Tumor subsites and risk of osteoradionecrosis of the jaw in patients with oral cavity cancer: a national-based cohort study

Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity‐modulated radiotherapy era

“…Liao et al assessed 8000 patients with oral cavity cancer and identified post-RT tooth extraction as a risk factor. 8 However, other studies have identified pre-RT tooth extractions as independent risk factors for ORN. 5,31,32 Our findings suggest that prophylactic tooth extraction must be carefully evaluated prior to treatment initiation to minimize post-RT disturbances.…”

“…5,6 High radiation dose (>50-60 Gray [Gy]), oral cavity tumor site, mandibular surgery, poor dental hygiene, smoking, and alcohol use are known risk factors for the development of ORN. [7][8][9][10][11][12][13][14] Fibular flap reconstruction has become a mainstay treatment of locally invasive oral cavity cancers involving the mandible. However, it is unknown whether reconstructed mandibles carry an elevated risk of ORN.…”

“…Despite the ability to focus beams more precisely, reported incidence of ORN remains at 5%–35% of head and neck cancers following IMRT 5,6 . High radiation dose (>50–60 Gray [Gy]), oral cavity tumor site, mandibular surgery, poor dental hygiene, smoking, and alcohol use are known risk factors for the development of ORN 7–14 …”

Dental Evaluation Prior to Cancer Therapy

“…Dental evaluation and treatment should be ideally performed prior to the initiation of anti-neoplastic therapy. If extractions are required after HNRT, some authors have suggested that atraumatic extractions are best performed within 6 months after HNRT to mitigate the risks of ORNJ [ 86 – 88 ]. This recommendation is based on a landmark histology study by Marx et al whereby serial biopsies from 64 patients at varying times (unspecified) during and after receiving 72 Gy of HNRT demonstrated hyperemia and endarteritis in the first 6 months post-HNRT [ 74 ].…”

Letter to the editor – Reply to the “Association between dental extraction after radiotherapy and osteoradionecrosis”

“…The period that we followed up the patients in our database was until 2019/12/31, or until the occurrence of death or ORN. The inclusion and exclusion criteria were same as our previous studies (Kuo et al, 2016; Liao et al, 2021). 66,328 cases of head neck cancer were identified, exclusion criteria are the followings: subjects with missing or incomplete data ( n = 571), younger than 20 y/o ( n = 163), no radiotherapy treatment course ( n = 36,451), missing of cancer stage ( n = 689), diagnosis to first day of RT >180 days or delayed surgery or unreasonable RT period ( n = 1821), with a history of other cancers ( n = 1381), early death (index day to death <3 months) ( n = 695), or ORN occurring <3 months from the index day ( n = 145).…”