Risk assessment for osteoradionecrosis of the jaws in patients with head and neck cancer

Pan-immune-inflammatory value and systemic immune-inflammatory index in relation to osteoradionecrosis of the jaws: a single institutional experience over 15 years

Osteoradionecrosis of the jaws (ORNJ) is a pernicious complication of radiation therapy that significantly affects the quality of life of patients with head and neck cancer. The present study aims to investigate the risk factors for the clinical prognosis of ORNJ in the same scenario. A cross-sectional study was designed and implemented in a tertiary teaching hospital from January 2005 to December 2020. A total of 106 patients were divided into normal wound-healing group (n = 79) and delayed wound-healing group (n = 27) according to two different prognosis. The risk factors associated with the prognosis in patients with ORNJ were comparatively analyzed via performing one-way and multifactorial logistic analyses. The majority of the study cohort (n = 59, 55.7%) was found to be characterized with Glanzmann and Gratz grade 2 and followed up for a median of 38.6 months. Diabetes mellitus (p = 0.045), Charlson comorbidity index (p = 0.042), American Society of Anesthesiologists score (p < 0.001), primary tumor site (p = 0.012), T stage (p = 0.008), ORNJ grade at initial diagnosis (p < 0.001), pan-immune-inflammatory value and systemic immune-inflammatory index at initial radiotherapy (p = 0.01 and p < 0.001 respectively) were detected as risk factors associated with poor prognosis in patients with ORNJ. We conclude that there are abundant risk factors for poor prognosis in these patients, and it is important to be evaluated before irradiation so that suitable post-radiated treatments can be given.

Osteoradionecrosis in osseous free flaps after maxillofacial reconstruction: a single-center experience

Objective

In the multimodal treatment of advanced head and neck malignancies, primary free flap reconstruction in a one stage procedure with tumor resection is frequently combined with adjuvant radiotherapy. Radiotherapy is known to exhibit side effects on transplanted free flaps, including osteoradionecrosis (ORN) of native and transplanted bone. This study aims to evaluate the therapeutic outcomes and potential predictors of free flap ORN within osseous free flaps based on a large-scale, single-center database.

Methods

A retrospective analysis was conducted on patients who underwent osseous free flap reconstruction of maxilla or mandible in a one stage procedure followed by adjuvant radiotherapy due to an advanced head and neck malignancy between April 2017 and July 2023. After case matching, patients with and without free flap ORN were assessed for potential predictors using univariate and multivariate analysis.

Results

112 patients met the inclusion criteria. 21 patients (19%) developed ORN within the free flap. Following case matching, 42 patients (10 females, mean age 61.5 ± 9.1 years) were included in the final analysis. The mean time to ORN diagnosis was 19 (7-56) months after surgery. Total flap loss occurred in 7 patients (33%) following flap ORN. Smoking (76% vs. 38%; OR 5.78; p=0.03) and prior plate exposure (67% vs. 24%; OR 5.61; p=0.03) emerged as robust predictors of flap ORN in uni- and multivariate analysis.

Conclusion

Osseous free flap ORN is a severe radiooncologic complication, often resulting in total flap loss and subsequently increased morbidity. Smoking and prior plate exposure were identified as key predictors of flap ORN development. Individual risk assessment and careful evaluation of osseous free flap irradiation must be evaluated in future radiooncological concepts.

The relevance of dental management prior to radiation therapy with severe oral mucositis in head and neck cancer patients

Background/purpose

Dental management prior to radiotherapy is often time-critical, and there are no studies on whether manipulations such as tooth extraction influence the risk of severe radiation-induced oral mucositis (ROM) during radiotherapy. Therefore, the aim of this study was to describe the relationship between dental management and the incidence of severe ROM.

Materials and methods

A retrospective analysis was conducted on 144 head and neck cancer (HNC) patients who received dental management before radiotherapy at Peking University Cancer Hospital, from January 2016 to December 2017. Demographic characteristics, primary tumor features, cancer treatment characteristics, and severity of oral mucositis during radiotherapy were recorded. Univariate analysis and logistic regression analysis were used to explore factors associated with severe radiation-induced oral mucositis.

Results

The incidence of grade 3 mucositis was 14.5% (22/144); univariate analysis showed that the number of extracted teeth (OR = 1.313; 95%CI = 1.012-1.702; P = 0.040) and patients with primary oral cancer had a higher risk of developing grade 3 mucositis (OR = 3.848; 95% CI = 1.508-9.822; P = 0.005). No statistical correlation was found between pre-radiation therapy prophylaxis, dental restoration, endodontic treatment, and grade 3 mucositis (P > 0.05). Logistic regression analysis showed that the number of extracted teeth (OR = 1.421, 95%CI = 1.071-1.885, P = 0.015) and primary tumor location in the oral cavity (compared with other head and neck cancers) (OR = 5.165, 95%CI = 1.636-16.311, P = 0.005) were significantly associated with grade 3 mucositis.

Conclusion

In HNC patients undergoing radiotherapy, the primary site located in the oral cavity and a higher number of teeth extracted are independent risk factors for the development of severe mucositis.

Risk factor analysis and development of predictive models for osteoradionecrosis in patients with nasopharyngeal carcinoma after concurrent chemoradiotherapy

Nasopharyngeal carcinoma (NPC) is a malignant tumor that targets the nasopharyngeal mucosal epithelium. Concurrent chemoradiotherapy (CCRT) is a pivotal treatment modality for NPC, yet it poses a risk for osteoradionecrosis (ORN), a complication that can impede further treatment. This study sought to explore the risk factors for ORN in NPC patients post-CCRT and to construct predictive models. We performed a retrospective analysis of clinical data from 417 NPC patients treated with CCRT at the Affiliated Hospital of Jiangnan University, with 204 patients from Longyan First Hospital as a validation cohort for the models. Our findings indicated that a high radiation dose, tooth extraction after radiotherapy, inadequate oral hygiene, smoking, anemia, and advanced T staging were associated with an elevated risk of ORN in NPC patients following CCRT. We formulated risk prediction models for ORN utilizing a nomogram, gradient boosting machine (GBM), and random forest (RF) algorithms. The area under the curve (AUC) was 0.813 (95% CI: 0.724-0.902) for the nomogram model in the validation cohort, 0.821 (95% CI: 0.732-0.910) for the GBM, and 0.735 (95% CI: 0.614-0.855) for the RF. Delong's test indicated no statistically significant differences in the AUC values among the three models. The nomogram has strong performance across both the training and validation cohorts, featuring a straightforward structure that is both intuitive and comprehensible. Taking into account the model's discriminative power, generalizability, and clinical practicability, the nomogram was proven to be highly applicable in the current study.

To extract or not extract teeth prior to head and neck radiotherapy? A systematic review and meta-analysis

PURPOSE

Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT.

METHODS

The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool.

RESULTS

Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01).

CONCLUSION

It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN.

Palliative oral care in patients undergoing radiotherapy: Integrated review

Maintaining a patient's quality of life is main the aim while treating cancer patients. Patients getting treated for oral cancer encountered with numerous symptoms at the time of radiotherapy and most of these are side effect which can persist even after few months to year after the treatment gets over. Radiotherapy is a vital aspect of both curative and palliative cancer care. Understanding the basics complications of radiotherapy along with its primary management of oral symptoms can assist family physicians in providing complete primary care for their cancer patients. Palliative oral care helps to ease symptoms from the cancer treatment. Oral care negligence is still a major cause of worsening of posttreatment quality of life of an individual. The article mainly empathies on the oral health care need to be taken care by primary care physicians in the cancer patients during and after the radiotherapy. Consequences associated with radiotherapy in oral cavity and its systematic overview of preventing and managing acute and chronic condition. It enlightens the importance of dentist role on improving quality of life of these patients.