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. 2016 Jan;192(1):32-9.
doi: 10.1007/s00066-015-0875-6. Epub 2015 Aug 12.

Risk profile for osteoradionecrosis of the mandible in the IMRT era

Gabriela Studer  1 , Marius Bredell  2 , Stephan Studer  2 , Gerhard Huber  3 , Christoph Glanzmann  4
Affiliations

Risk profile for osteoradionecrosis of the mandible in the IMRT era

Gabriela Studer et al. Strahlenther Onkol. 2016 Jan.

Abstract
in English, German

Background: 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 also be a risk factor.

Patients and methods: The impact of mandibular surgery on ORN in locally disease-free IMRT cohorts was retrospectively analyzed.

Results: Between 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).

Conclusion: Marginal or periosteal bone resection of the mandible was identified as the highest ORN risk factor in our IMRT cohort.

Hintergrund: Das Risiko für die Entwicklung einer Kiefernekrose nach Radiotherapie (Osteoradionekrose, ORN) korreliert bekanntlich mit dem Knochenvolumen, das einer Dosis von ~ > 60 Gy ausgesetzt wurde. Hypothese war, dass die Chirurgie bei kombinierten Therapien ebenfalls einen Risikofaktor darstellt.

Material und Methode: Der Einfluss chirurgischer Interventionen am Kiefer auf das Risiko einer ORN wurde in unserem lokal krankheitsfreien IMRT-Kollektiv retrospektiv analysiert.

Ergebnisse: Zwischen Oktober 2002 und Oktober 2013 wurden 531/715 Patienten mit Mundhöhlenkarzinomen (OCC), Mesopharynxkarzinomen (MC) oder Speicheldrüsentumoren mit Dosen > 60 Gy am Kieferknochen behandelt (mittlere Beobachtungszeit 38 Monate; Spanne 7–143 Monate). Von 531 Patienten entwickelten 36 eine ORN (7 %; 1,5 % mit Grad 3–4). Die ORN-Rate nach definitiver IMRT bei MC (16/227) und nach postoperativer IMRT bei OCC ohne chirurgischen Eingriff am Kieferknochen (3/46) belief sich auf je 7 %, bei OCC-Patienten mit Operation am Kieferknochen auf 29 % (15/60; p = 0,002). Das höchste ORN-Risiko fand sich dabei für marginale oder periosteale Knochenresektionen (39 %, vs. 7 % nach segmentaler oder keiner Resektion; p < 0,0001).

Schlussfolgerung: Marginale oder periosteale Kieferknochenresektionen gingen in unserer IMRT-Kohorte mit dem höchsten Risiko für die Entwicklung einer ORN einher.

Keywords: Osteoradionecrosis, ORN; Postoperative ORN; Preradiation surgery; Risk factors, ORN; Surgery-related ORN.

PubMed Disclaimer

Conflict of interest statement

G. Studer, M. Bredell, S. Studer, G. Huber, and C. Glanzmann state that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Mandible bone Dose–volume histograms (mean values, cc) of the following subgroups, all with the mandible exposed to > 60 Gy (n total = 458): -Postoperative IMRT in oral cavity cancer (OCC) patients with/without osteoradionecrosis (±ORN) who underwent mandibular surgery (+MS) or not (−MS) -Definitive IMRT in OCC patients (no MS, all in the cohort without ORN) -Definitive and postoperative IMRT in mesopharynx cancer (MC) patients ± ORN (none of them underwent mandibular surgery). Red curves represent the two cohorts with ORN (+ORN), dotted lines postoperative IMRT groups, and continuous lines definitive IMRT groups
Fig. 2
Fig. 2
Overall survival (OS) of definitively irradiated OCC patients, and ORN-free survival in the postoperative IMRT OCC and definitive IMRT MC cohorts. ORN osteoradionecrosis, OCC oral cavity cancer, MC mesopharyngeal cancer
See this image and copyright information in PMC

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