Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jun;123(3):401-405.
doi: 10.1016/j.radonc.2017.05.006. Epub 2017 May 23.

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Wencheng Zhang  1 , Xiaodong Zhang  2 , Pei Yang  3 , Pierre Blanchard  3 , Adam S Garden  3 , Brandon Gunn  3 , C David Fuller  3 , Mark Chambers  4 , Katherine A Hutcheson  4 , Rong Ye  5 , Stephen Y Lai  4 , Mohamed Abdallah Sherif Radwan  6 , X Ron Zhu  7 , Steven J Frank  8
Affiliations

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Wencheng Zhang et al. Radiother Oncol. 2017 Jun.

Abstract

Purpose: We compared mandibular doses and osteoradionecrosis in patients with oropharyngeal cancer after intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT).

Methods and materials: We identified 584 patients who received definitive radiotherapy for oropharyngeal cancer from January 2011 through June 2014 at MD Anderson Cancer Center (534 IMRT and 50 IMPT). The dosimetric variables and osteoradionecrosis were compared with Chi-square test or Fisher's exact test.

Results: Median follow-up time for all patients (534 IMRT and IMPT) was 33.8months (33.8months IMRT vs. 34.6months IMPT, P=0.854), and median time to osteoradionecrosis was 11.4months (range 6.74-16.1months). Mandibular doses were lower for patients treated with IMPT (minimum 0.8 vs. 7.3Gy; mean 25.6 vs. 41.2Gy; P<0.001), and osteoradionecrosis rates were lower as well: 2% IMPT (1 grade 1), 7.7% IMRT (12 grade 4, 5 grade 3, 1 grade 2 and 23 grade 1). Osteoradionecrosis location depended on the primary tumor site and high-dose field in the mandible.

Conclusions: Osteoradionecrosis events were significantly associated with higher dose irradiation to mandibular. Use of IMPT minimized excess irradiation of the mandible and consequently reduced the risk of osteoradionecrosis for oropharyngeal cancer.

Keywords: IMPT; IMRT; Mandibular dose; Oropharyngeal cancer; Osteoradionecrosis; Particle therapy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare no actual or potential financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Comparison of the Dose volume histograms (DVHs) between the IMRT and IMPT plans of the patients; Each error bar is constructed using a 95% confidence interval of the mean.
See this image and copyright information in PMC

References

    1. Wang L, Su YX, Liao GQ. Quality of life in osteoradionecrosis patients after mandible primary reconstruction with free fibula flap. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2009;108:162–8. - PubMed
    1. Niewald M, Fleckenstein J, Mang K, Holtmann H, Spitzer WJ, Rube C. Dental status, dental rehabilitation procedures, demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation. Radiation oncology. 2013;8:227. - PMC - PubMed
    1. Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral surgery, oral medicine, oral pathology and oral radiology. 2012;113:54–69. - PubMed
    1. Tsai CJ, Hofstede TM, Sturgis EM, Garden AS, Lindberg ME, Wei Q, et al. Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. International journal of radiation oncology, biology, physics. 2013;85:415–20. - PubMed
    1. Glanzmann C, Gratz KW. Radionecrosis of the mandibula: a retrospective analysis of the incidence and risk factors. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology. 1995;36:94–100. - PubMed

LinkOut - more resources