Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: A nationwide population-based retrospective study in Taiwan

Kuo, Tsu-Jen; Leung, Chung-Man; Chang, Hao-Sheng; Wu, Ching-Kuan; Chen, Wei-Li; Chen, Guang-Jhong; Lai, Yi-Chun; Huang, Wei-Chun

doi:10.1016/j.oraloncology.2016.03.005

Cited by 56 publications

(53 citation statements)

References 32 publications

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“…Patients with post-RT dental extractions are at an increased risk of developing ORN [20, 31–33]. However, in this study 82% of the patients who developed ORN had no prior traumatic event or dentoalveolar procedure prior to development of ORN.…”

Section: Discussionmentioning

confidence: 65%

“…The local risk factors include tumor site, tumor stage, proximity of the tumor to bone, radiation field, dose of radiation, poor oral hygiene, and associated trauma, such as dental extraction/surgery before or after RT. Systemic factors include co-morbidities, smoking and drinking alcohol, immunodeficient status, and infection [15– 20]. The aims of this study are: (1) to report the current prevalence of ORN in patients with oral cavity cancer (OCC) and oropharyngeal cancer (OPC) treated with IMRT between 2004 and 2013 in our institution; and (2) to evaluate the correlation between various risk factors [radiation dose, periodontal status, alcohol and smoking] and the development of ORN.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

et al. 2017

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Objective To determine the prevalence and correlation of various risk factors [radiation dose, periodontal status, alcohol and smoking] to the development of osteoradionecrosis (ORN). Patients and Methods The records of 1023 patients treated with IMRT for oral cavity cancer (OCC) and oropharyngeal (OPC) between 2004 and 2013 were retrospectively reviewed to identify patients who developed ORN. Fisher exact tests were used to analyze patient characteristics between ORN patients with OCC and OPC. Paired Wilcoxon tests were used to compare the dose volumes to the ORN and contralateral non-ORN sites. To evaluate an association between ORN and risk factors, a case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by gender, tumor site and size. General estimation equations models were used to compare the risk factors in ORN cases and matched controls. Results 44 (4.3%) patients developed ORN during a median follow-up time of 52.5 months. In 82% of patients, ORN occurred spontaneously. Patients with OPC are prone to develop ORN earlier compared to patients with OCC (P=0.03). OPC patients received a higher Dmax compared to OCC patients (P=0.01). In the matched case-control analysis the significant risk factors on univariate analysis were poor periodontal status, history of alcohol use and radiation dose (P=0.03, 0.002 and 0.009, respectively) and on multivariate analysis were alcohol use and radiation dose (P=0.004 and 0.026, respectively). Conclusion In our study, higher radiation dose, poor periodontal status and alcohol use are significantly related to the risk of developing ORN.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

et al. 2017

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“…A recent retrospective cohort study of 1759 patients with head and neck cancer in Taiwan concluded that a tooth extraction time less than half a year after head and neck radiotherapy or during the head and neck radiotherapy period, and extraction tooth number ≤ 5 would significant lower the ORN prevalence. 28 Multidisciplinary approach is mandatory in the management of the patient. Further improvement in therapeutic and treatment options is required in order to reduce ORN complications and its negative impact on the quality of life.…”

Section: Case Reportmentioning

confidence: 99%

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

Moraes

Thomaz

Silva

et al. 2016

RGO, Rev. Gaúch. Odontol.

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Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. RESUMOOsteorradionecrose dos maxilares é uma das complicações mais sérias da radioterapia para o tratamento de tumores de cabeça e pescoço. O manejo da osteorradionecrose continua sendo discutido e há poucos relatos de casos descrevendo modalidades de tratamento conservadoras. Este artigo apresenta um caso de osteorradionecrose na mandíbula de um paciente de 58 anos de idade, após a realização de exodontia e explora uma modalidade de tratamento conservador com um follow-up de três anos. Foram combinadas antibioticoterapia e irrigação diária utlizando clorexidina. Após três anos é possível observar a resolução do caso em imagens de tomografia computadorizada de feixe cônico e reconstruções 3D. As imagens evidenciam remodelação óssea após este período de acompanhamento e sem a presença de osso exposto. Pode-se concluir que a terapia proposta resultou em sucesso e o paciente continua em acompanhamento periódico.

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“…Post-RT dental extraction is well-recognized as patient-related risk factor for ORNJ [28][29][30]. A systematic review reported that the incidence rate of ORNJ after tooth extraction in irradiated patients was 7% [31].…”

Section: Discussionmentioning

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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Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: A nationwide population-based retrospective study in Taiwan

Cited by 56 publications

References 32 publications

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

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

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