PURPOSE: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. RESULTS: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received >or=65 Gy and >or=70 Gy to >or=1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). CONCLUSION: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.
PURPOSE: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. RESULTS: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received >or=65 Gy and >or=70 Gy to >or=1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). CONCLUSION: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.
Authors: Jacques Bernier; Christian Domenge; Mahmut Ozsahin; Katarzyna Matuszewska; Jean-Louis Lefèbvre; Richard H Greiner; Jordi Giralt; Philippe Maingon; Frédéric Rolland; Michel Bolla; Francesco Cognetti; Jean Bourhis; Anne Kirkpatrick; Martine van Glabbeke Journal: N Engl J Med Date: 2004-05-06 Impact factor: 91.245
Authors: J C Horiot; S Schraub; M C Bone; Y Bain; J Ramadier; G Chaplain; N Nabid; B Thevenot; D Bransfield Journal: Radiother Oncol Date: 1983-08 Impact factor: 6.280
Authors: Avraham Eisbruch; Lon H Marsh; Laura A Dawson; Carol R Bradford; Theodoros N Teknos; Douglas B Chepeha; Francis P Worden; Susan Urba; Alexander Lin; Matthew J Schipper; Gregory T Wolf Journal: Int J Radiat Oncol Biol Phys Date: 2004-05-01 Impact factor: 7.038
Authors: K S Clifford Chao; Gokhan Ozyigit; Angel I Blanco; Wade L Thorstad; Joseph O Deasy; Bruce H Haughey; Gershon J Spector; Donald G Sessions Journal: Int J Radiat Oncol Biol Phys Date: 2004-05-01 Impact factor: 7.038
Authors: D M Brizel; M E Albers; S R Fisher; R L Scher; W J Richtsmeier; V Hars; S L George; A T Huang; L R Prosnitz Journal: N Engl J Med Date: 1998-06-18 Impact factor: 91.245
Authors: A Eisbruch; L H Marsh; M K Martel; J A Ship; R Ten Haken; A T Pu; B A Fraass; A S Lichter Journal: Int J Radiat Oncol Biol Phys Date: 1998-06-01 Impact factor: 7.038
Authors: S M Magrini; S Tonoli; L Costa; N Pasinetti; F Paiar; L Livi; G Simontacchi; I Meattini; L Pegurri; P Borghetti; P Frata; P Ponticelli; M Buglione; G Biti Journal: Radiol Med Date: 2011-11-17 Impact factor: 3.469