Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study

Abstract

A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.

Histopathological insight into a healed case of osteoradionecrosis treated with triple therapy medical management

“…The classic histological picture of established ORN has also been characterised by empty osteocyte lacunae, absence of osteoblastic rimming and empty Haversian-Volkmann canals. 7,8 Marx and Tursun have previously described no osteoblasts to be present in ORN as well as a non-viable periosteum and no evidence of reactive bone. 9 Histologically, the extent of devitalised bone typically appears homogenous with no interspersing vital bone.…”

“…There remains understandable hesitancy for the use of medical management in ORN while evidence and long‐term outcome data are gathered and reported. The classic histological picture of established ORN has also been characterised by empty osteocyte lacunae, absence of osteoblastic rimming and empty Haversian–Volkmann canals 7,8 . Marx and Tursun have previously described no osteoblasts to be present in ORN as well as a non‐viable periosteum and no evidence of reactive bone 9 .…”