Long term chemoradiotherapy-related dental and skeletal complications in a young female with nasopharyngeal carcinoma

Abstract

We describe the long-term complications six years after chemoradiotherapy in a 20-year old woman with nasopharyngeal carcinoma. We wanted to know whether the radiation dose was constant throughout the oral cavity, and thus uniformly affecting the corresponding dental and skeletal structures. Clinical and radiologic findings are described six years after chemoradiotherapy based on a two-dimensional computerized treatment planning system. This revealed radiation caries limited only to posterior teeth, proximal caries in the anterior teeth, limited but continuous salivary flow, mild periodontal infection, mild xerostomia, and a regenerative capacity of bones and the developmental process. The quantitative assessment of radiation delivered to the mandible revealed a high radiation dose in the posterior area and a minimal dose in the anterior area. This explains the differences in caries manifestation between the anterior and posterior teeth. According to the present study, individualized radiation fields, using a two-dimensional treatment planning system, result in restriction of severe damage of the dental and skeletal structures, which usually follows chemoradiotherapy. Orthodontic treatment could be initiated according to individual patient needs.

Cervico-facial irradiation and orthodontic treatment

“…Because most growth in children occurs before the age of 4 and then during puberty, the effects of radiotherapy on the skeleton will be more marked during these periods of rapid growth, just when the incidence of ALL is at its highest [2][3][4][5][6].…”

“…Thirty grays (30 Gy) is potentially harmful for the development of cranio-facial structures; 4 Gy modifies soft tissue development [2,4,5].…”

“…In fact, irradiation not only diminishes vascularization but also has a direct cytotoxic effect on epiphyseal chondrocytes. The reduction in height observed in irradiated children can also be explained by an early onset of puberty and a shortening of the accompanying growth spurt [2][3][4][5][6].…”

“…However, radiotherapy, in combination or not with chemotherapy and performed during the growth phase, has a harmful impact on growth generally and more particularly on cranio-facial and oro-dental development. These consequences, whether slight or evident, may appear months or even years after the end of treatment and may complicate orthodontic procedures [2][3][4][5].…”

“…Des ann ees apr es leur traitement, ces patients ayant pr esent e une pathologie h ematologique et malgr e leurs probl emes de sant e chroniques, aspirent à avoir, dans la mesure du possible, un acc es au traitement orthodontique à l'instar des sujets en bonne sant e. Or les traitements par radioth erapie associ ee ou non à la chimioth erapie, appliqu es à ces enfants en p eriode de croissance, auront des cons equences n efastes sur la croissance g en erale, ainsi que sur le d eveloppement craniofacial et buccodentaire en particulier. Ces cons equences, manifestes ou nuanc ees, peuvent apparaître des mois, voire des ann ees apr es la fin du traitement, et pourraient compliquer le traitement orthodontique [2][3][4][5]. L'objectif de ce travail est d' etudier les effets de la radioth erapie pr econis ee à unâge pr ecoce sur le d eveloppement craniofacial et buccodentaire, l'interf erence de ces effets avec le traitement orthodontique, et la strat egie th erapeutique la mieux adapt ee pour les g erer.…”