Does radiation-induced fibrosis have an important role in pathophysiology of the osteoradionecrosis of jaw?

Zhuang, Qiya; Zhang, Zhiyuan; Fu, Honghai; He, Jie; He, Yue

doi:10.1016/j.mehy.2011.03.024

Cited by 22 publications

(24 citation statements)

References 35 publications

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“…Importantly, it has been postulated that radiation-induced fibrosis is linked to the development and progression to radiation-induced osteoradionecrosis. 23 Therefore, the histopathological finding of radiation-induced fibrosis supports the idea of radiation-induced late effects on the bone as a factor in the pathogenesis of VCF post-SRS. Osteoradionecrosis is a rare but well-known late effect of high-dose radiation and has been reported predominantly in the mandible following high-dose conventional radiation therapy in the head and neck literature.…”

Section: Discussionsupporting

confidence: 61%

“…9 Osteoradionecrosis has been defined as a slow-healing radiation-induced ischemic necrosis of the bone tissue. 23 The mechanism of osteoradionecrosis is thought to relate to radiation therapy by the production of a hypoxic, hypocellular, and hypovascular environment in which the basic metabolic demands for cellular survival cannot be met. 23 The onset of osteoradionecrosis has been described to range from 6 months to 3 years posttreatment, and even up to 25 years after radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…23 The mechanism of osteoradionecrosis is thought to relate to radiation therapy by the production of a hypoxic, hypocellular, and hypovascular environment in which the basic metabolic demands for cellular survival cannot be met. 23 The onset of osteoradionecrosis has been described to range from 6 months to 3 years posttreatment, and even up to 25 years after radiation therapy. 10 With respect to the spine, there have been few specific reports of osteoradionecrosis, 3,10,19,21 and ours is the first report specific to spine SRS.…”

Section: Discussionmentioning

confidence: 99%

“…2 We reported an actuarial VCF rate of 12.7% at 1 year post-SRS with a mean time to VCF of 3 months. It was observed that patients treated at the highest biologically effective dose level of [20][21][22][23][24] Gy in 1 fraction were the most susceptible to VCF. The mechanism of action was postulated as due to radiationinduced late effects within the tumor and bone tissue that ultimately weaken the VB to manifest clinically as VCF.…”

mentioning

confidence: 99%

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Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Al-Omair

Smith²,

Kiehl

et al. 2013

SPI

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Spine SRS, also known as stereotactic body radiotherapy, is increasingly being applied to treat primary and metastatic spinal tumors.12,13 Spine SRS is a paradigm shift from conventional radiotherapy practice, where the aim is to deliver low dose-per-fraction treatments (1.8-4.0 Gy per day) daily to a total dose limited by the tolerance of the spinal cord. Spine SRS overcomes this convention by using modern radiation technologies that allow for concentrating the dose within the tumor and away from the spinal cord, to permit tumor dose escalation while maintaining safe spinal cord dose constraints. 5 Delivery precision has been reported to be within 1.5 mm and 1° with a 95% confidence interval. Recently, the Canadian Association of Radiation Oncology defined stereotactic body radiotherapy (including as it pertains to the spine) as "The precise delivery of highly conformal and image-guided hypofractionated external beam radiotherapy, delivered in a single or few fraction(s), to an extracranial body target with doses at least biologically equivalent to a radical course when given over a protracted conventionally fractionated schedule."17 Philosophically, this translates to delivering a "locally curative" dose as opposed to a "locally palliative" dose for spinal metastatic disease. As experience with high dose-per-fraction spine SRS is gained (such that the most common practices range from 30 to 40 Gy in 5 frac- Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral compression fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Al-Omair

Smith²,

Kiehl

et al. 2013

SPI

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“…Moreover, it could focus on more details from specific issues as dose reduced fractionation protocols and modalities, as long as data obtained from in vitro studies [31][32][33][34][35][36][37][38][39][40].…”

Section: Cutting and Obtaining Blocks Of Dental Enamel And Root Dentinmentioning

confidence: 99%

ATR-FTIR Assessment of the Biochemical Composition and Micro Hardness of the Hard Tissues of Oral Cavity Submitted to Gamma Irradiation

Paredes¹,

Geraldo²,

Andrade³

2017

J Cancer Sci Ther

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Osteoradionecrosis of mandible bone in patients with oral cancer—associated factors and treatment outcomes

et al. 2015

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Does radiation-induced fibrosis have an important role in pathophysiology of the osteoradionecrosis of jaw?

Cited by 22 publications

References 35 publications

Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

ATR-FTIR Assessment of the Biochemical Composition and Micro Hardness of the Hard Tissues of Oral Cavity Submitted to Gamma Irradiation

Osteoradionecrosis of mandible bone in patients with oral cancer—associated factors and treatment outcomes

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