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Humbert-Vidan L, Kamel S, Wentzel A, Kaffey Z, Abdelaal M, Spier KB, West NA, Marai GE, Canahuate G, Zhang X, Chen MM, Wahid KA, Rigert J, Hosseinian S, Schaefer AJ, Brock KK, Chambers M, Otun AO, Aponte-Wesson R, Patel V, Hope A, Phan J, Garden AS, Frank SJ, Morrison WH, Spiotto MT, Rosenthal D, Lee A, He R, Naser MA, Watson E, Hutcheson KA, Mohamed ASR, Sandulache VC, van Dijk LV, Moreno AC, Urbano TG, Fuller CD, Lai SY. Externally validated digital decision support tool for time-to-osteoradionecrosis risk-stratification using right-censored multi-institutional observational cohorts. Radiother Oncol 2025; 207:110890. [PMID: 40222595 DOI: 10.1016/j.radonc.2025.110890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 04/01/2025] [Accepted: 04/04/2025] [Indexed: 04/15/2025]
Abstract
BACKGROUND Existing studies on osteoradionecrosis of the jaw (ORNJ) have primarily used cross-sectional data, assessing risk factors at a single time point. Determining the time-to-event profile of ORNJ has important implications to monitor oral health in head and neck cancer (HNC) long-term survivors. METHODS Data were retrospectively obtained for a clinical observational cohort of 1129 patients (198 ORNJ cases) with HNC treated with radiotherapy (RT) at The University of Texas MD Anderson Cancer Center. A Weibull Accelerated Failure Time model was trained on previously identified dosimetric, clinical and demographic predictors. External validation was performed using an independent cohort of 265 patients (92 ORNJ cases) treated at Guy's and St. Thomas' Hospitals. To facilitate clinical implementation of the model, an online graphical user interface (GUI) was developed, including formal stakeholder usability testing. RESULTS Our model identified that gender (males), pre-RT dental extractions and D25% were associated with a 38 %, 27 % and 12 % faster onset of ORNJ, respectively, with adjusted time ratios of 0.62 (p = 0.11), 0.73 (p = 0.13) and 0.88 (p < 0.005). The model demonstrated strong internal calibration (integrated Brier score of 0.133, D-calibration p-value 0.998) and optimal discrimination at 72 months (Harrell's C-index of 0.72). CONCLUSION This study is the first to demonstrate a direct relationship between radiation dose and the time to ORNJ onset, providing a novel characterization of the impact of delivered dose and patient-related factors not only on the probability of a late effect (ORNJ), but the conditional risk during survivorship.
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Affiliation(s)
- Laia Humbert-Vidan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA; King's College London, London, UK
| | - Serageldin Kamel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Kyle B Spier
- Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Natalie A West
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Xinhua Zhang
- University of Illinois Chicago, Chicago, IL, USA
| | - Melissa M Chen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem A Wahid
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian Rigert
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Kristy K Brock
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Chambers
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adegbenga O Otun
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Vinod Patel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Hope
- University of Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jack Phan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S Garden
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - David Rosenthal
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed A Naser
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erin Watson
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | | | - Amy C Moreno
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Teresa Guerrero Urbano
- King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Clifton D Fuller
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Stephen Y Lai
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Naseer A, Brennan S, MacCarthy D, O'Connell JE, O'Sullivan E, Leech M. Prevention of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy. Head Neck 2025; 47:472-484. [PMID: 39211976 PMCID: PMC11717965 DOI: 10.1002/hed.27927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues. METHODS This paper sought to determine consensus on the prevention and management of osteoradionecrosis by an international panel of multidisciplinary professionals expert in the management of patients with head and neck cancer using a Delphi methodology. Unique to this work is our direct inclusion of the views of patients and carers in our findings. RESULTS This study reached consensus on the importance of pre and post oral health assessment and education for patients with head and neck cancer. This was also noted by the patients and carers who took part in the study. CONCLUSIONS This work highlights the need for a standardized oral health assessment tool and multidisciplinary care of patients to prevent and manage osteoradionecrosis.
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Affiliation(s)
- Amara Naseer
- Applied Radiation Therapy Trinity, Discipline of Radiation TherapyTrinity College DublinDublinIreland
- Trinity St. James's Cancer InstituteDublinIreland
| | - Sinead Brennan
- Trinity St. James's Cancer InstituteDublinIreland
- St. Luke's Radiation Oncology NetworkDublinIreland
| | | | | | | | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation TherapyTrinity College DublinDublinIreland
- Trinity St. James's Cancer InstituteDublinIreland
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Topkan E, Somay E, Bascil S, Pehlivan B. Underrated But Significant Risk Factors of Osteoradionecrosis of the Jaw in Patients With Head and Neck Cancer. J Clin Oncol 2025; 43:106-107. [PMID: 39361939 DOI: 10.1200/jco.24.01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/16/2024] [Indexed: 10/05/2024] Open
Affiliation(s)
- Erkan Topkan
- Erkan Topkan, MD Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey, Efsun Somay, PhD Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey, Sibel Bascil, PhD Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey, and Berrin Pehlivan, MD Department of Radiation Oncology, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Efsun Somay
- Erkan Topkan, MD Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey, Efsun Somay, PhD Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey, Sibel Bascil, PhD Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey, and Berrin Pehlivan, MD Department of Radiation Oncology, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Sibel Bascil
- Erkan Topkan, MD Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey, Efsun Somay, PhD Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey, Sibel Bascil, PhD Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey, and Berrin Pehlivan, MD Department of Radiation Oncology, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Berrin Pehlivan
- Erkan Topkan, MD Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey, Efsun Somay, PhD Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey, Sibel Bascil, PhD Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey, and Berrin Pehlivan, MD Department of Radiation Oncology, School of Medicine, Bahcesehir University, Istanbul, Turkey
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Somay E, Bascil S, Ozturk D, Topkan E. Comment on "The spectrum of late radiation sequelae in head and neck cancer". J Cancer Res Ther 2025; 21:319-320. [PMID: 40214397 DOI: 10.4103/jcrt.jcrt_2184_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 01/11/2025] [Indexed: 05/04/2025]
Affiliation(s)
- Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Sibel Bascil
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Duriye Ozturk
- Department of Radiation Oncology, Faculty of Medicine, Afyonkarahisar Health and Science University, Afyonkarahisar, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
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Gong MJ, Lai ZG, Zhang YX, Hu N. Risk factor analysis and development of predictive models for osteoradionecrosis in patients with nasopharyngeal carcinoma after concurrent chemoradiotherapy. Am J Cancer Res 2024; 14:4760-4771. [PMID: 39553231 PMCID: PMC11560816 DOI: 10.62347/riwx7204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 10/06/2024] [Indexed: 11/19/2024] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant tumor that targets the nasopharyngeal mucosal epithelium. Concurrent chemoradiotherapy (CCRT) is a pivotal treatment modality for NPC, yet it poses a risk for osteoradionecrosis (ORN), a complication that can impede further treatment. This study sought to explore the risk factors for ORN in NPC patients post-CCRT and to construct predictive models. We performed a retrospective analysis of clinical data from 417 NPC patients treated with CCRT at the Affiliated Hospital of Jiangnan University, with 204 patients from Longyan First Hospital as a validation cohort for the models. Our findings indicated that a high radiation dose, tooth extraction after radiotherapy, inadequate oral hygiene, smoking, anemia, and advanced T staging were associated with an elevated risk of ORN in NPC patients following CCRT. We formulated risk prediction models for ORN utilizing a nomogram, gradient boosting machine (GBM), and random forest (RF) algorithms. The area under the curve (AUC) was 0.813 (95% CI: 0.724-0.902) for the nomogram model in the validation cohort, 0.821 (95% CI: 0.732-0.910) for the GBM, and 0.735 (95% CI: 0.614-0.855) for the RF. Delong's test indicated no statistically significant differences in the AUC values among the three models. The nomogram has strong performance across both the training and validation cohorts, featuring a straightforward structure that is both intuitive and comprehensible. Taking into account the model's discriminative power, generalizability, and clinical practicability, the nomogram was proven to be highly applicable in the current study.
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Affiliation(s)
- Ming-Jie Gong
- Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Zhi-Gang Lai
- Department of Otorhinolaryngology-Head and Neck Surgery, Longyan First HospitalLongyan 364000, Fujian, China
| | - Yun-Xia Zhang
- Department of Radiotherapy, Affiliated Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
| | - Na Hu
- Department of Anesthesiology, Affiliated Hospital of Jiangnan UniversityWuxi 214000, Jiangsu, China
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Mandibular dose-volume predicts time-to-osteoradionecrosis in an actuarial normal-tissue complication probability (NTCP) model: External validation of right-censored clinico-dosimetric and competing risk application across international multi-institutional observational cohorts and online graphical user interface clinical support tool assessment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.20.24312311. [PMID: 39228724 PMCID: PMC11370531 DOI: 10.1101/2024.08.20.24312311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Background Existing studies on osteoradionecrosis of the jaw (ORNJ) have primarily used cross-sectional data, assessing risk factors at a single time point. Determining the time-to-event profile of ORNJ has important implications to monitor oral health in head and neck cancer (HNC) long-term survivors. Methods Demographic, clinical and dosimetric data were retrospectively obtained for a clinical observational cohort of 1129 patients with HNC treated with radiotherapy (RT) at The University of Texas MD Anderson Cancer Center. ORNJ was diagnosed in 198 patients (18%). A multivariable logistic regression analysis with forward stepwise variable selection identified significant predictors for ORNJ. These predictors were then used to train a Weibull Accelerated Failure Time (AFT) model, which was externally validated using an independent cohort of 265 patients (92 ORNJ cases and 173 controls) treated at Guy's and St. Thomas' Hospitals. Findings Our model identified that each unit increase in D25% is significantly associated with a 12% shorter time to ORNJ (Adjusted Time Ratio [ATR] 0·88, p<0·005); pre-RT dental extractions was associated to a 27% faster (ATR 0·73, p=0·13) onset of ORNJ; male patients experienced a 38% shorter time to ORNJ (ATR 0·62, p = 0·11). The model demonstrated strong internal calibration (integrated Brier score of 0·133, D-calibration p-value 0.998) and optimal discrimination at 72 months (Harrell's C-index of 0·72). The model also showed good generalization to the independent cohort, despite a slight drop in performance. Interpretation This study is the first to demonstrate a direct relationship between radiation dose and the time to ORNJ onset, providing a novel characterization of the impact of delivered dose not only on the probability of a late effect (ORNJ), but the conditional risk during survivorship. Funding This work was supported by various funding sources including NIH, NIDCR, NCI, NAPT, NASA, BCM, Affirmed Pharma, CRUK, KWF Dutch Cancer Society, NWO ZonMw, and the Apache Corporation.
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Fitzgerald KT, Lyons C, England A, McEntee MF, Devine A, O'Donovan T, O'Sullivan E. Risk factors associated with the development of osteoradionecrosis (ORN) in Head and Neck cancer patients in Ireland: A 10-year retrospective review. Radiother Oncol 2024; 196:110286. [PMID: 38641259 DOI: 10.1016/j.radonc.2024.110286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND AND PURPOSES To assess osteoradionecrosis (ORN) incidence in a population of Irish Head and Neck cancer (HNC) patients, and assess precipitating factors that may contribute to ORN development to aid prevention. MATERIALS AND METHODS Review of 1050 HNC patients attending the Dental Oncology Clinic, CUDSH between 2010 and 2021 identified 47 cases of ORN. Medical, dental and radiotherapy records of these forty-seven patients were retrospectively reviewed. Patient-, tumour-, and treatment-related variables were investigated in association with osteoradionecrosis development. Analysis conducted using SPSS, Pearson's Chi-square test (p < 0.05), and ordinal regression model. RESULTS ORN incidence was 4.4 %. Median time from radiotherapy (RT) to ORN development was 9.5 months (range 1-98.5 months). ORN development within the mandibular surgical site was significant (p <.001), presenting at a higher Notani grade (p =.002), in mid-mandibular body region (p =.028), at radiation doses ≥ 60 Gy (p =.035), due to induced causes (p =.029), and without resolution (p =.019). CONCLUSION This is the first retrospective study of ORN in HNC patients in Ireland over 10-year period. ORN incidence was extremely low (4.4%). As patients reported high smoking/alcohol use and poor dental attendance pre-diagnosis, this suggests intensive dental intervention pre/post-diagnosis contributed to low ORN rates. Mandibular surgery pre-RT increased risk of developing ORN at the surgical site. Therefore, we recommend future treatment planning should contour the surgical site, designating it an organ at risk (OAR), assigning a dose constraint, where oncologically possible, with emphasis on reducing the hot-spot to this region; findings reinforce importance of life-long expert dental care to reduce ORN incidence.
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Affiliation(s)
| | - Ciara Lyons
- Radiation Therapy Dept., Glandore Centre, Cork University Hospital, Cork, Ireland
| | - Andrew England
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Mark F McEntee
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Annemarie Devine
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Theresa O'Donovan
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Eleanor O'Sullivan
- Radiation Therapy Dept., Glandore Centre, Cork University Hospital, Cork, Ireland; ENTO Research Unit, Cork University Dental School & Hospital, Cork, Ireland.
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de Almeida-Silva LA, Lupp JDS, Sobral-Silva LA, Dos Santos LAR, Marques TO, da Silva DBR, Caneppele TMF, Bianchi-de-Moraes M. The incidence of osteoradionecrosis of the jaws in oral cavity cancer patients treated with intensity-modulated radiotherapy: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:66-78. [PMID: 38772792 DOI: 10.1016/j.oooo.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE A systematic review with meta-analysis was conducted to define the incidence of osteoradionecrosis (ORN) in patients with oral cavity cancer (OCC) treated with intensity-modulated radiotherapy (IMRT), and to identify the risk factors influencing its development. STUDY DESIGN Six databases were searched systematically. A meta-analysis was performed to determine overall, spontaneous, and dental extraction-attributed incidences of ORN. The Grading of Recommendations Assessment, Development, and Evaluation tool evaluated evidence certainty. RESULTS Out of 11 eligible studies, 6 underwent meta-analysis for the overall aggregated ORN incidence in OCC patients receiving IMRT, resulting in an incidence rate of 8% (95% CI: 6%-11%). Regarding development reasons, 2 studies were assessed, revealing an incidence of 36% (95% CI: 1%-98%) for spontaneous ORN, and 17% (95% CI: 5%-44%) ensued from dental extraction exclusively pre-RT. All rates had very low certainty of evidence. Factors significantly correlated with ORN development included postoperative RT use (78%), employment of therapeutic doses above 50 Gy, and mandibular involvement (80.5%). CONCLUSION The findings suggest that IMRT alone is not sufficient to decrease ORN rates in OCC patients, underscoring the importance of precisely identifying the involved risk factors. However, further detailed primary studies will be necessary.
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Affiliation(s)
- Luis Augusto de Almeida-Silva
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil.
| | - Juliana Dos Santos Lupp
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Leonardo Alvares Sobral-Silva
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Luiz Augusto Rodrigues Dos Santos
- Department of Surgery and Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Thays Oliveira Marques
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Danillo Babinskas Ribeiro da Silva
- Department of Surgery and Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Taciana Marco Ferraz Caneppele
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Michelle Bianchi-de-Moraes
- Department of Surgery and Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
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Karaca Y, Beauvois S, Paesmans M, Mokhtari Z, Dequanter D, Wardi CA, Evrard L, Van Gestel D. Retrospective study evaluating dental side effects of radiotherapy in patients treated for head and neck cancer. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101858. [PMID: 38556165 DOI: 10.1016/j.jormas.2024.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/12/2024] [Accepted: 03/29/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient's quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40 Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed. MATERIAL AND METHODS Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analysed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model. RESULTS Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8% of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7 Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40 Gy and the occurrence of dental fractures (p = 0.0002) were demonstrated. CONCLUSIONS Our predictive model seems to be 82% accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient's oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40 Gy was observed.
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Affiliation(s)
- Y Karaca
- Department of Stomatology, Oral & Maxillofacial Surgery, Erasmus Hospital (HUB), Brussels, Belgium; Radiation Oncology Department, Jules Bordet Institute (HUB), Brussels, Belgium.
| | - S Beauvois
- Radiation Oncology Department, Jules Bordet Institute (HUB), Brussels, Belgium
| | - M Paesmans
- Information Management Unit, Jules Bordet Institute (HUB), Brussels, Belgium
| | - Z Mokhtari
- Department of Stomatology, Oral & Maxillofacial Surgery, Erasmus Hospital (HUB), Brussels, Belgium
| | - D Dequanter
- Department of Stomatology, Oral & Maxillofacial Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - C Al Wardi
- Clinical Trials Conduct Unit (CTCU), Institut Jules Bordet (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - L Evrard
- Department of Stomatology, Oral & Maxillofacial Surgery, Erasmus Hospital (HUB), Brussels, Belgium
| | - D Van Gestel
- Radiation Oncology Department, Jules Bordet Institute (HUB), Brussels, Belgium
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Topkan E, Somay E, Ozturk D, Bascil S, Selek U. The ongoing unnecessary debate regarding the risk factors for osteoradionecrosis of the jaw: Prescription dose versus mandibular doses. ORAL ONCOLOGY REPORTS 2024; 10:100532. [DOI: 10.1016/j.oor.2024.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
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Naseer A, Goode F, Doyle T. Osteoradionecrosis - an old problem with new consequences. Curr Opin Support Palliat Care 2024; 18:39-46. [PMID: 38170197 DOI: 10.1097/spc.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Osteoradionecrosis (ORN) is a devasting complication of radiation therapy (RT), especially in head and neck cancers (HNC), and is still poorly understood. The aim of this review is to report its incidence and consider the risk factors associated with ORN to highlight prevention strategies to decrease its incidence. RECENT FINDINGS The average incidence of ORN is between 2% and 23%, with incidence decreasing in more recent years with the introduction of modern RT technology and better oral health care. Smoking, diabetes mellitus, oropharyngeal and oral cavity cancers, pre- and post-RT dental extractions and a total radiation dose of over 60 Gy were all identified as risk factors for ORN. In prevention, strategies were mainly structured around minimising risk factors or targeting possible mechanisms of ORN's pathophysiology. SUMMARY At present, the controversy surrounding the risk factors and pathogenesis of ORN makes it difficult to establish a set of prevention guidelines for its incidence. In order to achieve this, more research examining its aetiology must be conducted as well as a universal staging system within which ORN may be classified.
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Affiliation(s)
- Amara Naseer
- School of Medicine, Discipline of Radiation Therapy, Trinity College Dublin, The University of Dublin
| | - Fiona Goode
- Trinity College: The University of Dublin Trinity College, Dublin, Republic of Ireland
| | - Tia Doyle
- Trinity College: The University of Dublin Trinity College, Dublin, Republic of Ireland
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Tanaka TI, Shanti R. A Patient with a History of Tonsillar Cancer Presents for Evaluation of Exposed Alveolar Bone in the Mouth. Dent Clin North Am 2023; 67:675-677. [PMID: 37714622 DOI: 10.1016/j.cden.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Osteoradionecrosis (ORN) is a rare but serious late complication of head and neck radiation therapy. The mandible, proximity of the primary tumor to the jawbones, radiation dose, poor oral hygiene, and smoking history are risk factors of ORN. ORN manifests as a chronic infection with exposed jawbone, which typically occurs in the first 3 years after radiotherapy; however, the risk for ORN development occurring in the patients who have undergone head and neck radiation therapy may be indefinite. Surgery has an important role in the management of cases of ORN, ranging from sequestrectomy, debridement, and extensive extirpative procedures with reconstructive surgery.
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Bevans S, Hammer D. Tenants of Mandibular Reconstruction in Segmental Defects. Otolaryngol Clin North Am 2023:S0030-6665(23)00066-X. [PMID: 37246030 DOI: 10.1016/j.otc.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The premises of mandibular reconstruction are the restoration of occlusion and mandibular contour for the purpose of preserving the facial identity, oral airway, and effective speech and mastication. Establishing functional occlusion is the primary tenant in all mandibular reconstruction. In cases of segmental defects, particularly in dentate regions of the mandible, there has been a paradigm shift over the past two decades in how surgeons are approaching the restoration of load-bearing mandibular continuity with capacity for dental implantation. Here we discuss considerations for deciding the most effective method of reconstruction in segmental defects.
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Affiliation(s)
- Scott Bevans
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, HI 96818, USA; Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Daniel Hammer
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Oral Maxillofacial Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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Topkan E, Kucuk A, Somay E, Yilmaz B, Pehlivan B, Selek U. Review of Osteoradionecrosis of the Jaw: Radiotherapy Modality, Technique, and Dose as Risk Factors. J Clin Med 2023; 12:3025. [PMID: 37109361 PMCID: PMC10143049 DOI: 10.3390/jcm12083025] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5-6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the "organ at risk" safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Medical Faculty, Baskent University, Adana 01120, Turkey
| | - Ahmet Kucuk
- Clinics of Radiation Oncology, Mersin City Education and Research Hospital, Mersin 33160, Turkey
| | - Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara 06490, Turkey
| | - Busra Yilmaz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara 06490, Turkey
| | - Berrin Pehlivan
- Department of Radiation Oncology, Bahcesehir University, Istanbul 34349, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, School of Medicine, Koc University, Istanbul 34450, Turkey
- Department of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA
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Zamora C, Castillo M, Puac-Polanco P, Torres C. Oncologic Emergencies in the Head and Neck. Radiol Clin North Am 2023; 61:71-90. [DOI: 10.1016/j.rcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Unforeseen Outcomes Post Treatment for Radiation Induced Trismus: A Case Report. MEDICINES 2022; 9:medicines9050031. [PMID: 35622070 PMCID: PMC9147736 DOI: 10.3390/medicines9050031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022]
Abstract
Post radiotherapy radiation trismus presents significant concerns for a patient’s quality of life and for the clinical monitoring for recurrence of head and neck oncology. Current treatments include scar band release surgery that has been shown to be safe and effective. We present a case with a rare, post-operative complication of difficulty of mouth closure that can pose a significant impact on quality of life that should be considered.
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