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Biomaterials Research 2014Osteoradionecrosis (ORN) of the jaw is a significant complication of radiotherapy for oral cavity cancer. In addition to antibiotic medication, treatment options such as... (Review)
Review
Osteoradionecrosis (ORN) of the jaw is a significant complication of radiotherapy for oral cavity cancer. In addition to antibiotic medication, treatment options such as hyperbaric oxygen therapy, surgical approaches, and combined therapy with pentoxifylline and tocopherol have been recently introduced. In this review article, we will discuss the definition and classifications of osteoradionecrosis, its etiology and pathophysiology, previous treatment options, oral and maxillofacial complications of radiotherapy, basic information on pentoxifylline and tocopherol, recent reports of pentoxifylline and tocopherol combined therapy, and, finally, ORN-induced animal models and future approaches.
PubMed: 26331064
DOI: 10.1186/2055-7124-18-13 -
Laryngoscope Investigative... Feb 2022To analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC).
OBJECTIVES
To analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC).
METHODS
Retrospective chart analysis of all 688 HNC patients treated during 2010-2015 at Turku University Hospital, Finland. All patients who survived for more than a year after RT/chemoRT were included ( = 233). Intensity modulated RT (IMRT) with standard fractionation was applied in each case.
RESULTS
One hundred and six patients (45%) reported persisting dysphagia, for which neck RT increased risk. Definitive neck RT to high-risk volume did not increase late toxicity risks compared to elective neck RT. Radiation-induced hypothyroidism (29%, = 67) was more common among younger patients and females. Osteoradionecrosis (12%, = 29) was more common in the oral cavity cancer group (20.7%, = 92) compared to all other subsites.
CONCLUSIONS
Late toxicities of RT for HNC are common. Age, gender, tumor subsite, and neck RT affect susceptibility to long-term side effects.
LEVEL OF EVIDENCE
4.
PubMed: 35155788
DOI: 10.1002/lio2.711 -
Acta Medica Okayama Aug 2017Osteoradionecrosis (ORN), a well-known complication of radiotherapy in the mandibular bone, is very rare in the cervical spine. The authors report the result of a 3-year...
Osteoradionecrosis (ORN), a well-known complication of radiotherapy in the mandibular bone, is very rare in the cervical spine. The authors report the result of a 3-year follow-up of a 63-year-old female patient with ORN of the cervical spine. The patient had a history of laryngeal carcinoma and was treated with chemotherapy and radiation therapy with a total of 120 Gy. Eight years later, she developed acute, severe neck pain due to cervical spine necrosis. The authors performed vascularized fibular bone graft and posterior pedicle screw fixation to reconstruct her cervical spine. The patient was successfully treated with surgery, and cervical alignment was preserved. She had neither neurological deficits nor severe neck pain at her final follow-up 3 years later. Delaying treatment of ORN may be life threatening, so the early diagnosis of this condition is important for patients who receive radiotherapy. Otolaryngologists and spine surgeons should understand this potential complication to speed diagnosis and treatment as early as possible.
Topics: Cervical Vertebrae; Female; Humans; Middle Aged; Osteoradionecrosis
PubMed: 28824191
DOI: 10.18926/AMO/55312 -
Seminars in Plastic Surgery May 2020The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this... (Review)
Review
The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primary site of malignancy. Osteoradionecrosis (ORN) of the facial bones, in particular the maxilla, is a debilitating complication of radiation therapy. Exposure to ionizing radiation results in devitalization of underlying bone with necrosis of adjacent soft tissue. Controversy surrounding appropriate early intervention in ORN persists and no consensus for clinical treatment has been established. In the present article, we review the pathophysiology of maxillary ORN and discuss the role of both conservative medical therapy and reconstruction.
PubMed: 32390778
DOI: 10.1055/s-0040-1709144 -
Radiotherapy and Oncology : Journal of... Jun 2017We compared mandibular doses and osteoradionecrosis in patients with oropharyngeal cancer after intensity-modulated radiation therapy (IMRT) or intensity-modulated...
PURPOSE
We compared mandibular doses and osteoradionecrosis in patients with oropharyngeal cancer after intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT).
METHODS AND MATERIALS
We identified 584 patients who received definitive radiotherapy for oropharyngeal cancer from January 2011 through June 2014 at MD Anderson Cancer Center (534 IMRT and 50 IMPT). The dosimetric variables and osteoradionecrosis were compared with Chi-square test or Fisher's exact test.
RESULTS
Median follow-up time for all patients (534 IMRT and IMPT) was 33.8months (33.8months IMRT vs. 34.6months IMPT, P=0.854), and median time to osteoradionecrosis was 11.4months (range 6.74-16.1months). Mandibular doses were lower for patients treated with IMPT (minimum 0.8 vs. 7.3Gy; mean 25.6 vs. 41.2Gy; P<0.001), and osteoradionecrosis rates were lower as well: 2% IMPT (1 grade 1), 7.7% IMRT (12 grade 4, 5 grade 3, 1 grade 2 and 23 grade 1). Osteoradionecrosis location depended on the primary tumor site and high-dose field in the mandible.
CONCLUSIONS
Osteoradionecrosis events were significantly associated with higher dose irradiation to mandibular. Use of IMPT minimized excess irradiation of the mandible and consequently reduced the risk of osteoradionecrosis for oropharyngeal cancer.
Topics: Adult; Aged; Female; Humans; Male; Mandible; Middle Aged; Oropharyngeal Neoplasms; Osteoradionecrosis; Proton Therapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated
PubMed: 28549794
DOI: 10.1016/j.radonc.2017.05.006 -
The Journal of Craniofacial SurgeryThe purpose of this study was to evaluate our 10 years clinical experience in surgical management of patients with bilateral osteoradionecrosis (BORN) of the mandible in...
PURPOSE
The purpose of this study was to evaluate our 10 years clinical experience in surgical management of patients with bilateral osteoradionecrosis (BORN) of the mandible in head and neck malignancies patients.
MATERIALS AND METHODS
The authors reviewed 22 patients with bilateral mandibular bone mineral density changed in image who had failed to respond to conservative treatments. They were treated by radical resection and reconstruction with free flaps immediately or second-stage at our institution between January 2008 and January 2018.
RESULTS
Nine patients received immediate bilateral mandibular radical resection. Six bone flaps (4 fibula osteocutaneous [fibular OC], 1 fibular OC + pectoralis major myocutaneous flap [PMMF] and 1 fibular OC + anterolateral thigh flap [ALTF]) and 3 soft flaps (1 PMMF, 1 PMMF + titanium plate and 1 ALTF) were used. Three (33.3%) of these patients complications occurred in the immediate postoperative period, but all patients have an acceptable follow-up outcomes. In remaining 13 patients who only experienced immediate unilateral mandible resection for the first time. Complications occurred in 1 patient (7.7%), and all patients have a good outcome in the immediate postoperative period. In follow-up, 1 patient titanium plate exposed, and 6 patients (46.2%) contralateral mandible ORN developed that underwent radical resection in second time. Three fibular OC, 2 PMMF, and 1 latissimus dorsi myocutaneous flap were used. The overall outcome of our experience with the use of bone or soft tissue transfers in managing BORN of mandible is encouraging.
CONCLUSIONS
An individualized management plan should be given for each patient depending on their own local and general condition. Radical resection followed by vascularized flaps reconstruction is an acceptable and reliable procedure for patients with BORN of the mandible.
Topics: Fibula; Free Tissue Flaps; Humans; Mandible; Osteoradionecrosis; Plastic Surgery Procedures; Retrospective Studies
PubMed: 34320577
DOI: 10.1097/SCS.0000000000007906 -
Radiologia 2020The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their... (Review)
Review
The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their follow-up, especially when the tumor recurrence is not clinically evident. Radiologically distinguishing post-treatment changes from a tumor recurrence is a challenge due to the anatomical alteration due to surgical techniques and their reconstructions, radiotherapy treatment and chemotherapeutic guidelines. The differential diagnosis must include the possible complications derived from radiotherapy (mucosal necrosis, osteoradionecrosis, vasculopathy, cerebral radionecrosis) and surgery (wound infections, flap necrosis, fistulas,...). A wide knowledge of the expected findings of multimodal treatment and its complications is essential for an accurate diagnosis of tumor recurrence. Finally, choosing the appropriate image study and having a baseline post-treatment study is also relevant for a suitable radiological control.
Topics: Combined Modality Therapy; Diagnosis, Differential; Head and Neck Neoplasms; Humans; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Postoperative Complications; Radiation Injuries; Radiologists; Surgical Flaps; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31668715
DOI: 10.1016/j.rx.2019.07.006 -
The Laryngoscope Sep 2021To determine the frequency and management of short- and long-term complications related to oromandibular free flap reconstruction and identify potentially predictive...
OBJECTIVES/HYPOTHESIS
To determine the frequency and management of short- and long-term complications related to oromandibular free flap reconstruction and identify potentially predictive factors of hardware complications.
STUDY DESIGN
Retrospective chart review.
METHODS
A retrospective database from chart review was formed consisting of 266 oromandibular free flap reconstructions performed at a single institution over a 15-year period. Data were collected on demographics, surgical treatment, complications, and management of complications. Subgroup univariate and multivariate analyses were performed to compare patients with hardware complications and those without.
RESULTS
Eighty-one of 266 patients (30.5%) that underwent oromandibular reconstruction had an early complication (<4 weeks after surgery), and the most common complications were cervical wound dehiscence (11.3%) and fistulas (9.40%). Eighty of 266 patients (30.1%) had a long-term complication (>4 weeks after surgery) and the most common complication was plate exposure (26.7%). Univariate and multivariate analyses showed no association between whether there was hardware extrusion and fibula versus scapula, smoking history, virtual surgical planning (VSP), and dental implantation (P > .05). Only early complications (OR, 3.59, 95% CI, 1.83-7.05, P < .01) and patients undergoing oromandibular reconstruction for osteoradionecrosis (OR, 2.26, 95% CI, 1.10-4.64, P = .03) were strongly and independently associated with subsequent hardware extrusion on univariate analysis.
CONCLUSIONS
Both short- and long-term complications are common after oromandibular reconstruction. The most important predictive factor for a late complication is an early complication and prior radiation. There was no difference of plate complications among the various free flap types. Dental implantation and use of VSP were not associated with hardware complications.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:1997-2005, 2021.
Topics: Adult; Aged; Bone Plates; Case-Control Studies; Comorbidity; Female; Fibula; Fistula; Free Tissue Flaps; Humans; Male; Mandibular Reconstruction; Middle Aged; Multivariate Analysis; Osteoradionecrosis; Postoperative Complications; Predictive Value of Tests; Plastic Surgery Procedures; Retrospective Studies; Scapula; Surgical Wound Dehiscence
PubMed: 33571385
DOI: 10.1002/lary.29430