Predictive factors for osteoradionecrosis of the jaws: A retrospective study

Sathasivam, Hans Prakash; Davies, Gareth; Boyd, Nicholas M.

doi:10.1002/hed.24907

Cited by 61 publications

(53 citation statements)

References 45 publications

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“…Increase in the radiation dose in the bone and soft tissue adjacent to the implant material can contribute to difficulties in healing . There is no specific amount of radiation that is known to cause osteoradionecrosis but the risk is shown to increase with dose . Our results show that the dose reduces most with titanium compared to other tested reconstruction materials.…”

Section: Discussionmentioning

confidence: 68%

Scattering of therapeutic radiation in the presence of craniofacial bone reconstruction materials

Toivonen

Björkqvist

Minn

et al. 2019

J Applied Clin Med Phys

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PurposeRadiation scattering from bone reconstruction materials can cause problems from prolonged healing to osteoradionecrosis. Glass fiber reinforced composite (FRC) has been introduced for bone reconstruction in craniofacial surgery but the effects during radiotherapy have not been previously studied. The purpose of this study was to compare the attenuation and back scatter caused by different reconstruction materials during radiotherapy, especially FRC with bioactive glass (BG) and titanium.MethodsThe effect of five different bone reconstruction materials on the surrounding tissue during radiotherapy was measured. The materials tested were titanium, glass FRC with and without BG, polyether ether ketone (PEEK) and bone. The samples were irradiated with 6 MV and 10 MV photon beams. Measurements of backscattering and dose changes behind the sample were made with radiochromic film and diamond detector dosimetry.ResultsAn 18% dose enhancement was measured with a radiochromic film on the entrance side of irradiation for titanium with 6 MV energy while PEEK and FRC caused an enhancement of 10% and 4%, respectively. FRC‐BG did not cause any measurable enhancement. The change in dose immediately behind the sample was also greatest with titanium (15% reduction) compared with the other materials (0–1% enhancement). The trend is similar with diamond detector measurements, titanium caused a dose enhancement of up to 4% with a 1 mm sample and a reduction of 8.5% with 6 MV energy whereas FRC, FRC‐BG, PEEK or bone only caused a maximum dose reduction of 2.2%.ConclusionsGlass fiber reinforced composite causes less interaction with radiation than titanium during radiotherapy and could provide a better healing environment after bone reconstruction.

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Section: Discussionmentioning

confidence: 68%

Scattering of therapeutic radiation in the presence of craniofacial bone reconstruction materials

Toivonen

Björkqvist

Minn

et al. 2019

J Applied Clin Med Phys

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“…Radiological evidence of bone necrosis within the RT eld is also important for the diagnosis and classi cation of ORNJ severity [3]. Several risk factors of ORNJ have been reported, including patientrelated [4][5][6][7], tumor-related [4,5,8,9], and treatment-related factors [5,8,[10][11][12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Squamous Cell Carcinoma

Kubota

Miyawaki

Mukumoto

et al. 2020

Preprint

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Background: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.Methods: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008–2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy–70 Gy [V10–70]) were investigated and compared between patients with and without ORNJ. The Mann–Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan–Meier analyses were performed for cumulative ORNJ incidence estimation. Results: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range, 3–145) months. The median time to ORNJ development was 27 (range, 2–127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 >14% were identified as important factors. In multivariate analyses, V60 >14% (p=0.0065) and primary tumor site (p=0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤14% and >14%, respectively (p<0.0001), and 1.4% and 9.3% in patients with oropharyngeal or oral cancer and other cancers, respectively (p<0.0001). Conclusions: V60 >14%, and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

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“…The treatment of these cancers depends on factors such as the location of the tumor, degree of malignancy, clinical staging, and general health of the patient. Surgery with a safety margin for tumor removal and radiotherapy (RT) with or without chemotherapy are the treatment alternatives most often indicated (Sathasivam et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…ORN can affect the patient's quality of life since it can cause severe pain, extra and intraoral fistulae, pathological fractures, systemic infections, trismus, masticatory and phonetic difficulties, fetid odor, as well as dysgeusia and dysesthesia (Sathasivam et al;Monteiro et al, 2005;Franco et al, 2017;Chronopoulos et al).…”

Section: Introductionmentioning

confidence: 99%

Osteoradionecrosis in a Patient Submitted to Head and Neck Radiotherapy: A Case Report

Ferreira¹,

Corrêa²,

Balenzio³

et al. 2019

Int. J. Odontostomat.

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Radiotherapy applies ionizing radiation at predetermined doses for a limited period of time in order to destroy tumors. The oral cavity, which has a high rate of cell renewal, is affected by the side effects of radiotherapy including osteoradionecrosis (ORN). This condition occurs due to irradiated bone tissue that becomes devitalized and exposed in the oral cavity. Conservative therapies are recommended for ORN lesions that are not extensive or in an early stage. Surgical intervention is necessary for extensive areas affected by necrosis. This study reports a case of ORN in the left mandibular body which resulted in a pathological fracture. The treatment consisted of segmental mandibulectomy and the use of a reconstruction plate. Also, low-level laser therapy around bone exposure was performed. After surgery, the patient underwent 6 months of follow-up and was satisfied with the outcome. However, the patient died before control of ORN was achieved due to a heart attack.

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Predictive factors for osteoradionecrosis of the jaws: A retrospective study

Abstract: Background: Osteoradionecrosis of the jaw (ORNJ) is a well-recognized complication of radiotherapy. The purpose of this study was to assess predictive factors for the development of ORNJ.

Cited by 61 publications

References 45 publications

Scattering of therapeutic radiation in the presence of craniofacial bone reconstruction materials

Scattering of therapeutic radiation in the presence of craniofacial bone reconstruction materials

Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Squamous Cell Carcinoma

Osteoradionecrosis in a Patient Submitted to Head and Neck Radiotherapy: A Case Report

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