Osteoradionecrosis: Patient characteristics and treatment outcome in a cohort from Copenhagen University Hospital 1995-2005

Abstract

Purpose: The present retrospective observational study was undertaken to evaluate disease characteristics, treatment strategy and treatment results of a large unselected cohort of patients with osteoradionecrosis (ORN) after radiation therapy (RT) for head and neck cancer at the Copenhagen University Hospital 1995-2005. Patients and Methods: Medical records of 180 consecutive patients diagnosed with ORN were reviewed. Patients had all received treatment for ORN at the Department of Oral Maxillofacial Surgery, Copenhagen University Hospital from 1 January 1995 to 31 December 2005. Only patients who had received their primary treatment for head and neck cancer in the eastern part of Denmark were included. Results: The cohort consisted predominantly of men (78%) of whom a clear majority were smokers (60.6%). The median age was 57. The median time until the onset of post-RT ORN was 1.9 years. ORN lesions were mostly located in the mandibular symphysis, body and angle regions. Hyperbaric oxygen treatment was given to 93% of the patients; and 25% of the patients completed disease-free follow-up after a median of 1.2 years. At the time of study termination, 17% were still undergoing active treatment. Social class distribution showed a clear predominance of the lower social classes. Conclusion: The present study demonstrates the variability of mandibular ORN. Onset varies greatly, which demonstrates the lifelong nature of the risk of ORN. In the majority of patients, the primary tumor was located in the oral cavity or the oropharynx. ORN does not appear to imply social inequality.