Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma

Abstract

Background To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose–volume histogram (DVH) parameters. Methods We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008–2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy–70 Gy [V10–70]) were investigated and compared between patients with and without ORNJ. The Mann–Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan–Meier analyses were performed for cumulative ORNJ incidence estimation. Results Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3–145) months. The median time to ORNJ development was 27 (range 2–127) months. DVH analysis revealed that V30–V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). Conclusions V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

Outcomes of metastasis-directed therapy of bone oligometastatic prostate cancer

“…Therefore, some experts aim to defer systemic therapies by MDT. Androgen deprivation therapy-free survival (ADT-FS) was introduced as a new endpoint and reported by some authors, ranging between 7 and 66 months with MDT [ 13 ]. Furthermore, the STOMP randomized phase II trial showed a prolonged ADT-FS compared to surveillance (21 vs. 13 months) [ 6 ].…”

“…Consecutive oligometastatic prostate cancer patients treated with MDT to bone metastases between November 2011 and December 2019 at the University Hospital LMU Munich were retrospectively analyzed. Men with histologically confirmed prostate cancer who received definitive-intent radiotherapy to five or less bone metastases were eligible for this study [ 13 ]. Both castration sensitive and castration resistant patients were included, and patients were allowed to have concomitant ADT administered during MDT.…”

“…Prostate cancer patients with bone metastases have a worse prognosis than patients with distant lymph node metastases [ 10 – 12 ], and data describing the outcome of MDT in bone oligometastatic disease are sparse compared to data of MDT for lymph node metastases [ 13 ]. The aim of this work was to investigate the outcome of metastasis directed radiotherapy in prostate cancer patients with bone metastases with a focus on different categories of oligometastasis.…”

Does the protocol-required uniform margin around the CTV adequately account for setup inaccuracies in whole breast irradiation?

“…The medial field border of WBI for the normal inhalation and normal exhalation scans were reported to move average of 6 mm anteriorly and 3 mm posteriorly compared with the free-breathing position, respectively [ 25 ]. Ono et al reported that the AP motion was 1.36 ± 0.94 (0.14–5.28) mm in left-sided breast cancer patients treated with WBI using deep inspiration breath-hold [ 26 ]. In our study, no method of controlling for respiration was applied and the set up errors in AP direction was 2.75 ± 1.56 cm in free breathing, which was much lager than Yuka Ono et al reported [ 26 ].…”

18F-FMISO-PET Hypoxia Monitoring for Head-and-Neck Cancer Patients: Radiomics Analyses Predict the Outcome of Chemo-Radiotherapy

“…Radiomics is an emerging field developing descriptive or predictive computational models for image analyses to improve individualized diagnosis or treatment selection [ 13 , 14 , 15 ]. Radiomics relies on the extraction of a large amount of quantitative imaging features (radiomic features) such as first-order statistics (histogram and shape parameters), and second or higher-order statistics simultaneously providing spatial and voxel intensity information (texture features).…”