Osteoradionecrosis: Exposing the Evidence Not the Bone

Frankart, A.J.; Frankart, Michael J.; Cervenka, Brian; Tang, Alice; Krishnan, Deepak G.; Takiar, Vinita

doi:10.1016/j.ijrobp.2020.12.043

Cited by 64 publications

(68 citation statements)

References 72 publications

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“…Of 54 patients with refractory osteoradionecrosis, 62% and 92% had healing by 4 and 12 months, respectively 79 . Most patients improve with conservative management 80 …”

Section: Head and Neckmentioning

confidence: 99%

Radiation therapy‐associated toxicity: Etiology, management, and prevention

Wang

Tepper

2021

CA A Cancer J Clinicians

223

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Radiation therapy (RT) is a curative treatment for many malignancies and provides effective palliation in patients with tumor-related symptoms. However, the biophysical effects of RT are not specific to tumor cells and may produce toxicity due to exposure of surrounding organs and tissues. In this article, the authors review the clinical context, pathophysiology, risk factors, presentation, and management of RT side effects in each human organ system. Ionizing radiation works by producing DNA damage leading to tumor death, but effects on normal tissue may result in acute and/or late toxicity. The manifestation of toxicity depends on both cellular characteristics and affected organs' anatomy and physiology. There is usually a direct relationship between the radiation dose and volume to normal tissues and the risk of toxicity, which has led to guidelines and recommended dose limits for most tissues. Side effects are multifactorial, with contributions from baseline patient characteristics and other oncologic treatments. Technological advances in recent decades have decreased RT toxicity by dramatically improving the ability to deliver RT that maximizes tumor dose and minimizes organ dose. Thus the study of RT-associated toxicity is a complex, core component of radiation oncology training that continues to evolve alongside advances in cancer management. Because RT is used in up to one-half of all patients with cancer, an understanding of its acute and late effects in different organ systems is clinically pertinent to both oncologists and nononcologists.

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“…Of 54 patients with refractory osteoradionecrosis, 62% and 92% had healing by 4 and 12 months, respectively 79 . Most patients improve with conservative management 80 …”

Section: Head and Neckmentioning

confidence: 99%

Radiation therapy‐associated toxicity: Etiology, management, and prevention

Wang

Tepper

2021

CA A Cancer J Clinicians

223

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“…Modern radiation techniques such as intensity-modulated radiotherapy (IMRT) with lower dose restrictions to critical normal tissues, e.g., parotid glands or mandibular bone, have resulted in considerably lower toxicity rates such as xerostomia and osteoradionecrosis compared to conventional 3D radiation techniques [ 46 , 47 , 48 ]. However, radiotherapy-related dysphagia remains a frequent and major toxicity, severely affecting the long-term quality of life of surviving HNSCC patients [ 49 , 50 ].…”

Section: Beyond Hpv: De-escalation Strategies For Hnsccsmentioning

confidence: 99%

De-Escalation Strategies of (Chemo)Radiation for Head-and-Neck Squamous Cell Cancers—HPV and Beyond

Rühle

Grosu

Nicolay

2021

Cancers

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Oncological outcomes for head-and-neck squamous cell carcinoma (HNSCC) patients are still unsatisfactory, especially for advanced tumor stages. Besides the moderate survival rates, the prevalence of severe treatment-induced normal tissue toxicities is high after multimodal cancer treatments, both causing significant morbidity and decreasing quality of life of surviving patients. Therefore, risk-adapted and individualized treatment approaches are urgently needed for HNSCC patients to optimize the therapeutic gain. It has been a well-known fact that especially HPV-positive oropharyngeal squamous cell carcinoma (OSCC) patients exhibit an excellent prognosis and may therefore be subject to overtreatment, resulting in long-term treatment-related toxicities. Regarding the superior prognosis of HPV-positive OSCC patients, treatment de-escalation strategies are currently investigated in several clinical trials, and HPV-positive OSCC may potentially serve as a model for treatment de-escalation also for other types of HNSCC. We performed a literature search for both published and ongoing clinical trials and critically discussed the presented concepts and results. Radiotherapy dose or volume reduction, omission or modification of concomitant chemotherapy, and usage of induction chemotherapy are common treatment de-escalation strategies that are pursued in clinical trials for biologically selected subgroups of HNSCC patients. While promising data have been reported from various Phase II trials, evidence from Phase III de-escalation trials is either lacking or has failed to demonstrate comparable outcomes for de-escalated treatments. Therefore, further data and a refinement of biological HNSCC stratification are required before deescalated radiation treatments can be recommended outside of clinical trials.

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“…In advanced stages, necrosis can progress through the full thickness of bone and lead to pathologic fractures. 68,69 Treatment of ORN correlates with severity of disease, ranging from conservative management to surgical resection and free flap reconstruction. Basic management approaches involve optimization of oral health.…”

Section: Osteoradionecrosismentioning

confidence: 99%

Radiation-Induced Tissue Damage: Clinical Consequences and Current Treatment Options

et al. 2021

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Radiation therapy is a valuable tool in the treatment of numerous malignancies but, in certain cases, can also causes significant acute and chronic damage to noncancerous neighboring tissues. This review focuses on the pathophysiology of radiation-induced damage and the clinical implications it has for plastic surgeons across breast reconstruction, osteoradionecrosis, radiation-induced skin cancers, and wound healing. The current understanding of treatment modalities presented here include hyperbaric oxygen therapy, autologous fat grafting and stem cells, and pharmaceutical agents.

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Osteoradionecrosis: Exposing the Evidence Not the Bone

Cited by 64 publications

References 72 publications

Radiation therapy‐associated toxicity: Etiology, management, and prevention

Radiation therapy‐associated toxicity: Etiology, management, and prevention

De-Escalation Strategies of (Chemo)Radiation for Head-and-Neck Squamous Cell Cancers—HPV and Beyond

Radiation-Induced Tissue Damage: Clinical Consequences and Current Treatment Options

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