Long-term effect of chemotherapy–intensity-modulated radiation therapy (chemo-IMRT) on dentofacial development in head and neck rhabdomyosarcoma patients

Abstract

Dentofacial developmental abnormalities have been reported in head and neck rhabdomyosarcoma (HNRMS) patients treated with conventional radiotherapy technique and chemotherapy. This current study investigates dentofacial long-term effects among HNRMS survivors managed with intensity-modulated radiotherapy (IMRT) and chemotherapy. In general, IMRT is a more effective 3D-conformal radiotherapy technique, which delivers high doses of radiation to the tumor target while minimizing doses received by the surrounding normal tissues. The medical records and radiographs were reviewed to identify the following: 1. Facial asymmetry and jaw hypoplasia. 2. Effects on the dental tissue causing tooth agenesis/hypodontia, root agenesis/stunting/malformation, and/or enamel hypoplasia. 3. Trismus, hyposalivation/xerostomia. Thirteen patients reviewed were evaluated at the dental service. Seven patients presented with facial asymmetry and jaw hypoplasia, 9 patients presented with effects on the dental tissue [root agenesis/stunting/malformation (9), tooth agenesis/hypodontia (7) and enamel hypoplasia (3)] and 7 patients developed trismus and /or xerostomia. All patients with facial asymmetry and jaw hypoplasia also developed dental abnormalities. Patients with dentofacial developmental abnormalities were ≤ 7 years of age at treatment. Our study shows that dentofacial developmental abnormalities are still a burden in the era of IMRT and as prognosis of childhood malignancy improves and more patients become long-term survivors, these late dentofacial sequelae among childhood cancer survivors will be common. To minimize these complications, dental oncologists should be integrated into the care of children with head and neck cancers.

Rhabdomyosarcoma, Spindle Cell/Sclerosing Variant: A Clinical and Histopathological Examination of this Rare Variant with Three New Cases from the Oral Cavity

“…Despite efforts at various treatment techniques, the prognosis for RMS, especially S-ScRMS, remains poor [4,9], and longterm survival decreases significantly when the patient exhibits recurrence [19]. When patients do survive, longterm sequela from treatment, including facial asymmetry, tooth formation abnormalities, jaw hypoplasia, trismus, and hyposalivation/xerostomia may remain and significantly alter patient's lifestyles [20]. Recent research into immunotherapy using monoclonal antibodies or suicide gene therapy seems promising [19].…”

Late effects of chemo and radiation treatment on dental structures of childhood cancer survivors. A systematic review and meta‐analysis

“…One of these new treatment modalities, IMRT, has been suggested to minimize late complications, as it delivers high doses of radiation to the tumor site while minimizing doses delivered to the surrounding normal tissues. 26 The beneficial effect of individualized prescreening and preventive dental care has to be investigated. Pretreatment evaluation, evaluation at the end of antineoplastic treatment, and long-term monitoring of survivors will allow for more clear conclusions on the effects of treatment on dental structures.…”

Late Side Effects of Chemotherapy and Radiotherapy in Early Childhood on the Teeth: Two Case Reports

“…Radiotherapy and chemotherapy can generate adverse results during or after the completion of therapy and these treatments can also cause some oral anomalies [ 1 , 2 , 3 ]. Early and late oral-dental abnormalities have been reported in head and neck cancer patients treated with radiotherapy and chemotherapy.…”

“…These treatments may have different effects depending on the dose, the duration of treatment, and the age of the patient [ 8 ]. In both of our patients, microdontia due to hypodontia and underdevelopment was observed because dental germs could not be formed [ 1 , 2 , 3 , 5 ]. Both patients had low salivary flow rates.…”