Osteoradionecrosis of the mandible: A ten year single-center retrospective study

Chronopoulos, Aristeidis; Zarra, T.; Tröltzsch, Matthias; Mahaini, Salah; Ehrenfeld, Michael; Otto, Sven

doi:10.1016/j.jcms.2015.03.024

Cited by 46 publications

(54 citation statements)

References 67 publications

(113 reference statements)

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“…Oh et al demonstrated that patients who continued smoking or alcohol use are at risk of failing conservative management and are more prone to having a surgical intervention [17]. A recent study by Chronopoulos et al showed that patients who continued smoking or alcohol use were more likely to develop a severe grade of ORN [19]. In our study 75% of patients with ORN still continued alcohol use and 25% continued smoking.…”

Section: Discussionsupporting

confidence: 46%

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: Discussionsupporting

confidence: 46%

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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“…In the current study, we examined patients with OPC, a group who are routinely treated with definitive RT with or without systemic therapy at the Princess Margaret Cancer Centre. 14,20 Smoking is associated with poor oral hygiene, but may decrease oxygenation of tissues and affect the healing process of the acute damage and vascular disorders occurring throughout RT. Patients requiring mandibulotomies or mandibulectomies have been reported to have a higher risk of bone necrosis after RT.…”

Section: Discussionmentioning

confidence: 99%

“…Because interventions (including sequestration, medical interventions, HBO, and surgery) were applied based on the duration and extent of ORN, these interventions in combination with clinical and radiographic information provide a consistent estimate of severity, which is the purpose of a grading schema. In other publications, a large variety of grading guidelines have been used, including the Radiation Therapy Oncology Group, 6,11,13,18 the Common Terminology Criteria for Adverse Events, 9,12,19 Schwartz and Kagan grading, 7,8 the grading system of Glanzmann and Graetz 3,10 the grading guidelines of Tsai et al 14 Lyons et al, 19 Notani et al's, 20 the National Cancer Institute Common Toxicity Criteria, 18 and the Late Effects of Normal Tissues Task Force/Subjective, Objective, Management, Analytic (LENT/SOMA) scale. 16 However, in some publications, the grading system is not mentioned.…”

Section: Discussionmentioning

confidence: 99%

Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity‐modulated radiotherapy

Caparrotti

Huang

Lü

et al. 2017

Cancer

118

109

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ORN is relatively uncommon among patients with oropharyngeal carcinoma who are treated with IMRT, but continues to occur beyond 5 years after treatment. Modifiable risk factors that are associated with higher rates of ORN include smoking and the use of bisphosphonates. Minimizing the volumes of the mandible receiving >50 Gy or > 60 Gy also may have an effect on the ORN rate. Cancer 2017;123:3691-3700. © 2017 American Cancer Society.

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“…For the aforementioned reasons, we set the cut-off for the radiation dose at 80 Gy and performed further analysis. Controversy persists among investigations as to whether the radiation dose is directly proportional to the development or severity of ORNM 18, 20–22 ; nevertheless, no coherent conclusion has been drawn because the distinct grading system used in previous investigations made comparison baseless and meaningless. Mucke et al .…”

Section: Discussionmentioning

confidence: 99%

Nomogram model to predict postoperative infection after mandibular osteoradionecrosis surgery

Liu¹,

Dai²,

Wang³

et al. 2017

Sci Rep

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Osteoradionecrosis of the mandible (ORNM) is one of the most dreaded complications of radiotherapy. The poor healing capacity of soft tissue after radiation may lead to surgical failure. The current study was designed to identify prognostic factors for postoperative infection (PPI) and propose corresponding prophylaxis and intervention protocols. A retrospective study was conducted concerning ORNM patients from 2000 to 2015. A risk-stratification score and nomogram model were established to predict the risk of PPI. A total of 257 patients were analyzed, and the total incidence of PPI was 23.3% (60/257). In multiple logistic regression analysis, radiation dose 80 Gy (versus <80 Gy, OR = 2.044, P = 0.035, 95% CI: 1.05–3.979), bilateral ORNM (versus unilateral, OR = 4.120, P = 0.006, 95% CI: 1.501–11.307), skin fistula (versus none, OR = 3.078, P = 0.040, 95% CI: 1.05–9.023), and implant utilization (versus none, OR = 2.115, P = 0.020, 95% CI: 1.125–3.976) were significantly associated with PPI. The susceptibility to PPI in patients with risk-stratification scores of 14–22 was 2.833 times that of patients with scores of 7–13, and 7.585 times that of cases defined as scores of 0–6. The discrimination capability of the nomogram model was estimated using a ROC curve with an AUC of 0.708, revealing potentially useful predictive abilities. In conclusion, current risk-stratification scores and nomogram models effectively predicted the risk of PPI in ORNM patients.

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Osteoradionecrosis of the mandible: A ten year single-center retrospective study

Cited by 46 publications

References 67 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

Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity‐modulated radiotherapy

Nomogram model to predict postoperative infection after mandibular osteoradionecrosis surgery

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