Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy

Dhanda, Jagtar; Pasquier, David; Newman, Laurence; Shaw, Richard

doi:10.1016/j.clon.2016.03.002

Cited by 64 publications

(73 citation statements)

References 50 publications

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“…These results suggest that the theoretical advantages of IMPT translated to clinical benefit. Other factors such as tumor location and size, dental status, poor oral hygiene, alcohol consumption, and smoking also contribute to the development and severity of osteoradionecrosis [2, 6, 29, 30]; some those confounding effects are balanced in these two groups (table 1)Finally, osteoradionecrosis is also related to not only the radiation dose but also the primary tumor (and hence high-dose volume) location. Curi and Dib found osteoradionecrosis to be rare among patients who received doses lower than 50 Gy and its frequency to be related to the total radiation dose [8].…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Zhang

Yang

et al. 2017

Radiotherapy and Oncology

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Purpose We compared mandibular doses and osteoradionecrosis in patients with oropharyngeal cancer after intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT). Methods and materials We identified 584 patients who received definitive radiotherapy for oropharyngeal cancer from January 2011 through June 2014 at MD Anderson Cancer Center (534 IMRT and 50 IMPT). The dosimetric variables and osteoradionecrosis were compared with Chi-square test or Fisher’s exact test. Results Median follow-up time for all patients (534 IMRT and IMPT) was 33.8 months (33.8 months IMRT vs. 34.6 months IMPT, P=0.854), and median time to osteoradionecrosis was 11.4 months (range 6.74–16.1 months). Mandibular doses were lower for patients treated with IMPT (minimum 0.8 vs. 7.3 Gy; mean 25.6 vs. 41.2 Gy; P<0.001), and osteoradionecrosis rates were lower as well: 2% IMPT (1 grade 1), 7.7% IMRT (12 grade 4, 5 grade 3, and 1 grade 2 and 23 grade 1). Osteoradionecrosis location depended on the primary tumor site and high-dose field in the mandible. Conclusions: Osteoradionecrosis events were significantly associated with higher dose irradiation to mandibular Use of IMPT minimized excess irradiation of the mandible and consequently reduced the risk of osteoradionecrosis for oropharyngeal cancer.

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Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Zhang

Yang

et al. 2017

Radiotherapy and Oncology

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“…In addition to dosimetric factors, poor dental health before RT, post-radiation extraction of teeth and trauma (by prosthesis, bone biopsy, salvage surgery) in bone regions exposed to a high RT dose, are the main risk factors for ORN development. Xerostomia and trismus are well recognized contributing factors, as they impair oral hygiene and promote caries [133,134]. ORN presents clinically as a painful and denuded bony region, with purulent drainage and sometimes progresses to fistula formation (to the mucosal or skin surface).…”

Section: Mandible Osteoradionecrosismentioning

confidence: 99%

“…On a panoramic radiograph, loss of trabecular architecture usually seen though the appearance of the affected bone may be normal. In a historical RT series, the incidence of ORN ranged from 2% to 22%: this wide range reflects not only the differences in RT techniques employed but also ambiguity in definition and difficulties in the diagnosis of ORN [133,134]. In an extensive review of 31 studies published between 1990 and 2008 by Peterson et al [135], the weighted prevalence for ORN in patients with different types of HNC treated with conventional RT was 7.4%, with IMRT 5.2%, with (chemo)RT 6.8%, and with brachytherapy 5.3%.…”

Section: Mandible Osteoradionecrosismentioning

confidence: 99%

“…Surgery employing resection of involved bone and free-flap reconstructions are indicated in advanced-stage ORN cases with fractures and/or fistulas [133,134]. According to a systematic review of the pertinent literature by Lee et al [141], the fibula is the workhorse free flap for reconstruction in mandibular ORN, with the risk of flap failure and postoperative complications being significantly increased compared to reconstruction of the primary tumor in unirradiated patients.…”

Section: Mandible Osteoradionecrosismentioning

confidence: 99%

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Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

242

171

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Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.

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“…Komplikacije na maksili i mandibuli predstavljaju specifičan problem sa kliničkom slikom osteomijelitisa, i osteonekroze nakon zračne terapije i sekvestracije 21 . Rizik od ovih komplikacija značajno je smanjen ukoliko se koriste odgovarajuće zaštitne mere pre zračne terapije.…”

Section: Komplikacije Na Maksili I Mandibuli Uzrokovane Radioterapijounclassified

The effects of radiotherapy and chemotherapy on oral tissues

Petrović¹,

Cvetanović²,

Obradoviç³

et al. 2019

Acta stomatologica Naissi

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SažetakUvod:Tretman bolesnika koji boluju od raka, u smislu hemoterapije i radioterapije, značajno je evoluirao od svog začetka. Obe terapije, naročito ako se koriste u kombinaciji, imaju veoma ozbiljan potencijal da dovedu do neželjenih efekata, koji narušavaju kvalitet života i potencijalno povećavaju mortalitet bolesnika obolelih od raka. Cilj rada:U ovom radu opisan je uticaj radioterapije i hemoterapije na oralna tkiva. Oralne komplikacije koje se posledično javljaju mogu se svrstati u sledeće kategorije: mukozsitis, kserostomija, gljivične, virusne i bakterijske infekcije, disgeuzija, disfagija, profuzno krvarenje, osteonekroza i mišićni trizmus. Zaključak:Budući da je potreban širok spektar preventivnih i kurativnih mera, pojavljuje se potreba za sastavljanjem posebnih timova za brigu o bolesnicima pre, tokom i nakon radioterapije i hemoterapije. Takav onkološki tim trebalo bi imati doktora stomatologije, specijalistu oralne medicine kao aktivnog člana. AbstractIntroduction: Cancer treatment, in terms of chemotherapy and radiotherapy has evolved significantly from its beginning. Both therapies, especially used in combination, had the potential to cause side effects, that potentially decrease in quality of life and lead to increased mortality rate in patients with cancer. The aim:of the study: The effects of radiotherapy and chemotherapy were described. The oral complications which consequently occurred could be classified into following categories: mucositis, oral dryness, fungal, viral and bacterial infections, disgeusia, disfagio, profuse bleeding, osteonecrosis and muscle trismus. Conclusion: Because of the wide range of preventive and curative measures, it is necessary to create a special team for caring of patients before, during and after radiotherapy and chemotherapy. In such case, dentist, oral medicine specialists should be an active member of oncology team.

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Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy

Cited by 64 publications

References 50 publications

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Treatment of late sequelae after radiotherapy for head and neck cancer

The effects of radiotherapy and chemotherapy on oral tissues

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