Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity‐modulated radiotherapy

Maesschalck, Thibault De; Dulguerov, Nicolas; Caparrotti, Francesca; Scolozzi, Paolo; Picardi, C; Mach, Nicolas; Koutsouvelis, Nikolaos; Dulguerov, Pavel

doi:10.1002/hed.24505

Cited by 40 publications

(32 citation statements)

References 32 publications

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“…Current literature reports that 40% of ORN cases manifest within 36 months after RT with a peak around 18 months . In our cohort, the median ORN onset was 5 months after RT, and the bone most commonly affected was the mandible (20/21 patients).…”

Section: Discussionmentioning

confidence: 64%

“…It is defined as any area >1 cm of exposed bone in a previously irradiated situs, which is persisting for at least 3 months and is not caused by tumour recurrence/persistence . Even with intensity‐modulated radiation therapy (IMRT), the overall incidence of ORN remains at approximately 10% . Treatment strategies for ORN include conservative strategies (antibiotics) and surgical methods .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Contrast‐enhanced 18F‐FDG‐PET/CT for Differentiating Tumour and Radionecrosis in Head and Neck Cancer: Our experience in 37 Patients

Meerwein

Nakadate

Stolzmann

et al. 2018

Clinical Otolaryngology

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Contrast‐enhanced 18F‐FDG‐PET/CT for Differentiating Tumour and Radionecrosis in Head and Neck Cancer: Our experience in 37 Patients

Meerwein

Nakadate

Stolzmann

et al. 2018

Clinical Otolaryngology

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“…A recent study, however, reported no reduction in ORN rates in oropharyngeal cancer patients after IMRT in comparison to conventional 3D conformal radiotherapy techniques. [4] Most single-institution series of oral/oropharyngeal cancer patients treated with radiotherapy demonstrate frank osteoradionecrosis rates of approximately 1–11% [5–10]. Consequently, as Thariat et al[11] assert, “this low incidence may indeed make the establishment of statistically relevant correlations between dose and ORN difficult.”…”

Section: Introductionmentioning

confidence: 99%

“…Several groups have reported different dose correlates and various permutations of maximum and mean mandibular dose as usable constraints[6, 7, 13, 14]. Traditionally, doses under 50 Gy were considered unlikely to contribute substantively to osteoradionecrosis, and most recommendations and clinical protocols restrict dose only above 50 Gy or more[5–10]. …”

Section: Introductionmentioning

confidence: 99%

Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

Mohamed

Hobbs

Hutcheson

et al. 2017

Radiotherapy and Oncology

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Purpose To determine dosimetric parameters associated with Osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era. Material and Methods Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002–2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN. Results 68 ORN cases and 131 controls were matched. Median follow-up was 41 months and median time to development of ORN was 16 months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6 Gy, p < 0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p< 0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44≥42% and V58≥25%. Conclusions Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44<42% and V58<25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.

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“…Several reports have indicated the trend in the rate of jawrelated complications among patients receiving IMRT compared with those receiving 3-dimensional conformal RT (3D-CRT) [11,15,20]. In contrast, no reductions were observed in long-term ORNJ rates following IMRT in the absence of attempts to reduce the jaw volumes receiving high doses in IMRT plan optimization [21]. Thus, it is necessary to determine the dose-volumetric threshold of the jaw for IMRT plan optimization to reduce the incident of ORNJ.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Squamous Cell Carcinoma

Kubota

Miyawaki

Mukumoto

et al. 2020

Preprint

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Background: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.Methods: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008–2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy–70 Gy [V10–70]) were investigated and compared between patients with and without ORNJ. The Mann–Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan–Meier analyses were performed for cumulative ORNJ incidence estimation. Results: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range, 3–145) months. The median time to ORNJ development was 27 (range, 2–127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 >14% were identified as important factors. In multivariate analyses, V60 >14% (p=0.0065) and primary tumor site (p=0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤14% and >14%, respectively (p<0.0001), and 1.4% and 9.3% in patients with oropharyngeal or oral cancer and other cancers, respectively (p<0.0001). Conclusions: V60 >14%, and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

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Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity‐modulated radiotherapy

Cited by 40 publications

References 32 publications

Contrast‐enhanced 18F‐FDG‐PET/CT for Differentiating Tumour and Radionecrosis in Head and Neck Cancer: Our experience in 37 Patients

Contrast‐enhanced 18F‐FDG‐PET/CT for Differentiating Tumour and Radionecrosis in Head and Neck Cancer: Our experience in 37 Patients

Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Squamous Cell Carcinoma

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