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

Abstract

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.

Osteonecrosis of the jaws: a 14‐year retrospective survey of hospital admissions

“…ORN was diagnosed more commonly than MRONJ at a ratio of 3:1 and 80% of the patients who developed ORN were male. This strong male predominance is consistent with the findings of other epidemiological studies of ORN . The mean age of patients diagnosed with ORN was 62.7 years, compared with 66.9 years for MRONJ.…”

“…It was expected that MRONJ would be more prevalent due to the difficulties associated with providing preventative dental care to a more diverse group of patients. However, a number of patient behaviours such as poor oral hygiene, tobacco use and alcohol may be counteracting the benefits of preventative dental care in many of the ORN patients.…”

The survival impact of surgical therapy in squamous cell carcinoma of the hard palate

“…It is critical to similarly consider the treatment‐related effects of RT in this older population. Although novel techniques in the delivery of radiation, such as intensity modulation and more accurate mapping, have significantly reduced the incidence of osteoradionecrosis (ORN), a prevalence of 3% exists . This complication poses a significant threat in patients with cancer because high‐grade ORN requires a surgical intervention with or without reconstruction.…”

Predicting radiation dosimetric distribution in different regions of the jaw in patients receiving radiotherapy for squamous cell carcinoma of the tonsil

“…Late toxicities include osteoradionecrosis (ORN) to the mandible and maxilla, as well as subsequent dental complications (eg, dental caries and periodontal disease). 11 This has led to recommendations of the maximum dose that structures such as the parotid gland, mandible, and teeth can safely be F I G U R E 1 Measured maximum radiation dose delivered to six non-molar (A) and four molar (B) regions. The development of sequelae such as dental caries, periodontal disease, and ORN is due to both a direct effect of radiation on tooth structure as well as hyposalivation, which reduces oral clearance and alters oral microflora.…”

“…[7][8][9][10] In our own institution, multivariate analysis of over 1000 patients found that higher radiation dose was a significant risk factor for the development of ORN. 11 This has led to recommendations of the maximum dose that structures such as the parotid gland, mandible, and teeth can safely be F I G U R E 1 Measured maximum radiation dose delivered to six non-molar (A) and four molar (B) regions. Premolars (pmolar) and dental regions ipsilateral (ipsi) and contralateral (contra) to the primary tumor are indicated [Color figure can be viewed at wileyonlinelibrary.com] exposed to.…”