Abstract
BackgroundThe risk for osteoradionecrosis (ORN) of the mandible is positively related to bone volume exposed to > ~ 60 Gy. We hypothesized that in combined treatment, surgery may also be a risk factor.Patients and methodsThe impact of mandibular surgery on ORN in locally disease-free IMRT cohorts was retrospectively analyzed.ResultsBetween October 2002 and October 2013, 531 of 715 patients with oral cavity cancer (OCC), mesopharyngeal cancer (MC), or salivary gland tumor were treated with the mandible bone exposed to ~ > 60 Gy (mean follow-up, 38 months; 7–143 months). Of the 531 patients, 36 developed ORN (7 %; 1.5 % with grade 3–4). The ORN rate in definitive IMRT MC (16/227) and in postoperative IMRT OCC patients with no mandibular surgery (3/46) was 7 % each; in OCC patients with mandibular surgery the rate was 29 % (15/60, p = 0.002). Marginal or periosteal bone resection was found to be a high risk factor (39 %, vs. 7 % followed by segmental or no resection, p < 0.0001).ConclusionMarginal or periosteal bone resection of the mandible was identified as the highest ORN risk factor in our IMRT cohort.
Highlights
The risk for osteoradionecrosis ORN) of the mandible is known to be positively related to radiation doses of > 60 Gy to the bone [1, 2]
Marginal or periosteal bone resection of the mandible was identified as the highest ORN risk factor in our intensity-modulated radiation therapy (IMRT) cohort
In our oral cavity cancer (OCC) cohort, a higher ORN rate was observed in the postoperative subgroup (60–66 Gy in 2.0 Gy/fraction) than in the definitive IMRT subgroups as well as in the postoperative IMRT mesopharyngeal cancer (MC) cohort
Summary
The risk for osteoradionecrosis ORN) of the mandible is known to be positively related to radiation doses of > 60 Gy to the bone [1, 2]. In our OCC cohort, a higher ORN rate was observed in the postoperative subgroup (60–66 Gy in 2.0 Gy/fraction) than in the definitive IMRT subgroups as well as in the postoperative IMRT MC cohort. This observation motivated us to analyze the impact of previous mandibular surgery on the risk for ORN. The risk for osteoradionecrosis (ORN) of the mandible is positively related to bone volume exposed to > ~ 60 Gy. We hypothesized that in combined treatment, surgery may be a risk factor. Marginal or periosteal bone resection was found to be a high risk factor (39 %, vs. 7 % followed by segmental or no resection, p < 0.0001)
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