Three-dimensional (3D) anatomic location, extension, and timing of severe osteoradionecrosis of the mandible

Abstract

Background:The purpose of this study was to describe the topography, extension (volume), and timing of severe osteoradionecrosis (ORN) that required mandible resection in patients previously treated for head and neck cancer at a high-volume Veterans Affairs Medical Center. Materials and methods:The records from a reference hyperbaric oxygen clinic were retrospectively analyzed (n = 50, 2018-2021). Inclusion criteria were: I) severe ORN defined as progressive ORN that required resection; II) pathologic confirmation of ORN; and III) availability of pre-operative CT-imaging. Using a radiotherapy (RT) imaging software, we performed a detailed volumetric (3D) analysis of the bone involvement by ORN. Time intervals from RT to surgery for ORN and from surgery to the last follow-up were calculated.Results: All patients that met inclusion criteria (n = 10) were male with significant smoking history (median 47.5 pack-years) and a median age of 57 years old at the time of RT. The primary tumors were: oropharynx (n = 6), oral cavity (n = 3) and nasopharynx (n = 1). The median time from RT to ORN surgery was 8 years. The most common ORN location was the posterior lateral body (molar) and six patients had associated fractures. The mean ORN volume was 3.6 cc (range: 0.6-8.3), corresponding to a mean 6.3% (range: 0.7-14) of the total mandibular volume. After a median follow-up of 13.5 months, no recurrence of ORN occurred.Three patients died of non-cancer and non-ORN-recurrence related causes (1 y OS 77.1%). Conclusion:Severe ORN occurred after a median of 8 years from the previous RT and usually affected the posterior lateral body. Surgical resection achieved excellent ORN control.

Osteoradionecrosis – an old problem with new consequences

“…ORN can develop from months to years after RT [3] with Sapienza et al . [14] reporting that ORN can develop even 5–10 years post-RT. Multiple studies reported post-RT incidence of ORN was higher in males than females [3,5,11,13,15] because incidence of HNC is higher in males and behavioural factors linked to ORN development and HNC risk being more common in males [16,17].…”

“…Patients whose primary tumour was in the oropharynx had the highest incidence of developing ORN (6%) [14] and oral cavity was reported to be the most common primary tumour site (45%) with squamous cell carcinomas accounted for 77.5% of the patients [13,14].…”