Osteoradionecrosis following treatment for head and neck cancer and the effect of radiotherapy dosimetry: the Guy's and St Thomas' Head and Neck Cancer Unit experience

Symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors: A cohort analysis

“…The reported incidence of ORN following head and neck radiation is 6.4%, and clinically detectable chronic dysphagia is estimated to occur in at least 12% to 38.5% of survivors [6,7,11, 13]. The occurrence of ORN and dysphagia following head and neck radiation therapy are both extensively studied in the literature, but no study to date has examined the association between these two complications.…”

“…Previous studies have addressed the association of different mandibular dose-volume correlates and various permutations of maximum and mean dose with ORN development, but in part because of the relatively low incidence of ORN, it remains unclear what dose-volume parameters are most significantly associated with this detrimental complication of radiation therapy [13–15]. In a case-control analysis including patients from this cohort, dose-volume histogram (DVH) comparison found that mandibular mean dose was significantly higher in the ORN cases (48.1 vs 43.6 Gy) while the maximum dose was not significantly different [18].…”

“…ORN is diagnosed based on clinical features and symptoms. The most accepted definition of ORN is an area of exposed bone that fails to heal after a period of 3 months, after exclusion of all other diagnoses [12,13]. Fortunately, ORN is becoming a less common complication with increased use of intensity-modulated radiation therapy (IMRT).…”

“…Fortunately, ORN is becoming a less common complication with increased use of intensity-modulated radiation therapy (IMRT). Despite a declining rate of ORN, the rate is still significant with an estimated incidence of 6.4% in head and neck cancer patients [13]. Among the risk factors for ORN, the most significant are high osseous radiation dose distributions, extraction of teeth within the field of radiation, smoking and alcohol consumption [13–15].…”

“…Despite a declining rate of ORN, the rate is still significant with an estimated incidence of 6.4% in head and neck cancer patients [13]. Among the risk factors for ORN, the most significant are high osseous radiation dose distributions, extraction of teeth within the field of radiation, smoking and alcohol consumption [13–15]. ORN can manifest as an asymptomatic condition to severely debilitating presentation with related pain, disfigurement and functional impairment [12].…”