Patient and treatment-related risk factors for osteoradionecrosis of the jaw in patients with head and neck cancer.

Abstract

OBJECTIVE:

The purpose of this study was to evaluate risk factors for and the incidence of osteoradionecrosis (ORN) of the jaw in patients with head and neck cancer.

STUDY DESIGN:

This study was a retrospective analysis of the risk for ORN and outcome for 149 of 540 patients with head and neck cancer of the oral cavity (65%), oropharynx (26%), or other head and neck sites (9%) treated with radiotherapy between 2004 and 2009. ORN was graded according to Late Effects of Normal Tissues/Somatic Objective Management Analytic Scale (LENT/SOMA) criteria.

RESULTS:

Within a median follow-up of 41 months (95% confidence interval: 27.4-54.6), 38 patients (25.5%) had developed ORN, 37 patients (25%) had a local recurrence, and 53 patients (36%) had died. The median time to diagnosis of ORN was 14.5 months (range: 3-80), and 79% were diagnosed within 2 years of RT. Eleven of these patients had undergone previous mandibular surgery. Univariate significant risk factors for ORN were any comorbidity, poor oral hygiene, pre-radiotherapy osteotomy, close tumor-to-bone proximity, post-radiotherapy dentoalveolar surgery (DAS), DAS without sufficient wound closure, alcohol consumption, and denture pressure sores. In multivariate analysis, comorbidities, pre-radiotherapy mandibular surgery, poor oral hygiene, and insufficient DAS remained significant.

CONCLUSIONS:

Reducing the risk of ORN calls for maintaining optimal oral hygiene, ensuring good denture fit, receiving proper training in DAS, and helping patients to stop drinking and smoking.

• Authors: Jan-Dirk Raguse, Jaber Hossamo, Ingeborg Tinhofer, Bodo Hoffmeister, Volker Budach, Basil Jamil, Korinna Jöhrens, Nadine Thieme, Christian Doll, Susanne Nahles, Stefan T Hartwig, Carmen Stromberger
• Journal: Oral surgery, oral medicine, oral pathology and oral radiology (Oral Surg Oral Med Oral Pathol Oral Radiol) Vol. 121 Issue 3 Pg. 215-21.e1 (Mar 2016) ISSN: 2212-4411 [Electronic] United States
• PMID: 26703417 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Germany
• Head and Neck Neoplasms (pathology, radiotherapy)
• Humans
• Incidence
• Jaw Diseases (epidemiology, etiology, surgery)
• Male
• Middle Aged
• Neoplasm Staging
• Osteoradionecrosis (epidemiology, etiology, surgery)
• Risk Factors
• Treatment Outcome