Factors predictive of severity of osteoradionecrosis of the mandible

• Published in: Head & neck 2011-11, Vol.33 (11), p.1600-1605
• Main Authors: Chopra, Shamit, Kamdar, Dev, Tulunay Ugur, Ozlem E., Chen, George, Peshek, Brian, Marunick, Mark, Kim, Harold, Lin, Ho-Sheng, Jacobs, John
• Format: Article
• Language: English
• Subjects: Adjuvants; Adult; Age; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; Chemotherapy; Cohort Studies; dentition; Diseases of the osteoarticular system; Dose-Response Relationship, Radiation; Ethnic groups; Female; Follow-Up Studies; Head; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Humans; Immunohistochemistry; Incidence; Male; Mandible; Mandibular Diseases - epidemiology; Mandibular Diseases - etiology; Mandibular Diseases - pathology; Medical sciences; Middle Aged; Neck; Neoplasm Staging; Osteoradionecrosis; Osteoradionecrosis - epidemiology; Osteoradionecrosis - pathology; Otorhinolaryngology. Stomatology; Predictive Value of Tests; Prophylaxis; Radiation; radiation therapy; Radiotherapy Dosage; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Retrospective Studies; Risk Factors; Secondary infection; Severity of Illness Index; squamous cell carcinoma; Tumors; Vascular bone diseases; Young Adult
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.21654

Background An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition. Methods We retrospectively analyzed 46 patients diagnosed between June 2002 and March 2009: 93% had mandibular ORN, which was staged 0 to III (Store and Boysen). Patient, tumor, treatment‐related, and other variables were analyzed for association with mandibular ORN severity. Results Oral or oropharyngeal tumors comprised 85% of our primary tumors, 80% were stage IV, and 91% were squamous cell carcinomas. Most patients (87%) received 3‐dimensional (3D) conformal radiation therapy (RT), with 60 Gray (Gy) median dose; 28% and 72% received primary and adjuvant RT, respectively; 78% received chemotherapy, mostly concurrent (97%) and platinum‐based (96%). Median time to development of ORN was 7.5 months. White ethnicity and secondary infection correlated significantly with stage III mandibular ORN (p = .038, p = .0007, respectively). Advanced age, stage IV, RT dose, post‐RT, and lack of pre‐RT dental extractions appeared predictive of severe mandibular ORN. Conclusions The above‐cited factors are predictive of severity and can potentially guide prophylaxis and management. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.