrotic jaw site reach ranges associated with ORN formation (>40 Gy), with individual cases showing exposures as low as 0-2 Gy. Based on the modified diagnostic criteria almost 2/3 of the necrotic cases diagnosed as ORN should be diagnosed as MRONJ. CONCLUSIONS ORN diagnosis should only be considered in cases of radiation exposure >40 Gy to prevent misdiagnosis and suboptimal treatment. A modified criterion for MRONJ diagnosis is recommended where radiation exposure <40 Gy in the necrotic site is included. In cases with exposure >40 Gy and BMA administration, an additional modification to diagnostic criteria of 'medication- and radiation-related osteonecrosis of the jaw', should be used.
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Affiliation(s)
- Yehuda Zadik
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Oral Medicine, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
| | - Yotam Ganor
- Dental Branch, Medical Corps, Israel Defense Forces, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ori Rimon
- Dental Branch, Medical Corps, Israel Defense Forces, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Evgeniya Bersudski
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Amichay Meirovitz
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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12
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Kraeima J, Glas HH, Merema BBJ, Vissink A, Spijkervet FKL, Witjes MJH. Three-dimensional virtual surgical planning in the oncologic treatment of the mandible. Oral Dis 2020; 27:14-20. [PMID: 32881177 DOI: 10.1111/odi.13631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/30/2020] [Accepted: 08/22/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In case of surgical removal of oral squamous cell carcinomas, a resection of mandibular bone is frequently part of the treatment. Nowadays, such resections frequently include the application of 3D virtual surgical planning (VSP) and guided surgery techniques. In this paper, current methods for 3D VSP leads for optimisation of the workflow, and patient-specific application of guides and implants are reviewed. RECENT FINDINGS Current methods for 3D VSP enable multi-modality fusion of images. This fusion of images is not restricted to a specific software package or workflow. New strategies for 3D VSP in Oral and Maxillofacial Surgery include finite element analysis, deep learning and advanced augmented reality techniques. These strategies aim to improve the treatment in terms of accuracy, predictability and safety. CONCLUSIONS Application of the discussed novel technologies and strategies will improve the accuracy and safety of mandibular resection and reconstruction planning. Accurate, easy-to-use, safe and efficient three-dimensional VSP can be applied for every patient with malignancies needing resection of the mandible.
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Affiliation(s)
- Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Haye H Glas
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bram Barteld Jan Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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13
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Abstract
This article explores how to prevent and manage complications of dentoalveolar surgery. Many complications are avoidable. Surgical skills and knowledge of anatomy play an important role in prevention of complications. Prevention starts with detailed history and physical examination of the patient. Key to perioperative management of patients is risk assessment. Without a proper history and physical examination, the clinician is unable to assess the risk of performing surgery and anesthesia for each patient. Some illnesses and medications increase the risk of complications. The following complications are discussed: alveolar osteitis, displacement, fracture, hemorrhage, infection, nonhealing wound, oroantral communication, swelling, and trismus.
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Affiliation(s)
- Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, 1919 7th Avenue South, SDB 419, Birmingham, AL 35294, USA.
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14
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Mohamed ASR, He R, Ding Y, Wang J, Fahim J, Elgohari B, Elhalawani H, Kim AD, Ahmed H, Garcia JA, Johnson JM, Stafford RJ, Bankson JA, Chambers MS, Sandulache VC, Fuller CD, Lai SY. Quantitative Dynamic Contrast-Enhanced MRI Identifies Radiation-Induced Vascular Damage in Patients With Advanced Osteoradionecrosis: Results of a Prospective Study. Int J Radiat Oncol Biol Phys 2020; 108:1319-1328. [PMID: 32712257 DOI: 10.1016/j.ijrobp.2020.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/20/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE We aim to characterize the quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters associated with advanced mandibular osteoradionecrosis (ORN) compared with the contralateral normal mandible. METHODS AND MATERIALS Patients with a diagnosis of advanced ORN after curative-intent radiation treatment of head and neck cancer were prospectively enrolled after institutional review board approval and study-specific informed consent were obtained. Quantitative maps generated with the Tofts and extended Tofts pharmacokinetic models were used for analysis. Manual segmentation of advanced ORN 3-dimensional volume was done using anatomic sequences to create ORN volumes of interest (VOIs). Subsequently, normal mandibular VOIs were segmented on the contralateral healthy mandible of similar volume and anatomic location to create control VOIs. Finally, anatomic sequences were coregistered to DCE sequences, and contours were propagated to the respective parameter maps. RESULTS Thirty patients were included. The median time to ORN diagnosis after completion of IMRT was 38 months (range, 6-184 months), whereas median time to ORN progression to advanced grade after initial diagnosis was 5.6 months (range, 0-128 months). There were statistically significant higher Ktrans and Ve in ORN-VOIs compared with controls (0.23 vs 0.07 min-1, and 0.34 vs 0.15; P < .0001 for both). The average relative increase of Ktrans in ORN-VOIs was 3.2-fold higher than healthy mandibular control VOIs. Moreover, the corresponding rise of Ve in ORN-VOIs was 2.7-fold higher than in the controls. Using combined Ktrans and Ve parameters, 27 patients (90%) had at least a 200% increase of either of the studied parameters in the ORN-VOIs compared with their healthy mandible VOIs. CONCLUSIONS Our results confirm that there is a quantitatively significant higher degree of leakiness in the mandibular vasculature as measured using DCE-MRI parameters of areas with advanced ORN versus healthy mandible.
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Affiliation(s)
- Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Renjie He
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Yao Ding
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jihong Wang
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Joly Fahim
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Andrew D Kim
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Hoda Ahmed
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jose A Garcia
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - R Jason Stafford
- Department of Imaging Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - James A Bankson
- Department of Imaging Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Vlad C Sandulache
- Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas; Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
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15
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Re K, Patel S, Gandhi J, Suh Y, Reid I, Joshi G, Smith NL, Khan SA. Clinical utility of hyperbaric oxygen therapy in dentistry. Med Gas Res 2020; 9:93-100. [PMID: 31249258 PMCID: PMC6607863 DOI: 10.4103/2045-9912.260651] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This fuller impact of the use of hyperbaric oxygen therapy within dentistry is taking greater notice with newer research findings. There are new advancements in research regarding postradiotherapy cases, osteonecrosis of the jaw, osteomyelitis, periodontal disease, and dental implants. Hyperbaric oxygen therapy can even be used in conjunction with other procedures such as bone grafting. Although the research and clinical utility has come a long way, there are several complications to be mindful of during the application of hyperbaric oxygen therapy.
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Affiliation(s)
- Kaitlyn Re
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Shrey Patel
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA; Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Yiji Suh
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Inefta Reid
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | | | - Sardar Ali Khan
- Department of Physiology and Biophysics; Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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16
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He Y, Ma C, Hou J, Li X, Peng X, Wang H, Wang S, Liu L, Liu B, Tian L, Liu Z, Liu X, Xu X, Zhang D, Jiang C, Wang J, Yao Y, Zhu G, Bai Y, Wang S, Sun C, Li J, He S, Wang C, Zhang Z, Qiu W. Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible. Int J Oral Maxillofac Surg 2020; 49:411-419. [PMID: 31353174 DOI: 10.1016/j.ijom.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/23/2019] [Accepted: 06/05/2019] [Indexed: 02/08/2023]
Abstract
Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This 'expert consensus statement on diagnosis and clinical management of MORN' is for clinical reference.
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Affiliation(s)
- Y He
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - C Ma
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - J Hou
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - X Li
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - H Wang
- Stomatology Hospital Affiliated to School of Medicine, Zhejiang University, Zhejiang, China
| | - S Wang
- Salivary Gland Disease Center and Molecular Laboratory for Gene Therapy and Tooth Regeneration, School of Stomatology, Capital Medical University, Beijing, China
| | - L Liu
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - B Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - L Tian
- Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, China; The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Z Liu
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Liu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - X Xu
- Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - D Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - C Jiang
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - J Wang
- Department of Head and Neck Surgery, Gansu Province Tumor Hospital, Lanzhou, China
| | - Y Yao
- Department of Radiotherapy, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - G Zhu
- Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Bai
- Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - C Sun
- Department of Oromaxillofacial - Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China
| | - J Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - S He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - C Wang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Z Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - W Qiu
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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17
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Zhang Z, Xiao W, Jia J, Chen Y, Zong C, Zhao L, Tian L. The effect of combined application of pentoxifylline and vitamin E for the treatment of osteoradionecrosis of the jaws: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:207-214. [DOI: 10.1016/j.oooo.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 11/25/2022]
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18
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Spijkervet FKL, Brennan MT, Peterson DE, Witjes MJH, Vissink A. Research Frontiers in Oral Toxicities of Cancer Therapies: Osteoradionecrosis of the Jaws. J Natl Cancer Inst Monogr 2019; 2019:5551359. [DOI: 10.1093/jncimonographs/lgz006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/13/2019] [Indexed: 01/28/2023] Open
Abstract
AbstractThe deleterious effects of head and neck radiation on bone, with osteoradionecrosis (ORN) as the major disabling side effect of head and neck cancer treatment, are difficult to prevent and hard to treat. This review focuses on the current state of the science regarding the pathobiology, clinical impact, and management of ORN. With regard to the pathobiology underlying ORN, it is not yet confirmed whether the current radiation schedules by 3-dimensional conformal radiotherapy and intensity modified radiotherapy result in an unchanged, decreased, or increased risk of developing ORN when compared with conventional radiation treatment, the main risk factor being the total radiation dose delivered on any clinically significant surface of the mandible.With regard to the prevention of ORN, a thorough, early pre-irradiation dental assessment is still considered the first step to reduce the hazard of developing ORN post-radiotherapy, and hyperbaric oxygen (HBO) treatment reduces the risk of developing ORN in case of dental surgery in an irradiated field.With regard to the treatment of ORN, the focus is bidirectional: elimination of the necrotic bone and improving the vascularity of the normal tissues that were included in the radiation portal. The cure rate of limited ORN by conservative therapy is approximately 50%, and the cure rate of surgical approaches when conservative therapy has failed is approximately 40%.Whether it is effective to support conservative or surgical treatment with HBO as an adjuvant is not set. HBO treatment is shown to increase the vascularity of hard and soft tissues and has been reported to be beneficial in selected cases. However, in randomized clinical trials comparing the preventive effect of HBO on developing ORN with, eg, antibiotic coverage in patients needing dental surgery, the preventive effect of HBO was not shown to surpass that of a more conservative approach.More recently, pharmacologic management was introduced in the treatment of ORN with success, but its efficacy has to be confirmed in randomized clinical trials. The major problem of performing well-designed randomized clinical trials in ORN is having access to large numbers of patients with well-defined, comparable cases of ORN. Because many institutions will not have large numbers of such ORN cases, national and international scientific societies must be approached to join multicenter trials. Fortunately, the interest of funding organizations and the number researchers with an interest in healthy aging is growing. Research aimed at prevention and reduction of the morbidity of cancer treatment fits well within these programs.
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Affiliation(s)
- Frederik K L Spijkervet
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC
| | - Douglas E Peterson
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Neag Comprehensive Cancer Center, UConn Health, Farmington, CT
| | - Max J H Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Danielsson D, Gahm C, Haghdoost S, Munck-Wikland E, Halle M. Osteoradionecrosis, an increasing indication for microvascular head and neck reconstruction. Int J Oral Maxillofac Surg 2019; 49:1-6. [PMID: 31296436 DOI: 10.1016/j.ijom.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 04/22/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023]
Abstract
Better cancer treatment has led to a steadily growing population of cancer survivors suffering from late adverse effects after cancer treatment. The aim of this study was to investigate whether there has been an increase in free flap reconstruction due to osteoradionecrosis (ORN). A retrospective review was conducted to identify all consecutive head and neck free flap reconstructions performed over an 18-year period (1995-2012) at Karolinska University Hospital. A total of 235 free flaps were identified. Cases were divided into two groups: head and neck cancer reconstructions and ORN reconstructions. A comparison between the two groups showed longer survival (P<0.001) and higher rates of late complications (P<0.001) among ORN cases. ORN as an indication for reconstruction increased over time, from 7.0% of the total number of free flaps performed in 1995-2000, to 15.2% during the period 2001-2006, and to 27.3% in 2007-2012 (P<0.001). This, in accordance with the results of other studies, highlights the importance of the appropriate allocation of resources within the healthcare system to treat this patient group within the steadily increasing population of cancer survivors.
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Affiliation(s)
- D Danielsson
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institute, Stockholm, Sweden; Patient Area Craniofacial Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - C Gahm
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - S Haghdoost
- Department of Molecular Bioscience, Centre for Radiation Protection Research, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden & University of Caen Normandy, Laria- Cimap, Caen, France
| | - E Munck-Wikland
- Department of Otorhinolaryngology, Head and Neck Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - M Halle
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
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20
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Huang YF, Liu SP, Muo CH, Tsai CH, Chang CT. The association between dental therapy timelines and osteoradionecrosis: a nationwide population-based cohort study. Clin Oral Investig 2019; 24:455-463. [DOI: 10.1007/s00784-019-02866-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
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Danielsson D, Munck-Wikland E, Hagel E, Halle M. Quality of life after microvascular mandibular reconstruction for osteoradionecrosis-A prospective study. Head Neck 2019; 41:2225-2230. [PMID: 30721560 DOI: 10.1002/hed.25681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/30/2018] [Accepted: 01/15/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Reconstructive surgery for mandibular osteoradionecrosis is increasing; however, evidence regarding the impact on health-related quality of life is lacking. The current exploratory study prospectively investigates whether resection with reconstruction is associated with changes in HRQoL parameters for these patients. METHODS Seventeen patients underwent microvascular reconstruction for mandibular osteoradionecrosis between 2012 and 2015, and 16 completed the EORTC quality of life questionnaires QLQ-C30 and QLQ-H&N35 1 month before and 1 year after surgery. RESULTS Increases in emotional (P = 0.01) and social functioning (P = 0.004) were observed, together with improvements in the fatigue (P = 0.04), appetite loss (P = 0.02) and pain (P = 0.02) scores, as evaluated by the QLQ-C30. Pain reduction was further confirmed by the QLQ-H&N35 (P = 0.04), which also showed improved scores for feeling ill (P = 0.001) and sexual difficulties (P = 0.04). CONCLUSION This exploratory study suggests that microvascular reconstruction after mandibular osteoradionecrosis may improve HRQoL, with an emphasis on pain reduction; however, further studies are needed.
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Affiliation(s)
- Daniel Danielsson
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institute, Stockholm, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institute, Stockholm, Sweden.,Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Hagel
- Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Plastic and Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden
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Secondary surgical management of osteoradionecrosis using three-dimensional isodose curve visualization: a report of three cases. Int J Oral Maxillofac Surg 2018; 47:214-219. [DOI: 10.1016/j.ijom.2017.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/28/2017] [Accepted: 08/10/2017] [Indexed: 11/18/2022]
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23
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Salmon B, Liu B, Shen E, Chen T, Li J, Gillette M, Ransom RC, Ezran M, Johnson CA, Castillo AB, Shen WJ, Kraemer FB, Smith AA, Helms JA. WNT-activated bone grafts repair osteonecrotic lesions in aged animals. Sci Rep 2017; 7:14254. [PMID: 29079746 PMCID: PMC5660190 DOI: 10.1038/s41598-017-14395-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/10/2017] [Indexed: 02/05/2023] Open
Abstract
The Wnt pathway is a new target in bone therapeutic space. WNT proteins are potent stem cell activators and pro-osteogenic agents. Here, we gained insights into the molecular and cellular mechanisms responsible for liposome-reconstituted recombinant human WNT3A protein (L-WNT3A) efficacy to treat osteonecrotic defects. Skeletal injuries were coupled with cryoablation to create non-healing osteonecrotic defects in the diaphysis of the murine long bones. To replicate clinical therapy, osteonecrotic defects were treated with autologous bone graft, which were simulated by using bone graft material from syngeneic ACTB-eGFP-expressing mice. Control osteonecrotic defects received autografts alone; test sites received autografts treated ex vivo with L-WNT3A. In vivo µCT monitored healing over time and immunohistochemistry were used to track the fate of donor cells and assess their capacity to repair osteonecrotic defects according to age and WNT activation status. Collectively, analyses demonstrated that cells from the autograft directly contributed to repair of an osteonecrotic lesion, but this contribution diminished as the age of the donor increased. Pre-treating autografts from aged animals with L-WNT3A restored osteogenic capacity to autografts back to levels observed in autografts from young animals. A WNT therapeutic approach may therefore have utility in the treatment of osteonecrosis, especially in aged patients.
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Affiliation(s)
- B Salmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
- Paris Descartes University - Sorbonne Paris Cité, EA 2496 - Orofacial Pathologies, Imaging and Biotherapies Lab and Dental Medicine Department, Bretonneau Hospital, HUPNVS, AP-HP, Paris, France
| | - B Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - E Shen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - T Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - M Gillette
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - R C Ransom
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - M Ezran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - C A Johnson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - A B Castillo
- Department of Mechanical and Aerospace Engineering, New York University Polytechnic School of Engineering, Brooklyn, NY, USA
| | - W J Shen
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - F B Kraemer
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - A A Smith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - J A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
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24
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Hatakeyama H, Fujima N, Tsuchiya K, Mizoguchi K, Mizumachi T, Sakashita T, Kano S, Homma A, Fukuda S. Osteoradionecrosis of the hyoid bone after intra-arterial chemoradiotherapy for oropharyngeal cancer: MR imaging findings. Cancer Imaging 2017; 17:22. [PMID: 28750685 PMCID: PMC5531026 DOI: 10.1186/s40644-017-0123-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/04/2017] [Indexed: 11/24/2022] Open
Abstract
Background Osteoradionecrosis (ORN) of the hyoid bone sometimes induces severe front neck infection and can cause laryngeal stenosis and carotid rupture. Although ORN of the hyoid bone is known to be a complication of chemoradiotherapy for head and neck cancer, there has been no basis for its evaluation. Our purpose is to present the clinical and MR imaging features of ORN of the hyoid bone. Methods The study group comprised patients with advanced oropharyngeal cancer treated with targeted intra-arterial cisplatin infusion with concomitant radiotherapy. ORN of the hyoid bone was identified on the basis of decreased signal intensity of the bone marrow on T1WI images. Signal intensity on T2WI images was used to distinguish between inflammation and fibrosis. Results A total of 39 pre-treatment MR images and follow-up MR images were reviewed. ORN of the hyoid bone were detected in 30% of patients after treatment, with 23% of them showing inflammation and 7.7% fibrosis. Two patients developed severe neck infection and received antibiotics and underwent surgical intervention by tracheostomy and resection of the hyoid bone. Conclusion Our MR imaging study showed that ORN of the hyoid bone is not particularly rare in patients with oropharyngeal cancer treated with chemoradiotherapy. Clinicians should evaluate images carefully to prevent the development of severe complication due to infection associated with ORN of the hyoid bone.
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Affiliation(s)
- Hiromitsu Hatakeyama
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan. .,Department of Otolaryngology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Noriyuki Fujima
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiko Tsuchiya
- Department of Radiotherapy, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenji Mizoguchi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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25
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Frydrych AM, Slack-Smith LM, Parsons R. Compliance of post-radiation therapy head and neck cancer patients with caries preventive protocols. Aust Dent J 2017; 62:192-199. [DOI: 10.1111/adj.12491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 01/15/2023]
Affiliation(s)
- AM Frydrych
- School of Dentistry; The University of Western Australia; Perth Western Australia Australia
| | - LM Slack-Smith
- School of Dentistry; The University of Western Australia; Perth Western Australia Australia
| | - R Parsons
- School of Occupational Therapy and Social Work; Curtin University; Perth Western Australia Australia
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26
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Nekhlyudov L, Lacchetti C, Davis NB, Garvey TQ, Goldstein DP, Nunnink JC, Ninfea JIR, Salner AL, Salz T, Siu LL. Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline. J Clin Oncol 2017; 35:1606-1621. [PMID: 28240970 DOI: 10.1200/jco.2016.71.8478] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose This guideline provides recommendations on the management of adults after head and neck cancer (HNC) treatment, focusing on surveillance and screening for recurrence or second primary cancers, assessment and management of long-term and late effects, health promotion, care coordination, and practice implications. Methods ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The American Cancer Society (ACS) HNC Survivorship Care Guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. Results The ASCO Expert Panel determined that the ACS HNC Survivorship Care Guideline, published in 2016, is clear, thorough, clinically practical, and helpful, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorsed the ACS HNC Survivorship Care Guideline, adding qualifying statements aimed at promoting team-based, multispecialty, multidisciplinary, collaborative head and neck survivorship care. Recommendations The ASCO Expert Panel emphasized that caring for HNC survivors requires a team-based approach that includes primary care clinicians, oncology specialists, otolaryngologists, dentists, and other allied professionals. The HNC treatment team should educate the primary care clinicians and patients about the type(s) of treatment received, the likelihood of potential recurrence, and the potential late and long-term complications. Primary care clinicians should recognize symptoms of recurrence and coordinate a prompt evaluation. They should also be prepared to manage late effects either directly or by referral to appropriate specialists. Health promotion is critical, particularly regarding tobacco cessation and dental care. Additional information is available at www.asco.org/HNC-Survivorship-endorsement and www.asco.org/guidelineswiki .
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Affiliation(s)
- Larissa Nekhlyudov
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Lacchetti
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy B Davis
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas Q Garvey
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David P Goldstein
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Chris Nunnink
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose I Ruades Ninfea
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Salner
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Talya Salz
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lillian L Siu
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
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Samuels MA, Freedman LM, Elsayyad N. Intensity-modulated radiotherapy for early glottic cancer: transition to a new standard of care? Future Oncol 2016; 12:2615-2630. [DOI: 10.2217/fon-2016-0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
For decades, the standard of care for radiation treatment of early larynx cancers has been conventional treatment using opposed lateral fields encompassing the larynx and overlying neck structures, including the adjacent carotid arteries. While intensity-modulated radiotherapy (IMRT) has replaced conventional radiotherapy for all other head/neck cancer situations, the use of IMRT to treat early glottic cancers remains controversial. The article reviews the published experience with IMRT for this clinical situation and provides a detailed review of the literature on radiation-induced carotid toxicity and how it might apply to the controversy. Finally, we discuss whether the radiation oncology community should transition to IMRT as a new standard of care for the treatment of early glottic cancers.
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Affiliation(s)
- Michael A Samuels
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Laura M Freedman
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Nagy Elsayyad
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
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28
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A retrospective study of osteomyelitis and osteonecrosis of the jaws and its etiologic implication of bisphosphonate in Asians. Clin Oral Investig 2016; 21:1905-1911. [DOI: 10.1007/s00784-016-1973-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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29
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Wei FC, AL Deek NF, Cheng MH, Lin CH. The Triangle of Unfavorable Outcomes After Microsurgical Head and Neck Reconstruction. Clin Plast Surg 2016; 43:615-20. [DOI: 10.1016/j.cps.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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The Osteosarcoradionecrosis as an Unfavorable Result Following Head and Neck Tumor Ablation and Microsurgical Reconstruction. Clin Plast Surg 2016; 43:753-9. [PMID: 27601399 DOI: 10.1016/j.cps.2016.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Osteoradionecrosis is preferably called osteosarcoradionecrosis to adequately cover the scope of the problem: multitissue necrosis. The changes following radiotherapy and leading to necrosis are further classified into 2 phases based on improved understanding of the underlying mechanisms. The reversible-damage phase could respond to the medical treatment, while the irreversible damage phase or osteosarcoradionecrosis may benefit from complete resection and free flap reconstruction. The role of ablation and reconstruction in paving the road for the development of osteosarcoradionecrosis is discussed, a case study provided, and a refined reconstructive approach proposed.
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31
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Grisar K, Schol M, Schoenaers J, Dormaar T, Coropciuc R, Vander Poorten V, Politis C. Osteoradionecrosis and medication-related osteonecrosis of the jaw: similarities and differences. Int J Oral Maxillofac Surg 2016; 45:1592-1599. [PMID: 27427547 DOI: 10.1016/j.ijom.2016.06.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/24/2016] [Accepted: 06/21/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to compare medication-related osteonecrosis of the jaw (MRONJ) with osteoradionecrosis (ORN). Group 1 comprised 74 MRONJ patients (93 lesions) and group 2 comprised 59 ORN patients (69 lesions). Patient characteristics, clinical presentation of the lesions, the presence of complications, and the relationship with previous dental extractions were analyzed for both groups. Significant differences were found between the groups with regard to the characteristics of the patient populations, extraction as the precipitating event, the type of initial complaint, the prevalence of pain, and the location of the lesions. In the ORN group, significantly more patients complained of pain (P=0.0108) compared with the MRONJ group. Furthermore, significantly more pathological fractures (P<0.0001) and skin fistulae (P<0.0001) occurred in the ORN group. The treatment was more often conservative in the MRONJ group than in the ORN group (61.3% vs. 36.2%). Despite similarities in terms of imaging, risk factors, prevention, and treatment, MRONJ and ORN are two distinct pathological entities, as highlighted by the differences in patient characteristics, the initial clinical presentation, course of the disease, and outcome.
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Affiliation(s)
- K Grisar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - M Schol
- Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - J Schoenaers
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - T Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - V Vander Poorten
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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32
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Piccin A, Di Pierro AM, Tagnin M, Russo C, Fustos R, Corvetta D, Primerano M, Magri E, Conci V, Gentilini I, Burkia Stocker E, Negri G, Mazzoleni G, Gastl G, Fontanella F. Healing of a soft tissue wound of the neck and jaw osteoradionecrosis using platelet gel. Regen Med 2016; 11:459-63. [PMID: 27346565 DOI: 10.2217/rme-2016-0031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Bone osteoradionecrosis is a serious complication of radiation treatment. Current treatment approaches are not curative and treatment response is often poor leading to high social and healthcare costs. CASE REPORT We report on the first case of osteoradionecrosis with successful restitutio ab integro by repeated administration of platelet gel (PLT-gel) and surgery in a critically ill patient. The administration of PLT-gel during a severe septic episode helped regeneration of bone and soft tissues, shortening the hospital stay of the patient. It was also noted that following applications of PLT-gel, both the use of morphine and the numbers of infective episodes were reduced. CONCLUSION Additional studies are needed to confirm the promising effect of PLT-gel for the treatment of osteoradionecrosis.
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Affiliation(s)
- Andrea Piccin
- Haematology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy.,Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria
| | - Angela Maria Di Pierro
- Haematology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy.,Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.,Biochemistry Laboratory, San Maurizio Regional Hospital, Bolzano, Italy
| | - Mario Tagnin
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Odontostomatology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
| | - Carla Russo
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,ENT Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
| | - Roland Fustos
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,ENT Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
| | - Daisy Corvetta
- Haematology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy.,Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Pathology Dept., San Maurizio Regional Hospital, Bolzano, Italy
| | - Marco Primerano
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Hospital Pharmacy, San Maurizio Regional Hospital, Bolzano, Italy
| | - Elena Magri
- Radiotherapy Dept, Santa Chiara Hospital, Trento, Italy
| | - Viviana Conci
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Odontostomatology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
| | | | - Evelyn Burkia Stocker
- Haematology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy.,Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy
| | - Giovanni Negri
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Pathology Dept., San Maurizio Regional Hospital, Bolzano, Italy
| | - Guido Mazzoleni
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Pathology Dept., San Maurizio Regional Hospital, Bolzano, Italy
| | - Günther Gastl
- Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria
| | - Fabrizio Fontanella
- Interdisciplinary Medical Research Center (IMREST), Bolzano, South Tyrol, Italy.,Odontostomatology Dept, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
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Kuo TJ, Leung CM, Chang HS, Wu CN, Chen WL, Chen GJ, Lai YC, Huang WC. Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: A nationwide population-based retrospective study in Taiwan. Oral Oncol 2016; 56:71-7. [PMID: 27086489 DOI: 10.1016/j.oraloncology.2016.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Osteoradionecrosis of the jaws (ORNJ) is painful for patients and relatively difficult to treat clinically. The high risk of ORNJ for post radiotherapy R/T dental extraction is known; however, many patients still have to have teeth extracted after head and neck R/T. The objective of the present study is to review post R/T dental extraction and determine the ORNJ risk. MATERIALS AND METHODS We preformed a retrospective cohort study of 1759 patients with head and neck cancer s/p R/T from a random sample of 1,000,000 insurants in the National Health Insurance Research Database during 2000-2013 in Taiwan. Statistical methods included two-proportion Z-test. RESULTS We evaluated two cohorts: 522 patients with post R/T dental extraction and 1237 patients without post R/T extraction. Overall moderate-to-severe ORNJ after R/T was 2.22% (39/1759), and a total of 39 ORNJ cases were noted during an average of 3.02years (range: 0.62-8.89years, ±2.07). ORNJ prevalence in the overall post R/T extraction-exposed cohort (5.17%, 27/522) was significantly greater than that in the unexposed cohort (0.97%, 12/1237). In a group of patients with ⩽5 post R/T dental extractions (n=373), the ORNJ risk was 2.4% (ORNJ case n=9); in a group of patients with >5 dental extractions (n=149), the ORNJ risk was 12.1% (ORNJ case n=18) (Z-score=4.5062; p-value<0.0001). In the extraction-exposed cohort, the ORNJ risk is higher if the index day to first extraction day was ⩽0.5year (n=103) compared with the group with the index day to first extraction day >0.5year (n=419) (Z-score=-2.1506; p-value=0.0315). CONCLUSION A tooth extraction time less than half a year after R/T or during the head and neck R/T period, and extraction tooth number ⩽5 would significant lower the ORNJ prevalence.
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Affiliation(s)
- Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chung-Man Leung
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Hao-Sheng Chang
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chao-Nan Wu
- Department of Dentistry, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Wei-Li Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Guang-Jhong Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Wei-Chun Huang
- Section of Critical Care Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
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Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement. Crit Rev Oncol Hematol 2016; 102:47-54. [PMID: 27061883 DOI: 10.1016/j.critrevonc.2016.03.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 03/09/2016] [Indexed: 01/28/2023] Open
Abstract
Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements).
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Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Paganelli C, Majorana A, Gastaldi G, Bossi P, Berruti A, Pavanato G, Nicolai P, Maroldi R, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement. Crit Rev Oncol Hematol 2016; 97:131-42. [DOI: 10.1016/j.critrevonc.2015.08.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022] Open
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Rosow DE, Al-Bar MH. Type I Thyroplasty in Previously Irradiated Patients. Otolaryngol Head Neck Surg 2015; 153:582-5. [DOI: 10.1177/0194599815599970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/21/2015] [Indexed: 11/15/2022]
Abstract
Objectives (1) Review and report our experience performing medialization thyroplasty (MT) in previously irradiated patients and (2) compare complications and voice outcomes in 2 cohorts (irradiated vs nonradiated) to evaluate safety and efficacy. Study Design Case series with chart review. Setting Academic medical center. Subjects All patients (44 total) who underwent MT from 2011 to 2015. Methods Demographic data, complications, and acoustic and subjective voice outcome parameters were collected. The complication rates and voice outcome results were compared between 2 cohorts: patients with a history of radiation to the neck versus those with no radiation history. Results There were 7 previously irradiated patients and 37 nonradiated patients, with median follow-up of 314 and 538 days, respectively. One complication was noted in each group, and this complication rate was not significantly different ( P = .26). Both cohorts demonstrated significant postoperative improvement in subjective voice assessment ( P = .04, P < .0001) as well as maximum phonation time ( P = .02, .001) when compared with preoperative data. Conclusions Our study suggests that MT can be safely and effectively performed in irradiated patients. We found no statistically significant difference in the safety of performing MT in irradiated versus nonradiated patients, and there was significant improvement in subjective voice parameters and maximum phonation time in both groups. A larger prospective study is required to statistically determine whether the significant improvements in objective parameters seen in the nonradiated group are present in irradiated patients as well.
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Affiliation(s)
- David E. Rosow
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mohammad H. Al-Bar
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Chronopoulos A, Zarra T, Tröltzsch M, Mahaini S, Ehrenfeld M, Otto S. Osteoradionecrosis of the mandible: A ten year single-center retrospective study. J Craniomaxillofac Surg 2015; 43:837-46. [DOI: 10.1016/j.jcms.2015.03.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 01/08/2023] Open
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Danielsson D, Brehwens K, Halle M, Marczyk M, Sollazzo A, Polanska J, Munck-Wikland E, Wojcik A, Haghdoost S. Influence of genetic background and oxidative stress response on risk of mandibular osteoradionecrosis after radiotherapy of head and neck cancer. Head Neck 2015; 38:387-93. [PMID: 25352150 DOI: 10.1002/hed.23903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/30/2014] [Accepted: 10/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the mandible is a severe complication of head and neck radiotherapy (RT) treatment, where the impact of individual radiosensitivity has been a suggested explanation. METHODS A cohort of patients with stage II/III ORN was compared to matched controls. Blood was collected and irradiated in vitro to study the capacity to handle radiation-induced oxidative stress. Patients were also genotyped for 8 single-nucleotide polymorphisms (SNPs) in genes involved in the oxidative stress response. RESULTS A difference in 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) levels was found between the patient cohorts (p = 0.01). The SNP rs1695 in glutathione s-transferase p1 (GSTP1) was also found to be more frequent in the patients with ORN (p = .02). Multivariate analysis of the clinical and biological factors revealed concomitant brachytherapy plus the 2 biomarkers to be significant factors which influense risk of mandibular osteoradionecrosis after radiotherapy of head and neck cancer. CONCLUSION The current study indicates that oxidative stress response contributes to individual radiosensitivity and healthy tissue damage caused by RT and may be predicted by biomarker analysis.
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Affiliation(s)
- Daniel Danielsson
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose, and Throat Diseases, Karolinska Institute, Stockholm, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Karl Brehwens
- Department of Molecular Bioscience, Centre for Radiation Protection Research, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Reconstructive Plastic Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Michal Marczyk
- Data Mining Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland
| | - Alice Sollazzo
- Department of Molecular Bioscience, Centre for Radiation Protection Research, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Joanna Polanska
- Data Mining Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland
| | - Eva Munck-Wikland
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Andrzej Wojcik
- Department of Molecular Bioscience, Centre for Radiation Protection Research, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden.,Institute of Biology, Jan Kochanowski University, Kielce, Poland
| | - Siamak Haghdoost
- Department of Molecular Bioscience, Centre for Radiation Protection Research, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
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Conservative Treatment With Plasma Rich in Growth Factors-Endoret for Osteoradionecrosis. J Craniofac Surg 2015; 26:731-6. [DOI: 10.1097/scs.0000000000001537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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40
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Zheng M, Li L, Tang Y, Liang XH. How to improve the survival rate of implants after radiotherapy for head and neck cancer? J Periodontal Implant Sci 2014; 44:2-7. [PMID: 24616827 PMCID: PMC3945392 DOI: 10.5051/jpis.2014.44.1.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/10/2014] [Indexed: 02/05/2023] Open
Affiliation(s)
- Min Zheng
- Department of Stomatology, Zhou Shan Hospital, Zhoushan Zhejiang, China. ; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan, China
| | - Li Li
- Department of Stomatology, Zhou Shan Hospital, Zhoushan Zhejiang, China. ; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan, China
| | - Yaling Tang
- Department of Stomatology, Zhou Shan Hospital, Zhoushan Zhejiang, China. ; Department of Oral Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan, China
| | - Xin-Hua Liang
- Department of Stomatology, Zhou Shan Hospital, Zhoushan Zhejiang, China. ; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu Sichuan, China
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Avril L, Lombardi T, Ailianou A, Burkhardt K, Varoquaux A, Scolozzi P, Becker M. Radiolucent lesions of the mandible: a pattern-based approach to diagnosis. Insights Imaging 2013; 5:85-101. [PMID: 24323536 PMCID: PMC3948901 DOI: 10.1007/s13244-013-0298-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 12/19/2022] Open
Abstract
Objectives Radiolucent mandibular lesions seen on panoramic radiographs develop from both odontogenic and non-odontogenic structures. They represent a broad spectrum of lesions with a varying degree of malignant potential. The purpose of this review is to illustrate the characteristic imaging findings—as well as the clinical and histological features—of common and uncommon radiolucent lesions of the mandible. Methods This review article is based on the retrospective evaluation of 11,725 panoramic radiographs seen in our institution during the past 6 years. It provides a comprehensive, practical approach to the radiological interpretation of radiolucent lesions of the mandible. To facilitate the diagnostic approach, we have classified radiolucent lesions into two groups: lesions with well-defined borders and those with ill-defined borders. Results Lesion prevalence, age of manifestation, location within the mandible, relationship to dental structures, effect on adjacent structures and characteristic findings at computed tomography (CT), cone beam CT (CBCT) and magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) are discussed. Pitfalls including malignant lesions mimicking benign disease and pseudo-lesions are equally addressed. Conclusion Knowledge of the characteristic imaging features of radiolucent mandibular lesions narrows the differential diagnosis and is crucial for the identification of those lesions, where biopsy is indicated for definitive histology. Teaching points • Panoramic X-rays, CT and MRI are essential for the work-up of radiolucent mandibular lesions. • Lesion borders, location within the mandible, relationship to dental structures and tissue characteristics on cross-sectional imaging are indispensable to narrow the differential diagnosis. • High-resolution CT and CBCT play a major role for the assessment of lesion margins and their relationship to important anatomic structures, such as the inferior alveolar nerve. • Although most radiolucent lesions with well-defined sclerotic borders are benign, MRI may reveal clinically unsuspected malignant disease.
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Affiliation(s)
- Laurène Avril
- Department of Radiology, University Hospital of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
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