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. 2017 Jan:64:44-51.
doi: 10.1016/j.oraloncology.2016.11.015. Epub 2016 Dec 3.

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

Adepitan A Owosho  1 , C Jillian Tsai  2 , Ryan S Lee  3 , Haley Freymiller  1 , Arvin Kadempour  1 , Spyridon Varthis  1 , Adi Z Sax  1 , Evan B Rosen  1 , SaeHee K Yom  1 , Joseph Randazzo  1 , Esther Drill  4 , Elyn Riedel  4 , Snehal Patel  5 , Nancy Y Lee  2 , Joseph M Huryn  1 , Cherry L Estilo  6
Affiliations

The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience

Adepitan A Owosho et al. Oral Oncol. 2017 Jan.

Abstract

Objective: To determine the prevalence and correlation of various risk factors [radiation dose, periodontal status, alcohol and smoking] to the development of osteoradionecrosis (ORN).

Patients and methods: The records of 1023 patients treated with IMRT for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) between 2004 and 2013 were retrospectively reviewed to identify patients who developed ORN. Fisher exact tests were used to analyze patient characteristics between ORN patients with OCC and OPC. Paired Wilcoxon tests were used to compare the dose volumes to the ORN and contralateral non-ORN sites. To evaluate an association between ORN and risk factors, a case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by gender, tumor site and size. General estimation equations models were used to compare the risk factors in ORN cases and matched controls.

Results: 44 (4.3%) patients developed ORN during a median follow-up time of 52.5months. In 82% of patients, ORN occurred spontaneously. Patients with OPC are prone to develop ORN earlier compared to patients with OCC (P=0.03). OPC patients received a higher Dmax compared to OCC patients (P=0.01). In the matched case-control analysis the significant risk factors on univariate analysis were poor periodontal status, history of alcohol use and radiation dose (P=0.03, 0.002 and 0.009, respectively) and on multivariate analysis were alcohol use and radiation dose (P=0.004 and 0.026, respectively).

Conclusion: In our study, higher radiation dose, poor periodontal status and alcohol use are significantly related to the risk of developing ORN.

Keywords: Head and neck cancer; Intensity-modulated radiation therapy; Oral cancer; Oropharyngeal cancer; Osteoradionecrosis; Prevalence; Risk factors.

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Conflict of interest statement

Disclosure: All authors declare that there are no financial conflicts associated with this study and that the funding source has no role in conceiving and performing the study.

Figures

Figure 1
Figure 1
Clinical pictures and radiographs of a patient who underwent partial mandibulectomy for the management of a grade 3 ORN. Pre-radiation cropped panoramic radiograph (A), Post-radiation cropped panoramic radiographs showing an area of ORN with pathologic fracture (B), Pre-surgrey extraoral picture showing the reduced maximal mouth opening of the patient (C), Pre-surgery intraoral picture (D), Post-surgery panoramic radiograph (E), Post-surgery extraoral picture (F) and Post-surgery intraoral picture (G)
See this image and copyright information in PMC

References

    1. Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg. 1983;41:283–8. - PubMed
    1. Epstein JB, Wong FL, Stevenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg. 1987;45:104–10. - PubMed
    1. Store G, Boysen M. Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 2000;25:378–84. - PubMed
    1. He Y, Liu Z, Tian Z, Dai T, Qiu W, Zhang Z. Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system. Int J Oral Maxillofac Surg. 2015;44:1547–57. - PubMed
    1. Owosho AA, Kadempour A, Yom SK, Randazzo J, Jillian Tsai C, Lee NY, et al. Radiographic osteoradionecrosis of the jaw with intact mucosa: Proposal of clinical guidelines for early identification of this condition. Oral Oncol. 2015;51:e93–6. - PMC - PubMed

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