Top

Radiation Oncology

Published in:

Open Access 01-12-2014 | Research

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy

Authors: Go Sasahara, Masashi Koto, Hiroaki Ikawa, Azusa Hasegawa, Ryo Takagi, Yoshitaka Okamoto, Tadashi Kamada

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

Osteoradionecrosis (ORN) is a critical complication after carbon ion (C-ion) or photon radiotherapy (RT) for head and neck tumors. However, the risk factors for ORN after C-ion RT remain unclear. Therefore, the present study aimed to investigate the effects of the dose-volume relationship on and risk factors for ORN development after C-ion RT. We, however, focused on the maxillary bone because most tumors treated with C-ion RT were primarily located in the sinonasal cavity.

Methods

The patients enrolled in this study received more than 10% of the prescribed total dose of 57.6 Gy equivalent (GyE) in 16 fractions to their maxilla. All patients were followed up for more than 2 years after C-ion RT. Those with tumor invasion to the maxilla before C-ion RT or local recurrence after the treatment were excluded from the study to accurately evaluate the effects of irradiation on the bone. Sixty-three patients were finally selected. The severity of ORN was assessed according to the Common Terminology Criteria for Adverse Events version 4.0. The correlation between clinical and dosimetric parameters and ORN incidence was retrospectively analyzed.

Results

The median follow-up period was 79 months. Of the 63 enrolled patients, 26 developed ORN of grade ≥1. Multivariate analysis revealed that the maxilla volume receiving more than 50 GyE (V50) and the presence of teeth within the planning target volume were significant risk factors for ORN. Dose-volume histogram analysis revealed that V10 to V50 parameters were significantly higher in patients with ORN than in those without ORN.

Conclusions

V50 and the presence of teeth within the planning target volume were independent risk factors for the development of ORN after C-ion RT using a 16-fraction protocol.

Available only for authorised users

Tsujii H, Kamada T: A review of update clinical results of carbon ion radiotherapy. Jpn J Clin Oncol 2012, 42: 670-685. 10.1093/jjco/hys104PubMedCentralCrossRefPubMed

Mizoe JE, Hasegawa A, Jingu K, Takagi R, Bessyo H, Morikawa T, Tonoki M, Tsuji H, Kamada T, Tsujii H, Okamoto Y, Organizing Committee for the Working Group for Head Neck Cancer: Results of carbon ion radiotherapy for head and neck cancer. Radiother Oncol 2012, 103: 32-37. 10.1016/j.radonc.2011.12.013CrossRefPubMed

Mendenhall WM: Mandibular osteoradionecrosis. J Clin Oncol 2004, 22: 4867-4868. 10.1200/JCO.2004.09.959CrossRefPubMed

Ben-David MA, Diamante M, Radawski JD, Vineberg KA, Stroup C, Murdoch-Kinch CA, Zwetchkenbaum SR, Eisbruch A: Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions. Int J Radiat Oncol Biol Phys 2007, 68: 396-402. 10.1016/j.ijrobp.2006.11.059PubMedCentralCrossRefPubMed

Wang X, Hu C, Eisbruch A: Organ-sparing radiation therapy for head and neck cancer. Nat Rev Clin Oncol 2011, 8: 639-648. 10.1038/nrclinonc.2011.106CrossRefPubMed

Tsai CJ, Hofstede TM, Sturgis EM, Garden AS, Lindberg ME, Wei Q, Tucker SL, Dong L: Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2013, 85: 415-420. 10.1016/j.ijrobp.2012.05.032CrossRefPubMed

Chang DT, Sandow PR, Morris CG, Hollander R, Scarborough L, Amdur RJ, Mendenhall WM: Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible? Head Neck 2007, 29: 528-536. 10.1002/hed.20538CrossRefPubMed

Studer G, Studer SP, Zwahlen RA, Huguenin P, Grätz KW, Lütolf UM, Glanzmann C: Osteoradionecrosis of the mandible: minimized risk profile following intensity-modulated radiation therapy (IMRT). Strahlenther Onkol 2006, 182: 283-288. 10.1007/s00066-006-1477-0CrossRefPubMed

Lee IJ, Koom WS, Lee CG, Kim YB, Yoo SW, Keum KC, Kim GE, Choi EC, Cha IH: Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys 2009, 75: 1084-1091. 10.1016/j.ijrobp.2008.12.052CrossRefPubMed

10.

Mizoe JE, Tsujii H, Kamada T, Matsuoka Y, Tsuji H, Osaka Y, Hasegawa A, Yamamoto N, Ebihara S, Konno A: Organizing Committee for the Working Group for Head-And-Neck Cancer: Dose escalation study of carbon ion radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004, 60: 358-364. 10.1016/j.ijrobp.2004.02.067CrossRefPubMed

11.

Endo M, Koyama-Ito H, Minohara S, Miyahara N, Tomura H, Kanai T, Wawachi K, Tsujii H, Morita K: HIPLAN - A heavy ion treatment planning system at HIMAC. J Jpn Soc Ther Radiol Oncol 1996, 8: 231-238.

12.

Kanai T, Endo M, Minohara S, Miyahara N, Koyama-ito H, Tomura H, Matsufuji N, Futami Y, Fukumura A, Hiraoka T, Furusawa Y, Ando K, Suzuki M, Soga F, Kawachi K: Biophysical characteristics of HIMAC clinical irradiation system for heavy-ion radiation therapy. Int J Radiat Oncol Biol Phys 1999, 44: 201-210. 10.1016/S0360-3016(98)00544-6CrossRefPubMed

13.

Amirul Islam M, Yanagi T, Mizoe JE, Mizuno H, Tsujii H: Comparative study of dose distribution between carbon ion radiotherapy and photon radiotherapy for head and neck tumor. Radiat Med 2008, 26: 415-421. 10.1007/s11604-008-0252-9CrossRefPubMed

14.

Morrish RB, Chan E, Silverman S, Meyer J, Fu KK, Greenspan D: Osteoradionecrosis in patients irradiated for head and neck carcinoma. Cancer 1981, 48: 1980-1983.CrossRef

15.

Katsura K, Sasai K, Sato K, Saito M, Hoshina H, Hayashi T: Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008, 105: 731-738. 10.1016/j.tripleo.2007.10.011CrossRefPubMed

Title: Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy
Authors: Go Sasahara
Masashi Koto
Hiroaki Ikawa
Azusa Hasegawa
Ryo Takagi
Yoshitaka Okamoto
Tadashi Kamada
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-92

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Establishment of a small animal tumour model for in vivo studies with low energy laser accelerated particles

Accelerated hyperfractionated intensity-modulated radiotherapy for recurrent/unresectable rectal cancer in patients with previous pelvic irradiation: results of a phase II study

Evaluation of permanent alopecia in pediatric medulloblastoma patients treated with proton radiation

A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery

Treatment outcomes and late toxicities in patients with embryonal central nervous system tumors

Long-term outcomes of adjuvant radiotherapy after surgical resection of central neurocytoma