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Oral Oncology Jan 2024Head and neck cancer ranks as the seventh most common cancer worldwide. Proton therapy is widely used in head and neck cancer. Osteoradionecrosis(ORN) is currently a... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Head and neck cancer ranks as the seventh most common cancer worldwide. Proton therapy is widely used in head and neck cancer. Osteoradionecrosis(ORN) is currently a commonly investigated side effect of proton therapy. A meta-analysis is needed to investigate this topic.
MATERIAL/METHODS
Two authors searched three databases, including PubMed, Embase, and Cochrane Library; the search period was from inception to June 2023. The search keyword was set to be ((("osteoradionecrosis") OR ("osteonecrosis")) AND ("proton")).
RESULTS
We initially collected 410 articles, and after article selections, 22 articles remained in our systematic reviews. Due to the overlapping of patient populations, 17 studies were finally included in our meta-analysis. The pooled grade 3 or more ORN rate is 0.01(95 % CI = 0.01-0.03). Subgroup analysis showed that IMPT didn't reduce grade 3 or more ORN compared with 3DCPT (p = 0.15).
CONCLUSIONS
Our meta-analysis showed that severe ORN rarely occurred in proton therapy for head and neck cancer patients.
Topics: Humans; Osteoradionecrosis; Proton Therapy; Head and Neck Neoplasms; Retrospective Studies
PubMed: 38035508
DOI: 10.1016/j.oraloncology.2023.106649 -
Frontiers in Medicine 2022Osteoradionecrosis of the hip is a serious complication of radiotherapy that is easily overlooked by physicians and patients in the early stages. There are relatively...
BACKGROUND
Osteoradionecrosis of the hip is a serious complication of radiotherapy that is easily overlooked by physicians and patients in the early stages. There are relatively few reports on this subject, so there is no clear scientific consensus for the pathogenesis, early diagnosis, and clinical treatment of hip osteoradionecrosis. In this paper, we report two cases of hip osteoradionecrosis and systematically review the related literature.
CASE PRESENTATION
We report two cases of hip osteoradionecrosis. One patient successfully underwent total hip arthroplasty in our hospital and recovered well postoperatively. Another patient although we offered a variety of surgical options for this patient, the patient was worried that the bone loss would lead to poor prosthesis fixation, resulting in prosthesis loosening and infection, and therefore ultimately refused surgical treatment.
CONCLUSION
With the development of radiological techniques, the incidence of hip osteoradionecrosis is decreasing year by year, but early diagnosis and rational treatment remain challenging. The effects of non-surgical treatment are limited. Early prevention, early detection, and early intervention are crucial to delay or prevent the emergence of more serious complications.
PubMed: 35402457
DOI: 10.3389/fmed.2022.858929 -
The British Journal of Oral &... Jun 2021This systematic review aimed to examine whether the incidence of osteonecrosis differed between patients who have dental extractions before or after radiotherapy (RT).... (Meta-Analysis)
Meta-Analysis Review
This systematic review aimed to examine whether the incidence of osteonecrosis differed between patients who have dental extractions before or after radiotherapy (RT). The reported incidence of osteoradionecrosis (ORN) of the jaws following RT to the head and neck varies widely in the literature. Currently, for patients with head and neck cancer there are no universally accepted guidelines on the optimal timing of dental surgery relative to RT to minimise incident ORN. A literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) criteria. A search of PubMed, EMBASE, Evidence-Based Medicine, and Web of Science databases targeted literature published up to and including 10 April 2020. Two independent reviewers assessed studies for eligibility against inclusion criteria. An assessment of bias was conducted for each of the included studies and relevant data extracted. A meta-analysis was undertaken using the statistical methods described. Twenty-four of 708 studies were included. They were heterogeneous and included a wide variation of RT methods, head and neck malignancies, and comorbidities. While some concluded that the incidence of ORN was dependent on the timing of dental extractions in relation to RT, with regard to the risk of its development, others reported additional factors such as age, comorbidities, extent of surgical resection, and dose and field of radiation, as more important predictors than timing. In many there was consistent lack of detail around the timing of dental procedures in relation to the delivery of RT. From 21 studies including 36,294 patients, of whom 14,389 had extractions before RT, the pooled incidence of ORN was 5.5% (95% CI: 2.1% to 10.1%). Significant heterogeneity was found in Cochran's Q-test (p<0.001) and Higgins I=98.0%. From 21 studies including 37,805 patients, of whom 6030 had extractions after RT, the pooled incidence of ORN was 5.3% (95% CI: 2.9% to 8.2%). Significant heterogeneity was found in Cochran's Q-test (p<0.001) and Higgins I=80.0%. There was no statistically significant difference between these two groups (random-effects model Q=0.12, p=0.73). Large, longitudinal studies with a priori-specified methods are needed to identify, recruit, and prospectively follow patients with head and neck cancer for the onset of ORN after dental surgery. This will allow clinical guidelines to be established to assist clinicians to plan treatment when extractions are indicated in patients undergoing RT to the head and neck.
Topics: Head and Neck Neoplasms; Humans; Incidence; Neck; Osteoradionecrosis; Tooth Extraction
PubMed: 33685773
DOI: 10.1016/j.bjoms.2020.10.006 -
The Annals of Otology, Rhinology, and... May 2019The aim of this study was to summarize the effectiveness of steroids in the prevention of osteoradionecrosis of the head and neck.
OBJECTIVE
The aim of this study was to summarize the effectiveness of steroids in the prevention of osteoradionecrosis of the head and neck.
DATA SOURCES
PubMED, MEDLINE, Embase, Google Scholar, and Cochrane trial registries.
METHODS
A systematic review of these data sources was performed through September 2018 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were English-language studies evaluating patients of all age groups diagnosed with head and neck cancer who underwent radiation therapy while receiving peritreatment steroids compared with those who did not receive steroids.
RESULTS
Two retrospective cohort studies were identified for qualitative review. On the basis of analysis of 25 328 participants (36-82 years of age) with head and neck cancer who underwent radiation therapy, the use of peritreatment steroids was associated with a significantly lower risk for osteoradionecrosis in both studies, with a hazard ratio of 0.74 (95% confidence interval, 0.59-0.94; P = .012) and a relative risk of 0.04 (95% confidence interval, 0.003-0.560; P = .017). Meta-analysis was precluded by clinical and statistical heterogeneity. Overall, the studies were of limited quality with high risk for bias and poor methodology.
CONCLUSIONS
Limited retrospective data suggest that steroids are predictive of a reduced risk for osteoradionecrosis; however, no definitive conclusions can be made given the poor quality of the available literature. Well-designed, comparison-controlled trials are needed to clarify the promising role of steroids in the prevention of osteoradionecrosis of the head and neck.
Topics: Glucocorticoids; Head and Neck Neoplasms; Humans; Osteoradionecrosis
PubMed: 30688080
DOI: 10.1177/0003489419826595 -
Discovery Medicine 2015Cisplatin-based chemoradiation (CRT) offers head and neck squamous cell carcinoma (HNSCC) patients better overall survival when compared to radiation alone. However, it... (Review)
Review
BACKGROUND
Cisplatin-based chemoradiation (CRT) offers head and neck squamous cell carcinoma (HNSCC) patients better overall survival when compared to radiation alone. However, it also increases acute and late toxicity (LT). Here we aimed to review the main aspects of diagnosis and treatment of long-term toxicities in HNSCC patients after CRT.
METHODS
We crossed-searched PubMed MeshTerms: Survivors, Deglutition Disorders, Xerostomia, Hypothyroidism, Cisplatin, Kidney, Hearing, and Osteoradionecrosis, with keywords: "Head and Neck Neoplasms" and "Chemoradiotherapy." A total of 5,541 publications were retrieved and 48 were selected for this systematic review.
RESULTS
Dysphagia (25%), xerostomia (40-80%, depending on the technique used), hypothyroidism (42%), ototoxicity (27%), and osteoradionecrosis (4%) were the most commonly reported LT and were related to compromised quality of life aspects in HNSCC patients. Concurrent cisplatin and higher radiation doses, especially to normal tissue, increased the rates of LT.
CONCLUSIONS
Late CRT toxicities were reported mostly in retrospective studies. Addressing these adverse effects as endpoints in future clinical trials is necessary to provide tools to prevent and treat them adequately, allowing better quality of life and survival results.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy; Cisplatin; Head and Neck Neoplasms; Humans
PubMed: 26321088
DOI: No ID Found -
Journal of Oral and Maxillofacial... Dec 2016The purpose of this study was to describe the trends pertaining to the use of the fibula free flap for mandibular reconstruction during the past 10 years. (Review)
Review
PURPOSE
The purpose of this study was to describe the trends pertaining to the use of the fibula free flap for mandibular reconstruction during the past 10 years.
MATERIALS AND METHODS
A systematic review for publications on the fibula free flap in mandibular reconstruction in the PubMed and Scopus databases was performed from January 1, 2005 until December 31, 2014. Publications were classified by topic, number of patients, and country of origin. The study period was split into 2 periods. The first 5-year period was compared with the second 5-year period.
RESULTS
Eighty-five publications were identified. There was an increase in publications regarding restorative decision making (11 vs 9), surgical techniques (13 vs 6), outcomes (20 vs 10), and computer-aided design and computer-aided manufacturing (CAD-CAM; 8 vs 2) in the second 5-year period. The number of patients reported also increased in publications on surgical techniques (1,085 vs 59), outcomes (777 vs 254), bisphosphonate-related osteonecrosis of the jaw and osteoradionecrosis (165 vs 28), and CAD-CAM (65 vs 15) in the second 5-year period. The United States, India, China, and Europe produced most of the publications.
CONCLUSIONS
In the past 10 years, there was a surge in publications on the use of the fibula free flap for mandibular reconstruction. There was a 1.8-fold increase in the number of publications and a 3.4-fold increase in the number of patients undergoing this method of mandibular reconstruction in the second 5-year period. Publications from the United States, India, and China contributed to a large increase in the number of patients in the second 5-year period. More interest in CAD-CAM technology was seen in the second 5-year period that was not seen in the first 5-year period.
Topics: Bibliometrics; China; Europe; Fibula; Free Tissue Flaps; Humans; India; Mandibular Reconstruction; Practice Patterns, Physicians'; United States
PubMed: 27400143
DOI: 10.1016/j.joms.2016.06.170 -
Journal of Cranio-maxillo-facial... Dec 2015Osteoradionecrosis of the mandible is a devastating complication of radiotherapy in patients with head and neck cancer. Many cases present at a late stage, from months... (Review)
Review
INTRODUCTION
Osteoradionecrosis of the mandible is a devastating complication of radiotherapy in patients with head and neck cancer. Many cases present at a late stage, from months to years following completion of radiation therapy. When medical treatment fails, surgery may be required with a variety of free flaps available for microvascular reconstructive techniques.
OBJECTIVE
To conduct a systematic review of the literature investigating the outcomes of free flap reconstruction of the jaw in mandibular osteoradionecrosis and determine the failure rates of different flap tissue.
METHODS
A systematic literature search was performed using Medline (Ovid) Pubmed and Embase databases and Google Scholar. Primary outcome measures were flap failures and complications, with donor site complications representing the secondary outcome measure. Analysis of pooled outcomes was undertaken for different flaps.
RESULTS
333 articles were identified and 15 articles met the final inclusion criteria, detailing 368 primary free tissue flap transfers. There was a flap failure rate of 9.8%. There were 146 post-operative complications (39.7%), the most common being fistula formation (8.4%), hardware plate exposure (7.1%) and flap wound infections (6.5%).
CONCLUSION
The fibula is the workhorse free flap for reconstruction in mandibular osteoradionecrosis. Evidence to date is largely limited with the need for larger powered multi-institutional prospective studies to determine the ideal flap donor tissue and evaluate patient and treatment predictors of free flap outcomes in order to tailor the best patient-based surgical approach for mandibular osteoradionecrosis.
Topics: Cranial Irradiation; Free Tissue Flaps; Humans; Osteoradionecrosis; Prospective Studies; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 26427619
DOI: 10.1016/j.jcms.2015.03.006 -
The Journal of Prosthetic Dentistry Dec 2022Intraoral stents have been provided to minimize acute and chronic toxicities induced by radiotherapy, including oral mucositis, salivary changes, trismus,... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Intraoral stents have been provided to minimize acute and chronic toxicities induced by radiotherapy, including oral mucositis, salivary changes, trismus, radiation-related caries, and osteoradionecrosis. However, a systematic review and meta-analysis is necessary to determine their effectiveness.
PURPOSE
The purpose of this systematic review and meta-analysis was to determine the effectiveness of intraoral stent use and determine whether these prosthetic devices can reduce radiation dosage to nontargeted oral tissues and adverse effects related to head and neck radiation.
MATERIAL AND METHODS
Two independent reviewers made a systematic search for articles published from January 2010 to March 2020 in 3 databases, supplemented by a manual search. Studies were included if they were clinical trials (randomized controlled trials, both prospective and retrospective), published in English, and evaluated radiation dose and oral adverse side effects (acute or chronic) induced by radiotherapy of participants with and without intraoral stents.
RESULTS
The search strategy identified 201 studies; of which, 9 were included. A total of 251 participants were evaluated; of whom, 168 (77.3%) used intraoral stents and 57 (22.7%) were treated with radiotherapy without a prosthetic device. A statistically significant difference was found regarding the use of intraoral stents for preventing oral mucositis (P<.001), salivary changes (P=.003), and trismus (P<.02). A funnel plot showed asymmetry among the differences of means in all selected studies.
CONCLUSIONS
Intraoral stents have a positive effect on preventing oral mucositis. Further clinical trials are needed to address the flaws identified in the present systematic review.
Topics: Humans; Head and Neck Neoplasms; Trismus; Retrospective Studies; Prospective Studies; Stomatitis; Radiation Injuries; Stents
PubMed: 33879318
DOI: 10.1016/j.prosdent.2021.03.009 -
Oral Oncology May 2023The aim of the present systematic review (SR) is to summarize Machine Learning (ML) models currently used to predict head and neck cancer (HNC) treatment-related... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of the present systematic review (SR) is to summarize Machine Learning (ML) models currently used to predict head and neck cancer (HNC) treatment-related toxicities, and to understand the impact of image biomarkers (IBMs) in prediction models (PMs). The present SR was conducted following the guidelines of the PRISMA 2022 and registered in PROSPERO database (CRD42020219304).
METHODS
The acronym PICOS was used to develop the focused review question (Can PMs accurately predict HNC treatment toxicities?) and the eligibility criteria. The inclusion criteria enrolled Prediction Model Studies (PMSs) with patient cohorts that were treated for HNC and developed toxicities. Electronic database search encompassed PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, LILACS, and Gray Literature (Google Scholar and ProQuest). Risk of Bias (RoB) was assessed through PROBAST and the results were synthesized based on the data format (with and without IBMs) to allow comparison.
RESULTS
A total of 28 studies and 4,713 patients were included. Xerostomia was the most frequently investigated toxicity (17; 60.71 %). Sixteen (57.14 %) studies reported using radiomics features in combination with clinical or dosimetrics/dosiomics for modelling. High RoB was identified in 23 studies. Meta-analysis (MA) showed an area under the receiver operating characteristics curve (AUROC) of 0.82 for models with IBMs and 0.81 for models without IBMs (p value < 0.001), demonstrating no difference among IBM- and non-IBM-based models.
DISCUSSION
The development of a PM based on sample-specific features represents patient selection bias and may affect a model's performance. Heterogeneity of the studies as well as non-standardized metrics prevent proper comparison of studies, and the absence of an independent/external test does not allow the evaluation of the model's generalization ability.
CONCLUSION
IBM-featured PMs are not superior to PMs based on non-IBM predictors. The evidence was appraised as of low certainty.
Topics: Humans; Head and Neck Neoplasms; Biomarkers; Xerostomia; Machine Learning
PubMed: 37023561
DOI: 10.1016/j.oraloncology.2023.106386 -
Otology & Neurotology : Official... Oct 2018To perform a systematic review evaluating etiologies, associated complications, and management of osteoradionecrosis of the temporal bone (ORNTB).
OBJECTIVES
To perform a systematic review evaluating etiologies, associated complications, and management of osteoradionecrosis of the temporal bone (ORNTB).
METHODS
The authors searched the PubMed, Embase, and Cochrane Library databases for relevant literature. Patient demographics, etiologies, treatments, and other clinical characteristics were obtained. Treatment success was defined as resolution of symptoms at last follow-up. Results were reported using the preferred reporting systems for systematic reviews and meta-analysis (PRISMA) guidelines.
RESULTS
Thirty-eight studies encompassing 364 patients with ORNTB were identified. The most common etiologies necessitating radiotherapy included: nasopharyngeal carcinoma (n = 133 [36.8%]), parotid tumors (n = 73 [20.2%]), and external auditory canal pathology (n = 59 [16.3%]). The mean dose of radiation was 58.0 Gy. The mean lag time between radiotherapy and osteoradionecrosis (ORN) symptoms was 7.9 years. The most common presenting symptoms were purulent otorrhea (33.3%), hearing loss (29.1%), and otalgia (17%). ORNTB complications included tympanic membrane perforation (n = 102 [63.8%]) and chronic otitis media (n = 16 [10%]). Treatments included lateral temporal bone resection (n = 99 [28.3%]), conservative treatment (n = 92 [26.3%]), and mastoidectomy (n = 82 [23.5%]) with 90.9, 89.13, and 59.76% considered successful, respectively.
CONCLUSIONS
ORNTB is a rare complication of radiotherapy that may present years after initial radiation exposure. Management should be aimed at relief of presenting symptoms and treatment of ORNTB associated complications. Both conservative and surgical measures may adequately control the disease process and symptomatology; however, randomized controlled studies comparing treatments would serve to further corroborate these findings.
Topics: Female; Humans; Male; Osteoradionecrosis; Temporal Bone
PubMed: 30106844
DOI: 10.1097/MAO.0000000000001925