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. 2023 Mar-Apr;44(2):103781.
doi: 10.1016/j.amjoto.2022.103781. Epub 2022 Dec 28.

Early detection of mandible osteoradionecrosis risk in a high comorbidity veteran population

David Chamberlayne Wilde  1 , Sagar Kansara  1 , Logan Banner  2 , Rickey Morlen  2 , David Hernandez  3 , Andrew Tsao Huang  3 , Weiyuan Mai  4 , Clifton David Fuller  5 , Stephen Lai  6 , Vlad Constantin Sandulache  7
Affiliations

Early detection of mandible osteoradionecrosis risk in a high comorbidity veteran population

David Chamberlayne Wilde et al. Am J Otolaryngol. 2023 Mar-Apr.

Abstract

Objective: Osteoradionecrosis (ORN) of the mandible is a devastating complication of external beam radiation therapy (EBRT) for head and neck squamous cell carcinoma (HNSCC). We sought to ascertain ORN risk in a Veteran HNSCC population treatment with definitive or adjuvant EBRT and followed prospectively.

Study design: Retrospective analysis of prospective cohort.

Setting: Tertiary care Veterans Health Administration (VHA) medical center.

Methods: Patients with HNSCC who initiated treatment at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) are prospectively tracked for quality of care purposes through the end of the cancer surveillance period (5 years post treatment completion). We retrospectively analyzed this patient cohort and extracted clinical and pathologic data for 164 patients with SCC of the oral cavity, oropharynx, larynx, and hypopharynx who received definitive or adjuvant EBRT (2016-2020).

Results: Most patients were dentate and 80 % underwent dental extractions prior to EBRT of which 16 (16 %) had complications. The rate of ORN was 3.7 % for oral cavity SCC patients and 8.1 % for oropharyngeal SCC patients. Median time to ORN development was 156 days and the earliest case was detected at 127 days post EBRT completion. All ORN patients were dentate and underwent extraction prior to EBRT start.

Conclusion: ORN development can occur early following EBRT in a Veteran population with significant comorbid conditions but overall rates are in line with the general population. Prospective tracking of HNSCC patients throughout the post-treatment surveillance period is critical to early detection of this devastating EBRT complication.

Keywords: Comorbidities; Head and neck cancer; Oropharynx; Osteoradionecrosis; Veterans.

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Conflict of interest statement

Declaration of competing interest Contents do not represent the views of the US Department of Veterans Affairs or the US Government. The authors report no conflicts of interest for the existing work.

Figures

Fig. 1.
Fig. 1.
Radiation plan for oropharyngeal cancer. Dosimetric plan for T4N2M0 OPSCC which developed right mandibular ORN. Approximately 75 % of the mandibular volume falls within 56Gy dose and approximately 90 % falls within 35Gy dose.
Fig. 2.
Fig. 2.
ORN development. A) Erosion of the mandibular body, reconstructed using a fibular free flap. B) Operative planning for reconstruction. C) Imaging of reconstructed mandible. D-F) Bony erosion at the time of diagnosis.
See this image and copyright information in PMC

Comment in

References

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