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Peterson DE, Koyfman SA, Yarom N, Lynggaard CD, Ismaila N, Forner LE, Fuller CD, Mowery YM, Murphy BA, Watson E, Yang DH, Alajbeg I, Bossi P, Fritz M, Futran ND, Gelblum DY, King E, Ruggiero S, Smith DK, Villa A, Wu JS, Saunders D. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline. J Clin Oncol 2024; 42:1975-1996. [PMID: 38691821 DOI: 10.1200/jco.23.02750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. METHODS The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. RESULTS A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. RECOMMENDATIONS Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lone E Forner
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Yvonne M Mowery
- UPMC Hillman Cancer Center, Pittsburgh, PA
- University of Pittsburgh, Pittsburgh, PA
| | | | - Erin Watson
- Department of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - David H Yang
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Ivan Alajbeg
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Neal D Futran
- University of Washington School of Medicine, Seattle, WA
| | | | - Edward King
- Northern Colorado Head and Neck Cancer Support Group, Windsor, CO
| | - Salvatore Ruggiero
- New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | | | - Jonn S Wu
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Deborah Saunders
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario, Canada
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Topkan E, Somay E, Yilmaz B. In reply to Shih YJ et.al. (doi: 10.1111/odi.14349). Oral Dis 2024; 30:814-815. [PMID: 36114821 DOI: 10.1111/odi.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Busra Yilmaz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey
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Tadokoro Y, Hasegawa T, Takeda D, Murakami A, Yatagai N, Iwata E, Saito I, Kusumoto J, Akashi M. Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116565. [PMID: 35682149 PMCID: PMC9180928 DOI: 10.3390/ijerph19116565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022]
Abstract
A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.
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Oley MH, Oley MC, Durry MF, Adam RN, Gunawan DF, Faruk M. Fostering a faster post-operative wound healing process with hyperbaric oxygen therapy in a rare case of squamous odontogenic tumor. Int J Surg Case Rep 2022; 90:106718. [PMID: 34968977 PMCID: PMC8717222 DOI: 10.1016/j.ijscr.2021.106718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The surgical removal of an intraoral tumor and preventing intraoral wound dehiscence are constant challenges faced by surgeons today. Hyperbaric oxygen therapy (HBOT), the inhalation of 100% oxygen at a greater atmospheric pressure, is often used in cases of wounds to induce a faster wound healing process, alongside other treatment modalities. We report a rare case of squamous odontogenic tumor (SOT) treated with HBOT after being surgically removed to foster an accelerated wound recovery. Case presentation A 39-year-old Asian male presented with an intraoral 3 × 4 cm tumor, accompanied by acute pain on the maxillary region. Biopsy results showed a solid, brown parenchyma with islands of mature squamous epithelial cells, confirming the diagnosis of an SOT. An intraoral surgical approach was performed to remove the tumor. The patient was then treated with prophylactic antibiotics and 5 consecutive, daily sessions of HBOT at 2.0 ATA as an adjuvant therapy. No further complaints and no abnormalities were found at the 2-week follow-up evaluation. Discussion In our case of SOT, HBOT plays a role to inhibiting the bacterial growth which could lead to post-operative wound infections. A number of studies have incorporated HBOT as an adjuvant therapy for post-operative intra oral wounds which has resulted in minimal wound complications. Conclusion The use of HBOT as an adjunctive therapy in managing possible wound complications after the resection of an intraoral tumor enables a faster angiogenesis process, reduces tissue hypoxia and minimizes the risk of post-operative wound infections; hence fostering the wound healing process. Squamous odontogenic tumors (SOT) are very rare tumors. SOTs are local infiltrating lesion described as aggressive, odontogenic, and epithelial. HBOT can be used as supportive therapy in SOT. Hyperbaric oxygen therapy (HBOT) can accelerate wound healing and minimize the possibility of postoperative infection.
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Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. Radiother Oncol 2021; 166:137-144. [PMID: 34843843 DOI: 10.1016/j.radonc.2021.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials. METHODS AND MATERIALS Patients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Primary outcome was healing of ORN one year after surgery evaluated by a clinically adjusted version of the Common Toxicity Criteria of Adverse Events (CTCAE) v 3.0. Secondary outcomes included xerostomia, unstimulated and stimulated whole salivation rates, trismus, dysphagia, pain, Activities of Daily Living (ADL) and quality of life according to EORTC. Data were combined from two separate trials. Ninety-seven were enrolled and 65 were eligible for the intent-to-treat analysis. The 33% drop-out was equally distributed between groups. RESULTS In group 1, 70% (21/30) healed compared to 51% (18/35) in group 2. HBO was associated with an increased chance of healing independent of baseline ORN grade or smoking status as well as improved xerostomia, unstimulated whole salivary flow rate, and dysphagia. Due to insufficient recruitment, none of the endpoints reached a statistically significant difference between groups. ADL data could only be obtained from 50 patients. CONCLUSION Hyperbaric oxygen did not significantly improve the healing outcome of osteoradionecrosis after surgical removal of necrotic bone as compared to standard care (70% vs. 51%). This effect is not statistically significant due to the fact that the study was underpowered and is therefore prone to type II error.
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Miyamoto I, Tanaka R, Kogi S, Yamaya G, Kawai T, Ohashi Y, Takahashi N, Izumisawa M, Yamada H. Clinical Diagnostic Imaging Study of Osteoradionecrosis of the Jaw: A Retrospective Study. J Clin Med 2021; 10:jcm10204704. [PMID: 34682827 PMCID: PMC8538245 DOI: 10.3390/jcm10204704] [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: 09/07/2021] [Revised: 09/23/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Radiation therapy (RT) plays a significant role in the management of head and neck malignancies. This study aimed to review the clinical symptoms and various imaging findings of osteoradionecrosis (ORN) and provide a clinical perspective on the development of ORN. The retrospective cohort was composed of 57 sites in 54 patients who had a history of RT and suspected ORN and 48 sites in 45 patients who were confirmed to have ORN. Image analyses included computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, bone scintigraphy, and single-photon emission CT (SPECT). The irradiated tissue was damaged by RT, and the extent of damage was correlated with clinical symptoms. The bone marrow showed sclerotic changes and the devitalized bone showed bone resorption after invasive stimulation. Chronic trismus and pathological fracture are considered severe conditions, typically occurring in the last stage of ORN. Furthermore, neurological symptoms were an important sign of tumor recurrence, since diagnostic imaging was difficult. The possible treatment options vary depending on the stage of ORN. We speculate that bone sclerosis reactions and bone resorption are sequential reactions that seem to be protective measures of the bone to radiation injury.
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Affiliation(s)
- Ikuya Miyamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
- Correspondence: ; Tel.: +81-19-651-5111
| | - Ryoichi Tanaka
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Shintaro Kogi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Genki Yamaya
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Tadashi Kawai
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Yu Ohashi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Noriaki Takahashi
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Mitsuru Izumisawa
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Hiroyuki Yamada
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
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Kim HW, Kim MY, Kim CH. A systematic review of therapeutic outcomes following treatment of squamous cell carcinoma of the retromolar trigone. J Korean Assoc Oral Maxillofac Surg 2021; 47:291-314. [PMID: 34462387 PMCID: PMC8408640 DOI: 10.5125/jkaoms.2021.47.4.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the retromolar trigone (RMT) is a rare but potentially fatal disease that carries a poor prognosis due to its unique anatomic position. RMT SCCs tend to spread to vital nearby structures, including the tonsillar pillar, masticatory muscles, and underlying mandibular bone, even in their early stages, and aggressive treatment is often warranted. This systematic review appraises and qualitatively analyzes all available literature regarding the survival outcomes and prognosis of RMT SCC. Four databases were searched to identify all eligible articles published since January 1980. Of the 1,248 studies, a total of 15 studies representing 4,838 cases met the inclusion criteria. The evaluated patients had a high rate of advanced tumor stage (T3 or T4: 61.4%), lymph node metastasis (38.8%), and mandibular bone invasion (24%) at the time of diagnosis. Aggressive surgical treatments such as lip-splitting (92%), segmental mandibulectomy (61.1%), radical neck dissection (44.1%), and reconstruction using free flaps (49.5%) was undertaken for 92% of the pooled patient population. The mean rates for local, regional, and systemic recurrence were 23.40%, 8.40%, and 8.50%, respectively. The mean 5-year overall survival rate was 38.90%. Osteonecrosis was noted in 11.6% of the 328 patients who received radiotherapy. In conclusion, RMT SCC is generally associated with high recurrence, low survival, and high postoperative complication rates. Early diagnosis and aggressive treatment are thus warranted. However, significant methodological problems hamper current knowledge. Future studies of this topic that use randomized or cohort designs are thus needed.
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Affiliation(s)
- Hye-Won Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| | - Moon-Young Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| | - Chul-Hwan Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
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Iqbal Z, Kyzas P. Analysis of the critical dose of radiation therapy in the incidence of Osteoradionecrosis in head and neck cancer patients: a case series. BDJ Open 2020; 6:18. [PMID: 33042578 PMCID: PMC7515872 DOI: 10.1038/s41405-020-00044-3] [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] [Received: 11/21/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction Osteoradionecrosis (ORN) is a dramatic complication following radiation therapy (RT) for head and neck tumours. Symptoms include pain, trismus, and malodour. ORN can present with exposed necrotic bone, an orocutaneous fistula, and/ or a pathological fracture. Aims To analyse the RT dose responsible for the pathogenesis of ORN and its associated risk factors. Methods The data of 17 patients from 2005 to 2017 were retrospectively reviewed from the Pinnacle(3), WebPublication, and Electronic patient records (EPR) provided by Christie Hospital and Pennine Acute NHS Trust. Results The mean RT dose that ORN sites received was 57.3 Gy. The mean onset duration for ORN after RT was 640.6 days. six patients (35.2%) developed ORN following post-RT dental extractions. Conclusion RT dosages of >57.3 Gy significantly increase the likelihood of developing ORN. Mandibular surgery, post-RT dental extraction, concurrent smoking, and alcohol abuse all amplify the risk of developing ORN.
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Affiliation(s)
- Zain Iqbal
- The University of Manchester, Manchester, UK.,The Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Northern Care Alliance NHS Group, Manchester, UK
| | - Panayiotis Kyzas
- The University of Manchester, Manchester, UK.,The Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Northern Care Alliance NHS Group, Manchester, UK
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Dieleman FJ, Meijer GJ, Merkx MAW. Does hyperbaric oxygen therapy play a role in the management of osteoradionecrosis? A survey of Dutch oral and maxillofacial surgeons. Int J Oral Maxillofac Surg 2020; 50:273-276. [PMID: 32674903 DOI: 10.1016/j.ijom.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
For decades, hyperbaric oxygen (HBO) has often been part of the treatment of osteoradionecrosis (ORN), despite controversy in the literature about its efficacy. An online survey was conducted to investigate the use of HBO in the treatment of ORN by Dutch oral and maxillofacial surgeons and to assess their perception of its efficacy. Of the 53 Dutch oral and maxillofacial surgery units contacted, 49 (92%) replied. Thirty-five were not head and neck cancer (HNC) units or preferred partner (PP-HNC) units recognized by the Dutch Head and Neck Association. All HNC and PP-HNC units (group 1) treated ORN patients, compared to only 12 (34%) of the non-HNC units (group 2). The average number of ORN patients seen and treated was higher in group 1. The units in group 1 more often referred patients for HBO therapy (HBOT) than those in group 2 (93% vs 84%). The efficacy of HBOT in curing ORN, rated on a scale of 1 to 5 points, was 3.7 in group 1 and 3.2 in group 2. This survey shows a trend towards centralization of ORN care to more experienced units. These units tend to use HBOT in curing ORN.
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Affiliation(s)
- F J Dieleman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Nabil S, Nordin R, Hariri F, Mohamad Bustaman A, Syed Zainal SJ, Panicker D, Nazimi A. The use of hyperbaric oxygen therapy in head-and-neck conditions. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2020. [DOI: 10.4103/jhnps.jhnps_16_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Helmers R, Straat NF, Navran A, Nai Chung Tong TAP, Teguh DN, van Hulst RA, de Lange J, Milstein DMJ. Patient-Side Appraisal of Late Radiation-Induced Oral Microvascular Changes. Int J Radiat Oncol Biol Phys 2018; 102:1299-1307. [PMID: 29506885 DOI: 10.1016/j.ijrobp.2018.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/09/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the clinical feasibility of examining and measuring late irradiation changes in the oral microcirculation of head and neck (HN) cancer patients using the novel CytoCam video microscope system. METHODS AND MATERIALS In 30 HN cancer patients and 30 age-matched controls, bilateral video images were recorded noninvasively of the oral microcirculation of the buccal mucosa and mandibular gingiva. Tissue perfusion parameters, such as functional capillary density (FCD), buccal blood vessel diameter, and microcirculatory flow index, were analyzed. RESULTS No difference was observed for mean buccal mucosa FCD in irradiated versus healthy tissue, whereas a lower mean gingival FCD in irradiated versus healthy tissue was observed (34 ± 17 capillaries per millimeter squared [cpll/mm2] vs 68 ± 19 cpll/mm2; P < .001). A significant difference in mean buccal blood vessel diameter of 16 ± 3 μm was measured, compared with 14 ± 1 μm in control buccal mucosa (P < .001). No significant difference in microcirculatory flow index was observed between the 2 groups. CONCLUSIONS Quantifying oral microcirculatory injury associated with late irradiation effects using the CytoCam was feasible in HN cancer patients. Results indicate that marked differences in tissue-specific microcirculatory measurements of angioarchitecture, diminished capillary density, and extensively dilated blood vessel diameters are associated with late irradiation effects in HN cancer patients.
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Affiliation(s)
- Renée Helmers
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - Nina F Straat
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Tim A P Nai Chung Tong
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - David N Teguh
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert A van Hulst
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Jenwitheesuk K, Mahakkanukrauh A, Punjaruk W, Jenwitheesuk K, Chowchuen B, Jinaporntham S, Uraiwan K, Limrattanapimpa P. Efficacy of Adjunctive Hyperbaric Oxygen Therapy in Osteoradionecrosis. Biores Open Access 2018; 7:145-149. [PMID: 30310729 PMCID: PMC6178923 DOI: 10.1089/biores.2018.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Osteoradionecrosis (ORN) is a common consequence resulting from radiation in patients with cancer. Presently, hyperbaric oxygen therapy (HBOT) is proposed to have a role in improving wound healing in ORN patients. There is no strong scientific evidence to confirm the benefits of HBOT for treatment of ORN as an adjunctive treatment. This study aimed to determine the benefits of adjunctive treatment of HBOT in ORN. A retrospective study was conducted at the Srinagarind Hospital, the Faculty of Medicine, Khon Kaen University, Thailand, between 2011 and 2017. The patients diagnosed with ORN, who received adjunctive HBOT before the operation, were enrolled. Complete healing of wounds was the primary outcome. There were 84 ORN patients with a mean age of 58.78 years; 54.76% were male and 45.24% were female. HBOT had a role significant in improving wound healing of ORN patients with stages 1 and 2. Poisson regression analysis showed that stage 3 of ORN negatively correlated with the number of HBOT dives (p = 0.001, incidence rates ratio = 0.85). In conclusion, HBOT improved wound healing of ORN patients with stages 1 and 2. In addition, stage 2 of ORN patients significantly required the highest number of HBOT dives compared to other types of ORN to promote wound healing, whereas stage 3 patients, who underwent bone debridement combined with HBOT, initiated to success of treatment process and required a smaller number of dives.
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Affiliation(s)
- Kamonwan Jenwitheesuk
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy-Immunology-Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wiyada Punjaruk
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kriangsak Jenwitheesuk
- General Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Bowornsilp Chowchuen
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suthin Jinaporntham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Krittinant Uraiwan
- Department of Dental, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Phasuk Limrattanapimpa
- Hospital Hyperbaric Oxygen Therapy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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13
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Affiliation(s)
- Thorakkal Shamim
- Department of Dentistry, Government Taluk Head Quarters Hospital, Malappuram, Kerala, India
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14
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Strojan P, Hutcheson KA, Eisbruch A, Beitler JJ, Langendijk JA, Lee AWM, Corry J, Mendenhall WM, Smee R, Rinaldo A, Ferlito A. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 59:79-92. [PMID: 28759822 PMCID: PMC5902026 DOI: 10.1016/j.ctrv.2017.07.003] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/05/2017] [Accepted: 07/09/2017] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne W M Lee
- Center of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincents's Hospital, Melbourne, Victoria, Australia
| | | | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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