-
Review of Osteoradionecrosis of the Jaw: Radiotherapy Modality, Technique, and Dose as Risk Factors.Journal of Clinical Medicine Apr 2023Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately,... (Review)
Review
Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5-6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the "organ at risk" safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results.
PubMed: 37109361
DOI: 10.3390/jcm12083025 -
The Laryngoscope Nov 2021To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors,...
OBJECTIVES/HYPOTHESIS
To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes.
STUDY DESIGN
Retrospective chart review.
METHODS
Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease.
RESULTS
TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful.
CONCLUSIONS
TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2578-2585, 2021.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Incidence; Male; Middle Aged; Osteoradionecrosis; Prognosis; Radiotherapy, Conformal; Retrospective Studies; Risk Assessment; Risk Factors; Skin Neoplasms; Temporal Bone; Young Adult
PubMed: 34287898
DOI: 10.1002/lary.29758 -
Journal of Cancer Research and... 2022Surgical ablation of a large tumor creates a defect which is technically difficult to reconstruct. Radiated tissue bed poses a challenge to reconstruction and is...
Surgical ablation of a large tumor creates a defect which is technically difficult to reconstruct. Radiated tissue bed poses a challenge to reconstruction and is complicated in presence of osteoradionecrosis. This report describes a case of a 62 year old gentleman with oral cancer who underwent surgery and radiotherapy twice. He developed an orocutaneous defect (OCD) following surgery and radiotherapy. Prosthetic rehabilitation of OCD was done. Full facial impression with irreversible hydrocolloid was made and wax sculpture made on the model obtained. Standard laboratory steps were followed for mould fabrication and maxillofacial silicone was used to fabricate the prosthesis. It was retained to the spectacle with silicone adhesives. The silicone facial prosthesis provided to the patient was easy to use, covered the defect and improved the quality of life of the patient.
Topics: Face; Humans; Male; Maxillofacial Prosthesis; Middle Aged; Prosthesis Design; Quality of Life; Silicones
PubMed: 35900575
DOI: 10.4103/jcrt.JCRT_1141_20 -
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 -
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 -
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 -
Journal of the Korean Association of... Apr 2020We present a case of osteoradionecrosis treated with leukocyte- and platelet-rich fibrin (LPRF) and surgery and followed up with clinical and tomographic investigations....
We present a case of osteoradionecrosis treated with leukocyte- and platelet-rich fibrin (LPRF) and surgery and followed up with clinical and tomographic investigations. A 65-year-old woman presented with pain in the posterior region of the right palate. Her medical history included cardiovascular disease and squamous cell carcinoma in the anterior region of the floor of the mouth that had been treated with intensity-modulated radiation therapy. Measurements of isodose curves showed a full dosage of 6,462.6 cGy in the anterior mandibular region, whereas that in the posterior region on the right side of the maxilla reached 5,708.1 cGy. Osteotomy was performed using rotary instruments, and debridement and placement of two LPRF membranes were also carried out. New gum tissue with no bone exposure was noted 14 days postoperatively. Tissue repair was complete, and the patient had no further complaints. During a 39-month follow-up period, the oral mucosa remained intact, and the patient was rehabilitated with a new upper denture. Since there is no consensus regarding the best protocol to treat osteoradionecrosis, LPRF might be an interesting adjuvant to a surgical approach. The use of LPRF is simple and reduces operational costs, time of handling, probability of technical failure, and associated morbidities for patients with osteoradionecrosis.
PubMed: 32364355
DOI: 10.5125/jkaoms.2020.46.2.150 -
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