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Radiation Oncology
Published in: Radiation Oncology 1/2016

Open Access 01-12-2016 | Research

Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer

Authors: Thomas Kuhnt, Andreas Stang, Andreas Wienke, Dirk Vordermark, Ramona Schweyen, Jeremias Hey

Published in: Radiation Oncology | Issue 1/2016

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Abstract

Introduction

To identify potential risk factors for the development of jaw osteoradionecrosis (ORN) after 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) among patients with newly diagnosed head and neck cancer.

Material and methods

This study included 776 patients who underwent 3D-CRT or IMRT for head and neck cancer at the Department of Radiotherapy at the University Hospital Halle-Wittenberg between 2003 and 2013. Sex, dental status prior to radiotherapy, tumor site, bone surgery during tumor resection, concomitant chemotherapy, and the development of advanced ORN were documented for each patient. ORN was classified as grade 3, 4, or 5 according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer classification or grade 3 or 4 according to the late effects in normal tissues/subjective, objective, management, and analytic scale. The cumulative incidence of ORN was estimated. Cox regression analysis was used to identify prognostic risk factors for the development of ORN.

Results

Fifty-one patients developed advanced ORN (relative frequency 6.6 %, cumulative incidence 12.4 %). The highest risk was found in patients who had undergone primary bone surgery during tumor resection (hazard ratio [HR] = 5.87; 95 % confidence interval [CI]: 3.09–11.19) and in patients with tumors located in the oral cavity (HR = 4.69; 95 % CI: 1.33–16.52). Sex, dentition (dentulous vs. edentulous), and chemotherapy had no clinically relevant influence.

Discussion and conclusion

In contrast to most previous studies, we noted a low cumulative incidence of advanced ORN. Patients with tumors located in the oral cavity and those who undergo bone surgery during tumor resection prior to RT may be considered a high-risk group for the development of ORN.
Literature
1.
Willich N. Technical and methodical developments of radiation oncology from a physician's point of view. Strahlenther Onkol. 2012;188:253–62.CrossRefPubMed
2.
Hey J, Setz J, Gerlach R, et al. Parotid gland-recovery after radiotherapy in the head and neck region--36 months follow-up of a prospective clinical study. Radiat Oncol. 2011;6:125.CrossRefPubMedPubMedCentral
3.
Nutting CM, Morden JP, Harrington KJ, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multi-centre randomised controlled trial. Lancet Oncol. 2011;12:127–36.CrossRefPubMedPubMedCentral
4.
Hey J, Seidel J, Schweyen R, et al. The influence of parotid gland sparing on radiation damages of dental hard tissues. Clin Oral Investig. 2013;17:1619–25.CrossRefPubMed
5.
Koga DH, Salvajoli JV, Alves FA. Dental extractions and radiotherapy in head and neck oncology: review of the literature. Oral Dis. 2008;14:40–4.CrossRefPubMed
6.
Jacobson AS, Zevallos J, Smith M, et al. Quality of life after management of advanced osteoradionecrosis of the mandible. Int J Oral Maxillofac Surg. 2013;42:1121–8.CrossRefPubMed
7.
Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws--a current overview--part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg. 2010;14:3–16.CrossRefPubMed
8.
Delanian S, Lefaix JL. The radiation-induced fibroatrophic process; therapeutic perspective via the antioxidant pathway. Radiother Oncol. 2004;73:119–31.CrossRefPubMed
9.
Curi MM, Dib LL. Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg. 1997;55:540–4.CrossRefPubMed
10.
Reuther T, Schuster T, Mende U, Kübler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review. Int J Oral Maxillofac Surg. 2003;32:289–95.CrossRefPubMed
11.
Chopra S, Kamdar D, Ugur OE, et al. Factors predictive of severity of osteoradionecrosis of the mandible. Head Neck. 2011;33:1600–5.CrossRefPubMed
12.
Monnier Y, Broome M, Betz M, Bouferrache K, Ozsahin M, Jaques B. Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx: incidence and risk factors. Otolaryngol Head Neck Surg. 2011;144:726–32.CrossRefPubMed
13.
Casares C, Ramírez-Camacho R, Trinidad A, et al. Reactive oxygen species in apoptosis induced by cisplatin: review of physiopathological mechanisms in animal models. Eur Arch Otorhinolaryngol. 2012;269:2455–9.CrossRefPubMed
14.
Studer G, Studer SP, Zwahlen RA, et al. Osteoradionecrosis of the Mandible. Minimized risk profile following Intensity-Modulated Radiation Therapy (IMRT). Strahlenther Onkol. 2006;182:283–8.CrossRefPubMed
15.
Steinhart H, Schroeder HG, Kleinsasser O. Temporäre sagittale Unterkieferspaltung zur Eröffnung eines Zuganges in die Fossa pterygopalatina, den Parapharyngealraum und den Oropharynx. Laryngo-Rhino-Otol. 1993;72:532–6.CrossRef
16.
Kolokythas A, Eisele DW, El-Sayed I, Schmidt BL. Mandibular osteotomies for access to select parapharyngeal space neoplasms. Head Neck. 2009;31:102–10.CrossRefPubMed
17.
Studer G, Bredell M, Studer S, Huber G, Glanzmann C. Risk profile for osteoradionecrosis of the mandible in the IMRT era. Strahlenther Onkol. 2016;192:32–9.CrossRefPubMed
18.
Kuhnt T, Janich M, Götz U, Gerlach R, Chiricuta I, Hänsgen G. Etablierung einer 3D-Konformationstechnik zur Radio therapie von Kopf-Hals-Tumoren unter Berücksichtigung der Parotisschonung. Strahlenther Onkol. 2006;182:325–30.CrossRefPubMed
19.
Georg D, Kroupa B, Georg P, et al. Inverse planning--a comparative intersystem and interpatient constraint study. Strahlenther Onkol. 2006;182:473–80.CrossRefPubMed
20.
International Commission on Radiation Units and Measurements. ICRU 50: Prescribing and reporting photon beam therapy. 1993.
21.
International Commission on Radiation Units and Measurements. ICRU 62: Prescribing, recording and reporting photon beam therapy. 1999.
22.
International Commission on Radiation Units and Measurements. ICRU 83 Prescribing, Recording, and Reporting Intensity-Modulated Photon-Beam Therapy (IMRT). 2010.
23.
Budach V, Stuschke M, Budach W, et al. Hyperfractionated accelerated chemoradiation with concurrent fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 Prospective Randomized Trial. J Clin Oncol. 2005;23:1125–35.CrossRefPubMed
24.
Grötz KA. Zahnärztliche Betreuung von Patienten mit tumortherapeutischer Kopf-Hals-Bestrahlung. Dtsch Zahnarztl Z. 2002;57:509–11.
25.
Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H. Radiation-related damage to dentition. Lancet Oncol. 2006;7:326–35.CrossRefPubMed
26.
Schwartz HC, Kagan AR. Osteoradionecrosis of the mandible: scientific basis for clinical staging. Am J Clin Oncol. 2002;25:168–71.CrossRefPubMed
27.
Støre G, Boysen M. Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 2000;25:378–84.CrossRefPubMed
28.
Rogers SN, Brown JS, Woolgar JA, et al. Survival following primary surgery for oral cancer. Oral Oncol. 2009;45:201–11.CrossRefPubMed
29.
Al-Mamgani A, van Rooij P, Verduijn GM, et al. The impact of treatment modality and radiation technique on outcomes and toxicity of patients with locally advanced oropharyngeal cancer. Laryngoscope. 2013;123:386–93.CrossRefPubMed
30.
Greenland S, Rothman KJ. Measures of occurrence. In: Rothman KJ, editor. Modern epidemiology. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2008. p. 43.
31.
Ziegler A, Lange S, Bender R. Überlebenszeitanalyse: Die Cox Regression. Dtsch Med Wochenschr. 2007;132:42–4.CrossRef
32.
Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation:a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:54–69.CrossRefPubMed
33.
Morrish RB, Chan E, Silverman S, Meyer J, Fu KK, Greenspan D. Osteonecrosis in patients irradiated for head and neck carcinoma. Cancer. 1981;47:1980–3.CrossRefPubMed
34.
Lee IJ, Koom WS, Lee CG, et al. Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 2009;75:1084–91.CrossRefPubMed
35.
Parliament M, Alidrisi M, Munroe M, et al. Implications of radiation dosimetry of the mandible in patients with carcinomas of the oral cavity and nasopharynx treated with intensity modulated radiation therapy. Int J Oral Maxillofac Surg. 2005;34:114–21.CrossRefPubMed
Metadata
Title
Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer
Authors
Thomas Kuhnt
Andreas Stang
Andreas Wienke
Dirk Vordermark
Ramona Schweyen
Jeremias Hey
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2016
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-016-0679-6

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