Osteoradionecrosis of the Mandibula in Patients Treated with Different Fractionations

Abstract

Comparison of the incidence of ON during the period between 1980 and 1990 with the following period between 1990 and 1998 shows a decrease in risk to a value of approximately 5% using modern three-dimensional techniques as well as hyperfractionation or moderately accelerated fractionation.

Frequency of symptomatic vertebral body compression fractures requiring intervention following single-fraction stereotactic radiosurgery for spinal metastases

“…While the literature lacks clear consensus about the association between radiation dose and adverse skeletal events, several studies have reported a higher risk of jaw osteonecrosis with increasing radiation doses. 12,19 As experience with single-fraction SRS is gained, a more sophisticated understanding of the procedure's side effects and their underlying causes is sought. Al-Omair et al reported 2 biopsy-confirmed cases of post-SRS osteonecrosis in the spine and found devitalized bone with necrotic debris mixed with microscopic adenocarcinoma fragments 2 years after post-SRS in the first case and bone marrow replacement by fibrosis and significantly thinned trabeculae 3 years post-SRS in the second.…”

“…The median follow-up among the patients who were alive at the time of our analysis was 34 months. The most common primary tumors included renal cell (66 tumors), prostate (35), sarcoma (32), melanoma (26), non-small cell lung (25), colon (25), breast (19), and thyroid (18). None of the included patients had a history of previous radiation.…”

Factors predictive of severity of osteoradionecrosis of the mandible

“…This is attributed to the advent of megavoltage RT, improved dental preventive care, and improved radiation techniques including 3-dimensional conformal RT (3DCRT) and intensity-modulated radiation therapy (IMRT). [4][5][6] The latent period from treatment completion to ORN development can be variable. Early ORN (latent period less than 2 years) has been historically associated with RT dose exceeding 70 Gray (Gy) or with surgical trauma.…”

Osteoradionecrosis after Radiation Therapy for Head and Neck Cancer: Differentiation from Recurrent Disease with CT and PET/CT Imaging

“…4 There is a wide range of incidence of mandibular ORN reported, ranging from 5% to 22%, with more recent studies showing a decreased incidence, presumably attributable to increasing awareness and to improvements in preventive care and radiation techniques. [5][6][7][8][9] Patients are often referred for imaging to evaluate the extent of clinically suspected ORN, and, at the same time, to assess potential tumor recurrence. Multiple previous reports have characterized the imaging findings of ORN, [10][11][12][13][14] namely soft-tissue thickening and enhancement, cortical bone erosion, trabecular disorganization, and bone fragmentation.…”