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. 2007 Jun 1;68(2):396-402.
doi: 10.1016/j.ijrobp.2006.11.059. Epub 2007 Feb 22.

Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions

Merav A Ben-David  1 , Maximiliano Diamante, Jeffrey D Radawski, Karen A Vineberg, Cynthia Stroup, Carol-Anne Murdoch-Kinch, Samuel R Zwetchkenbaum, Avraham Eisbruch
Affiliations

Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions

Merav A Ben-David et al. Int J Radiat Oncol Biol Phys. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Notification: No conflicts of interest exist.

Figures

Figure 1
Figure 1
Stents devised to reduce electron backscatter off dental metal restorations to the adjacent soft tissue. A. After completion, B. In place. If clinically required, teeth separation and tongue depression can be achieved by inserting a tongue depressor during the preparation of the stents or by making separate stents for the mandible and maxilla.
Figure 2
Figure 2
Combined cumulative DVH’s of the mandibule for all patients. The thick line represents the mean dose-volume and the vertical lines represent one standard deviation values.
Figure 3
Figure 3
The distribution of maximum doses to 1% of the mandibular volume in individual patients.
Figure 4
Figure 4
Axial CT slices at the levels of the mandibular angle (A) and rami (B) in a patient with tonsillar cancer demonstrating the dose fall-off from the buccal to the lingual surfaces of the mandible.
Figure 4
Figure 4
Axial CT slices at the levels of the mandibular angle (A) and rami (B) in a patient with tonsillar cancer demonstrating the dose fall-off from the buccal to the lingual surfaces of the mandible.
See this image and copyright information in PMC

Comment in

References

    1. Wahl MJ. Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys. 2006;64(3):661–9. - PubMed
    1. Schwartz HC, Kagan AR. Osteoradionecrosis of the mandible: scientific basis for clinical staging. Am J Clin Oncol. 2002;25(2):168–71. - PubMed
    1. Mendenhall WM. Mandibular Osteoradionecrosis. J Clin Oncol. 2004;22(24):4867–4868. - PubMed
    1. Sciubba JS, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol. 2006;7:175–83. - PubMed
    1. Eisbruch A, Foote RL, O’Sullivan B, Beitler JJ, Vikram B. Intensity-modulated radiation therapy for head and neck cancer: emphasis on the selection and delineation of the targets. Semin Radiat Oncol. 2002;12(3):238–49. - PubMed

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