-
Journal of Contemporary Brachytherapy Feb 2024Brachytherapy (BT) is a validated radiation technique for treatment of early stage tumors of oral cavity and oropharynx. This study aimed to analyze the results of our...
PURPOSE
Brachytherapy (BT) is a validated radiation technique for treatment of early stage tumors of oral cavity and oropharynx. This study aimed to analyze the results of our institute's patients after replacing low-dose-rate (LDR) with pulse-dose-rate (PDR) brachytherapy.
MATERIAL AND METHODS
We retrospectively collected data from all patients treated between 2009 and 2020 for squamous cell carcinoma (floor of the mouth, tongue, and oropharynx) using adjuvant interstitial BT with or without external RT. Primary outcome was local control. Secondary outcomes were regional control rate and toxicity. Statistical analysis of local and regional recurrences were described using Kaplan-Meier method. Prognostic value of each factor for recurrence or toxicity was evaluated with bivariate Fine-Gray model.
RESULTS
Data from 66 patients were analyzed. Local and regional recurrences were reported in 11% and 20% of the patients, respectively. No significant factors were identified in the present study. Grade 2 and 3 acute mucositis were reported in 21% of patients, and were more frequent in the BT only group. Almost half (47%) of the patients described acute pain following BT, and 26% required stage 2 or 3 analgesics. Trophic disorders were observed in 16 patients. Five patients presented with soft tissue necrosis (STN) and required medical treatment, of whom one subsequently required hyperbaric oxygen therapy. No predictive factors were identified for STN risk. Two patients developed osteoradionecrosis.
CONCLUSIONS
Oral and oropharyngeal PDR-BT as adjuvant treatment is safe and effective for well-defined indications.
PubMed: 38584888
DOI: 10.5114/jcb.2024.135626 -
JPRAS Open Mar 2024Skull osteoradionecrosis may happen after radiation therapy for head and neck cancer. Here in, the authors present a case of intracranial carcinoma with...
Skull osteoradionecrosis may happen after radiation therapy for head and neck cancer. Here in, the authors present a case of intracranial carcinoma with osteoradionecrosis and exposure of frontal bone with a large communication between nasal cavity and anterior fossa associated. The patient was successfully treated with resection of the tumor and reconstruction omentum free flap wrapped around autologous bone graft.
PubMed: 38269256
DOI: 10.1016/j.jpra.2023.12.005 -
Journal of Clinical Medicine Jul 2023Medication-related osteonecrosis of the jaws (MRONJ) is a challenging situation in clinics. Previous studies have shown that pentoxifylline combined with tocopherol...
Outcomes of a Pharmacological Protocol with Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Randomized Study on 202 Osteoporosis Patients.
Medication-related osteonecrosis of the jaws (MRONJ) is a challenging situation in clinics. Previous studies have shown that pentoxifylline combined with tocopherol proved to be beneficial in patients with osteoradionecrosis, due to their antioxidant and antifibrotic properties. The aim of this randomized study was to evaluate the effect of pentoxifylline and tocopherol in patients that had developed MRONJ after tooth extractions. The study population consisted of 202 Stage I MRONJ female patients with an average age of 66.4 ± 8.3 years, who were divided into two groups. The test group (n = 108) received a pharmacological protocol with pentoxifylline and tocopherol (2 months pre-operatively and 6 months post-operatively). The control group (n = 94) had sequestrectomy operations without any pharmacological preparation. The main outcomes were clinical healing of the mucosa after 1 month, and clinical and radiographic healing of the bone lesion at 6 months. In the test group all patients had mucosal healing and there was only one relapse within 6 months. In the control group, in 17% of the patients the mucosa did not heal, 71% of the patients relapsed within two months, and 7% developed infectious complications (such as abscess or phlegmon). After 6 months, the control group patients with persisting issues were prescribed pentoxifylline and tocopherol, as in the test group. At a subsequent follow-up, all those patients healed completely. Patients were monitored for a period of 7.8 ± 0.3 years, during which no relapse or additional problems were reported. As a conclusion, pentoxifylline and tocopherol protocol seems to be beneficial in the management of MRONJ patients.
PubMed: 37510777
DOI: 10.3390/jcm12144662 -
Journal of Neurological Surgery Reports Jul 2023Despites advances in radiation technology, skull base osteoradionecrosis (ORN) continues to be a rare, devastating, and hard to treat complication of radiotherapy....
Despites advances in radiation technology, skull base osteoradionecrosis (ORN) continues to be a rare, devastating, and hard to treat complication of radiotherapy. We present three cases of anterior skull base ORN in a cohort treated with intensity-modulated radiation therapy (IMRT). Three patients developed anterior skull base ORN after receiving at least one round of IMRT. ORN was diagnosed through either nasal endoscopy or imaging findings. The first was a 59-year-old woman with a sinonasal squamous cell carcinoma. Her chemoradiation history was notable for reirradiation and a high dose of radiation (143.3 Gy). The second was a 55-year-old man with recurrent nasopharyngeal carcinoma, whose history was notable for a high dose of radiation (∼140 Gy) and for being reirradiated. The final patient was a 37-year-old woman with an unremarkable history who received radiotherapy (65.0 Gy) for an esthesioneuroblastoma. One patient was asymptomatic and did not receive ORN-specific therapy. The other two were treated with a combination of medical and surgical intervention with successful short-term outcomes (no evidence of infection). Anterior skull base ORN can be treated through conservative and surgical means to achieve successful short-term outcomes. Further investigation of long-term outcomes is warranted.
PubMed: 37771656
DOI: 10.1055/a-2164-8637 -
Clinical and Translational Radiation... Jul 2024Current segmentation approaches for radiation treatment planning in head and neck cancer patients (HNCP) typically consider the entire mandible as an organ at risk,...
BACKGROUND
Current segmentation approaches for radiation treatment planning in head and neck cancer patients (HNCP) typically consider the entire mandible as an organ at risk, whereas segmentation of the maxilla remains uncommon. Accurate risk assessment for osteoradionecrosis (ORN) or implant-based dental rehabilitation after radiation therapy may require a nuanced analysis of dose distribution in specific mandibular and maxillary segments. Manual segmentation is time-consuming and inconsistent, and there is no definition of jaw subsections.
MATERIALS AND METHODS
The mandible and maxilla were divided into 12 substructures. The model was developed from 82 computed tomography (CT) scans of HNCP and adopts an encoder-decoder three-dimensional (3D) U-Net structure. The efficiency and accuracy of the automated method were compared against manual segmentation on an additional set of 20 independent CT scans. The evaluation metrics used were the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and surface DSC (sDSC).
RESULTS
Automated segmentations were performed in a median of 86 s, compared to manual segmentations, which took a median of 53.5 min. The median DSC per substructure ranged from 0.81 to 0.91, and the median HD95 ranged from 1.61 to 4.22. The number of artifacts did not affect these scores. The maxillary substructures showed lower metrics than the mandibular substructures.
CONCLUSIONS
The jaw substructure segmentation demonstrated high accuracy, time efficiency, and promising results in CT scans with and without metal artifacts. This novel model could provide further investigation into dose relationships with ORN or dental implant failure in normal tissue complication prediction models.
PubMed: 38712013
DOI: 10.1016/j.ctro.2024.100780 -
Cureus Dec 2023The most prevalent malignant tumor in the oral cavity is squamous cell carcinoma (SCC). Social interactions are impeded, including eating, conversing, and practicing...
The most prevalent malignant tumor in the oral cavity is squamous cell carcinoma (SCC). Social interactions are impeded, including eating, conversing, and practicing basic oral hygiene. A 43-year-old man who had previously suffered pus discharge in the right side of the buccal mucosa complained of dull aching in the lower right back of his jaw. The patient's right buccal mucosa was surgically treated for SCC two years ago. He received 30 cycles of high-dose radiation therapy for SCC of the right buccal mucosa. The right maxilla and mandible had osteoradionecrosis, according to a clinical and radiographic assessment. The aim of emphasizing the importance of cardiac rehabilitation and mouth opening exercises in oral squamous cell carcinoma (OSCC) is to address the multifaceted impact of this type of cancer on a patient's overall health and well-being. OSCC refers to a type of cancer that occurs in the cells lining the oral cavity, including the lips, tongue, gums, and the floor of the mouth. The implications of OSCC go beyond the local effects on the oral region and can have systemic consequences, affecting various aspects of a patient's health.
PubMed: 38249192
DOI: 10.7759/cureus.50954 -
World Journal of Oncology Jun 2024This study assessed clinical outcomes of three-dimensional-printed template (3DPT)-guided radioactive seed brachytherapy (RSBT) via a submental approach for recurrent...
BACKGROUND
This study assessed clinical outcomes of three-dimensional-printed template (3DPT)-guided radioactive seed brachytherapy (RSBT) via a submental approach for recurrent base of tongue and floor of mouth cancer.
METHODS
Thirty-one patients with recurrent lingual and floor of mouth squamous cell carcinoma after surgery and radiotherapy were treated with 3DPT-guided RSBT from 2015 to 2022. Seeds were implanted through a submental approach guided by 3DPTs. Local control (LC), overall survival (OS), disease control (DC) and quality of life (QOL) were evaluated.
RESULTS
The median follow-up was 13.7 months. The 1-, 3- and 5-year LC rates were 66.1%, 66.1%, and 55.1% respectively. The 1-, 3- and 5-year OS rates were 63.4%, 33.4%, and 8.3%. The 1-, 3- and 5-year DC rates were 37.8%, 26.5%, and 21.2%. Univariate analysis showed tumor size significantly affected LC (P = 0.031). The presence of extraterritorial lesions affected DC and OS on multivariate analysis (P < 0.01). QOL improved significantly in domains of pain, swallowing, chewing, taste, and emotion after treatment compared to baseline. Four patients (13%) developed necrosis and osteoradionecrosis.
CONCLUSIONS
3DPT-guided submental RSBT provided favorable LC and QOL for recurrent tongue/floor of mouth cancer with minimal toxicity; moreover, severe toxicity should be noted.
PubMed: 38751702
DOI: 10.14740/wjon1775 -
Journal of Stomatology, Oral and... Jun 2024Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally...
INTRODUCTION
Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient's quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40 Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed.
MATERIAL AND METHODS
Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analysed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model.
RESULTS
Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8% of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7 Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40 Gy and the occurrence of dental fractures (p = 0.0002) were demonstrated.
CONCLUSIONS
Our predictive model seems to be 82% accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient's oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40 Gy was observed.
Topics: Humans; Retrospective Studies; Osteoradionecrosis; Head and Neck Neoplasms; Male; Female; Middle Aged; Aged; Radiotherapy Dosage; Tooth Extraction; Adult; Squamous Cell Carcinoma of Head and Neck; Aged, 80 and over
PubMed: 38556165
DOI: 10.1016/j.jormas.2024.101858 -
Scientific Reports Jul 2023
PubMed: 37433965
DOI: 10.1038/s41598-023-38352-x -
Clinical and Translational Radiation... May 2024Patients with head and neck cancer are routinely screened for dental foci prior to radiotherapy (RT) to prevent post- RT tooth extractions associated with an increased...
OBJECTIVES
Patients with head and neck cancer are routinely screened for dental foci prior to radiotherapy (RT) to prevent post- RT tooth extractions associated with an increased risk of osteoradionecrosis. We evaluated the risk factors for post-RT tooth extraction to personalise dental screening and prevention protocols prior to RT.
MATERIALS AND METHODS
This retrospective cohort study included dentulous patients diagnosed with oropharyngeal cancer who had undergone radiation therapy at doses 60-70 Gy and achieved a disease-free survival of ≥ 1 year (N = 174). Risk factors were assessed using Cox regression models.
RESULTS
The cumulative incidence of post-RT tooth extraction was 30.7 % at 5 years. Main indications for extraction (n = 62) were radiation caries (n = 20) and periodontal disease (n = 27). Risk factors associated (p < 0.05) with radiation caries-related extractions included active smoking, alcohol abuse, poor oral hygiene, parotid gland irradiation, and mandibular irradiation. A high-dose volume in the mandible was associated with periodontal disease events.
CONCLUSION
Post-RT extractions due to radiation caries were influenced by lifestyle factors and RT dose in the mandible and parotid glands. Periodontal disease-related extractions were primarily associated with the mandibular dose. During dental screening these post-RT risk factors should be taken into account to prevent osteoradionecrosis.
PubMed: 38495648
DOI: 10.1016/j.ctro.2024.100759