Modern management of osteoradionecrosis

Raggio, Blake S.; Winters, Ryan

doi:10.1097/moo.0000000000000459

Cited by 32 publications

(27 citation statements)

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“…Osteoradionecrosis (ORN) of the jaws is a late complication of RT in head and neck cancer, with an approximate incidence of 4-7%, which has been described in recent studies [1,2]. Moreover, there is a higher prevalence of ORN in the mandible, commonly manifested in the first three years after treatment [3,4]. At clinical assessment, ORN is found to be a painful exposure of necrotic bone in the irradiated region, which does not heal spontaneously within 3-6 months, and may be associated with purulent drainage, orocutaneous fistulae, and pathological fracture [3,5].…”

Section: Introductionmentioning

confidence: 99%

Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report

Edison¹,

Rocha²,

Valdener³

et al. 2021

Int J Case Rep Images

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Introduction: Osteoradionecrosis (ORN) of the jaws is a late complication of radiotherapy (RT) of the head and neck, with higher prevalence in the mandible. Treatment of the condition is controversial, ranging from conservative non-surgical management to extensive surgical resections with reconstruction. Drug therapy with pentoxifylline and tocopherol (PENTO) associated with adjuvant therapies has shown satisfactory clinical results, also in advanced stages of ORN. The present case report aims to describe the conservative management of an advanced mandibular ORN by medication with PENTO and other adjuvant therapies.Case Report: A 62-year-old Afro-descendent woman, with a history of oral squamous cell carcinoma in the left floor of the mouth, who was submitted to surgical resection, RT, and concomitant chemotherapy 17 years

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Section: Introductionmentioning

confidence: 99%

Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report

Edison¹,

Rocha²,

Valdener³

et al. 2021

Int J Case Rep Images

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“…HBO-mediated oxidative stress reduces inflammation (Rocha et al, 2015, stimulates the differentiation of circulating stem/progenitor cells in vitro (Lin et al, 2014;Gardin et al, 2020) and growth of new blood vessels from local endothelial cells in vivo (Grassmann et al, 2015;An et al, 2019). Furthermore, HBO has bactericidal/bacteriostatic effects (Raggio & Winters, 2018), accelerates osteoblast differentiation (Al Hadi et al, 2015), and increases expression of vascular endothelial growth factor (VEGF) (Gardin et al, 2020) and Runt-related transcription factor 2 (Runx2) (Lin et al, 2014;Rocha et al, 2015), improving bone formation (An et al, 2019;Grassmann et al, 2015;Rocha et al, 2015;Alhadi et al, 2015;Park et al, 2019). In this context, the present study hypothesized that HBO therapy might improve repair in bone compromised by ionizing radiation.…”

Section: Introductionmentioning

confidence: 99%

Influência da oxigenação hiperbárica no reparo ósseo e organização do colágeno após radioterapia

Rocha¹,

Rezende²,

Reis³

et al. 2020

RSD

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O presente estudo teve como objetivo avaliar os efeitos da HBO no reparo ósseo após radiação ionizante, por meio da histomorfometria, tomografia computadorizada e microscopia de polarização. Vinte ratos Wistar machos foram usados. Uma dose de radiação (30 Gy) foi administrada na perna esquerda em todos os animais, e após 30 dias, defeitos ósseos foram criados em ambos os fêmures. Em seguida, 10 animais receberam sessões diárias de HBO (2,5 ATA por 90 minutos), e todos os animais foram sacrificados 5 ou 7 dias após a cirurgia. Os fêmures foram separados em 4 grupos (n = 5) para cada intervalo de tempo de eutanásia: Controle (fêmur direito: não irradiado e não HBO), RXT (fêmur esquerdo: irradiado e não HBO), HBO (fêmur direito: não-irradiado com HBO), RXT + HBO (fémur esquerdo: irradiado com HBO). A cortical óssea e os defeitos foram avaliados. Os dados foram analisados por meio dos testes de Kolmogorov-Smirnov, teste t não pareado e ANOVA com correção de Bonferroni. Valores maiores de HU e neoformação óssea foram observados nos grupos Controle e HBO, com melhora do reparo. O grupo HBO apresentou birrefringência de colágeno predominantemente amarela/laranja/vermelha na área do defeito. A HBO melhorou a reparação óssea em condições fisiológicas, com aumento dos vasos sanguíneos e formação óssea. No entanto, não foi eficiente em melhorar o reparo e a orientação do colágeno no osso após altas doses de radiação ionizante.

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“…The definitive pathogenesis of ORN remains unclear; however, the recently proposed radiation-induced fibroatrophic theory—free radical formation causing inflammation, microvascular thrombosis, fibrosis, and necrosis 7 —has gained traction as a principal mechanism of ORN. 4 Consequently, various anti-inflammatory agents (ie, pentoxifylline and tocopherol) have been evaluated for their protective role in ORN, with limited but promising results. 8,9 Similarly, steroid administration has been hypothesized to help prevent ORN on the basis of its potent anti-inflammatory effects, though this question remains unanswered.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Secondary to recent technological advances in the field of radiation oncology (ie, intensity-modulated radiotherapy), radiation-induced complications occur less often in the modern era. 3 Perhaps the most dreaded of these radiation-induced complications is osteoradionecrosis (ORN)-a chronic, nonhealing, necrotic process of the bone not related to tumor occurrence 4 -which occurs in a minority (7%) 5 of patients with HNC treated with radiotherapy but significantly affects health-related quality of life. 6 Therefore, a focus on identifying protective factors for this serious complication remains of great importance.…”

Section: Introductionmentioning

confidence: 99%

Role of Steroids in Preventing Osteoradionecrosis of the Head and Neck: A Systematic Review

Raggio

Winters

2019

Ann Otol Rhinol Laryngol

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Objective: The aim of this study was to summarize the effectiveness of steroids in the prevention of osteoradionecrosis of the head and neck. Data Sources: PubMED, MEDLINE, Embase, Google Scholar, and Cochrane trial registries. Methods: A systematic review of these data sources was performed through September 2018 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were English-language studies evaluating patients of all age groups diagnosed with head and neck cancer who underwent radiation therapy while receiving peritreatment steroids compared with those who did not receive steroids. Results: Two retrospective cohort studies were identified for qualitative review. On the basis of analysis of 25 328 participants (36-82 years of age) with head and neck cancer who underwent radiation therapy, the use of peritreatment steroids was associated with a significantly lower risk for osteoradionecrosis in both studies, with a hazard ratio of 0.74 (95% confidence interval, 0.59-0.94; P = .012) and a relative risk of 0.04 (95% confidence interval, 0.003-0.560; P = .017). Meta-analysis was precluded by clinical and statistical heterogeneity. Overall, the studies were of limited quality with high risk for bias and poor methodology. Conclusions: Limited retrospective data suggest that steroids are predictive of a reduced risk for osteoradionecrosis; however, no definitive conclusions can be made given the poor quality of the available literature. Well-designed, comparison-controlled trials are needed to clarify the promising role of steroids in the prevention of osteoradionecrosis of the head and neck.

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Modern management of osteoradionecrosis

Abstract: The fibroatrophic process has gained acceptance as a main mechanism of ORN. No gold standard treatment or consensus guidelines exist, though a combination of therapeutic strategies should be considered, taking into account the severity of disease and individual patient characteristics.

Cited by 32 publications

References 71 publications

Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report

Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report

Influência da oxigenação hiperbárica no reparo ósseo e organização do colágeno após radioterapia

Role of Steroids in Preventing Osteoradionecrosis of the Head and Neck: A Systematic Review

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