No abstract

Aim: This study investigates the incidence of osteoradionecrosis (ORN) in patients with oropharyngeal cancer (OPC) since the use of intensitymodulating radiation therapy (IMRT). Materials and methods: The multi-disciplinary log for head and neck cancer (HNC) at Guys & St Thomas' NHS Foundation Trust was used to identify and collect data on all patients with OPC and treated with a curative intent. Basic and oncology-related demographic data were collected retrospectively. The presence and absence of ORN along with the causative factor was recorded. Results: A total of 361 patients were available for analysis 1-year post-IMRT with the number decreasing to 129 patients at ≥5 years post-IMRT. Thirty-eight cases of ORN were identified from which 29 patients had necrotic areas in the region of pre-RT dental extractions. The occurrence of spontaneous ORN was most evident within the first 2 years following RT while induced causes appear a steady lifelong threat particularly in the human papilloma virus (HPV)-positive OPC group. Conclusions: The introduction of novel targeted IMRT has not seen a significant reduction in the incidence of ORN with the condition of concern particularly evident in the HPV-positive OPC group. These patients present with a relatively intact dentition receiving RT doses above the threshold for development of ORN. Additionally, the favourable long-term survival of the HPV-positve OPC population is likely to be contributory to the rise of cases seen which provides a clinical challenge the dental sector will have to proactively manage. Clinical Relevance Scientific rationale for studyThe use of the intensity-modulating radiation therapy in the treatment of oropharyngeal cancer (OPC) has not seen a significant decline in osteoradionecrosis (ORN) rates with their heightened risk, superior dental status and increasing incidence; ORN disease pattern in this group needs to be further understood. Principal findingsThe mean yearly incidence of ORN in OPC patients is 2.66%. Worryingly, the disease pattern shows a heightened risk in early years post-RT especially among the HPV-positive cohort in association with pre-RT dental extractions. Practical implicationsSuperior dental status of HPV-positive OPC patients coupled with increased survivorship poses a clinical Oral Surgery 14 (2021) 113--121.

No abstract

No abstract

No abstract