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[Preprint]. 2024 Apr 9:2024.04.07.24305400.

doi: 10.1101/2024.04.07.24305400.

International Expert-Based Consensus Definition, Staging Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study

International ORAL Consortium

Collaborators, Affiliations

Collaborators

International ORAL Consortium:
Amy C Moreno¹, Erin E Watson², Laia Humbert-Vidan¹, Douglas E Peterson³, Lisanne V van Dijk⁴, Teresa Guerrero Urbano⁵, Lisa Van den Bosch⁴, Andrew J Hope⁶, Matthew S Katz⁷, Frank Jp Hoebers⁸, Ruth A Aponte Wesson⁹, James E Bates¹⁰, Paolo Bossi¹¹, Adeyinka F Dayo¹², Mélanie Doré¹³, Eduardo Rodrigues Fregnani¹⁴, Thomas J Galloway¹⁵, Daphna Y Gelblum¹⁶, Issa A Hanna¹⁷, Christina E Henson¹⁸, Sudarat Kiat-Amnuay^{19

20}, Anke Korfage²¹, Nancy Y Lee¹⁶, Carol M Lewis⁹, Charlotte Duch Lynggaard²², Antti A Mäkitie²³, Marco Magalhaes²⁴, Yvonne M Mowery²⁵, Carles Muñoz-Montplet²⁶, Jeffrey N Myers²⁰, Ester Orlandi²⁷, Jaymit Patel²⁸, Jillian M Rigert¹, Deborah Saunders²⁹, Jonathan D Schoenfeld³⁰, Ugur Selek³¹, Efsun Somay³², Vinita Takiar³³, Juliette Thariat³⁴, Gerda M Verduijn³⁵, Alessandro Villa³⁶, Nick West³⁷, Max Jh Witjes³⁸, Alex Won²⁰, Mark E Wong¹⁷, Christopher Mkl Yao³⁹, Simon W Young¹⁷, Kamal Al-Eryani⁴⁰, Carly Ea Barbon²⁰, Doke Jm Buurman^{8

41}, François J Dieleman⁴², Theresa M Hofstede²⁰, Abdul Ahad Khan⁴³, Adegbenga O Otun²⁰, John C Robinson⁴⁴, Lauren Hum¹⁷, Jorgen Johansen⁴⁵, Rajesh Lalla⁴⁶, Alexander Lin⁴⁷, Vinod Patel⁴⁸, Richard J Shaw⁴⁹, Mark S Chambers²⁰, Daniel Ma⁵⁰, Mabi Singh⁵¹, Noam Yarom⁵², Abdallah Sherif Radwan Mohamed^{1

53}, Katherine A Hutcheson^{1

20}, Stephen Y Lai^{1

20

54}, Clifton David Fuller¹

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
² Department of Dental Oncology/Faculty of Dentistry, Princess Margaret Cancer Centre; University Health Network; University of Toronto, Toronto, CA.
³ Oral Health and Diagnostic Sciences, University of Connecticut, Farmington, USA.
⁴ Department of Radiation Oncology, University Medical Center Groningen, Groningen, NL.
⁵ Oncology Department, Guy's and St Thomas NHS Trust/King's College London, London, UK.
⁶ Department of Radiation Oncology, Princess Margaret Cancer Centre; University Health Network; University of Toronto, Toronto, CA.
⁷ Radiation Oncology, Lowell General Hospital, Lowell, USA.
⁸ Department of Radiation Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, NL.
⁹ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
¹⁰ Department of Radiation Oncology, Winship Cancer Institute/Emory University, Atlanta, USA.
¹¹ Medical Oncology, Department of Medical and Surgical Specialties, Humanitas University; IRCCS Humanitas Research Hospital, Milan, IT.
¹² Oral Medicine Department, University of Pennsylvania School of Dental Medicine, Philadelphia, USA.
¹³ Radiotherapy Department, Institut de Cancérologie de l'Ouest, Saint Herblain, FR.
¹⁴ Centro de Oncologia Molecular, Hospital Sírio-Libanês, São Paulo, BR.
¹⁵ Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA.
¹⁶ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
¹⁷ Katz Department of Oral and Maxillofacial Surgery, UTHealth Houston School of Dentistry, Houston, USA.
¹⁸ Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
¹⁹ Department of General Practice and Dental Public Health, UTHealth Houston School of Dentistry, Houston, USA.
²⁰ Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
²¹ Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, NL.
²² Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DK.
²³ Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, FI.
²⁴ Faculty of Dentistry, Oral Pathology and Oral Medicine, faculty of Dentistry, University of Toronto, Toronto, CA.
²⁵ Department of Radiation Oncology, UPMC Hillman Cancer Center/University of Pittsburgh, Pittsburgh, USA.
²⁶ Medical Physics and Radiation Protection, Catalan Institute of Oncology-Girona, Girona, ES.
²⁷ Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia/Clinical Department, National Center for Oncological Hadrontherapy (Fondazione CNAO), Pavia, IT.
²⁸ Department of Restorative Dentistry, Leeds Teaching Hospitals Trust, Leeds, UK.
²⁹ Department Dental Oncology, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, CA.
³⁰ Department of Radiation Oncology, Dana Farber-Cancer Institute and Brigham and Women's Hospital, Boston, USA.
³¹ Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, TR.
³² Department of Oral And Maxillofacial Surgery, Baskent University, Ankara, TR.
³³ Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, USA.
³⁴ Department of Radiation Oncology, Comprehensive Cancer Centre François Baclesse, Caen, FR.
³⁵ Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, NL.
³⁶ Oral Medicine, Oral Oncology, Miami Cancer Institute, Baptist Heath South Florida, Miami, USA.
³⁷ Northern Centre for Cancer Care, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals Trust, Newcastle, UK.
³⁸ Oral & Maxillofacial Surgery, University Medical Center Groningen, Groningen, NL.
³⁹ Department of Otolaryngology Head and Neck Surgery, University Health Network, Princess Margaret Cancer Center/University Health Network, Toronto, CA.
⁴⁰ Oral Medicine, Oral Pathology, and Oral Radiology, University of California, San Francisco, San Francisco, USA.
⁴¹ Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Centre, Maastricht, NL.
⁴² Department of Oral and Maxillofacial Surgery and Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, NL.
⁴³ Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, DK.
⁴⁴ Orofacial Sciences, University of California, San Francisco, San Francisco, USA.
⁴⁵ Department of Oncology, Odense University Hospital, Odense, DK.
⁴⁶ Oral and Maxillofacial Diagnostics Sciences, University of Connecticut, Farmington, USA.
⁴⁷ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
⁴⁸ Oral Surgery, Guy's and St Thomas NHS Trust, London, UK.
⁴⁹ Head & Neck Surgery, Molecular & Clinical Cancer Medicine, The University of Liverpool Cancer Research Centre/Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
⁵⁰ Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
⁵¹ Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, USA.
⁵² Department of Oral Medicine, Sheba Medical Center, Tel-Hashomer; School of Dental Medicine, Tel-Aviv University, Tel-Aviv, IL.
⁵³ Department of Radiation Oncology, Baylor College of Medicine , Houston, USA.
⁵⁴ Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

PMID: 38645105
PMCID: PMC11030490
DOI: 10.1101/2024.04.07.24305400

International Expert-Based Consensus Definition, Staging Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study

International ORAL Consortium. medRxiv. 2024.

[Preprint]. 2024 Apr 9:2024.04.07.24305400.

doi: 10.1101/2024.04.07.24305400.

Author

International ORAL Consortium

Collaborators

International ORAL Consortium:
Amy C Moreno¹, Erin E Watson², Laia Humbert-Vidan¹, Douglas E Peterson³, Lisanne V van Dijk⁴, Teresa Guerrero Urbano⁵, Lisa Van den Bosch⁴, Andrew J Hope⁶, Matthew S Katz⁷, Frank Jp Hoebers⁸, Ruth A Aponte Wesson⁹, James E Bates¹⁰, Paolo Bossi¹¹, Adeyinka F Dayo¹², Mélanie Doré¹³, Eduardo Rodrigues Fregnani¹⁴, Thomas J Galloway¹⁵, Daphna Y Gelblum¹⁶, Issa A Hanna¹⁷, Christina E Henson¹⁸, Sudarat Kiat-Amnuay^{19

20}, Anke Korfage²¹, Nancy Y Lee¹⁶, Carol M Lewis⁹, Charlotte Duch Lynggaard²², Antti A Mäkitie²³, Marco Magalhaes²⁴, Yvonne M Mowery²⁵, Carles Muñoz-Montplet²⁶, Jeffrey N Myers²⁰, Ester Orlandi²⁷, Jaymit Patel²⁸, Jillian M Rigert¹, Deborah Saunders²⁹, Jonathan D Schoenfeld³⁰, Ugur Selek³¹, Efsun Somay³², Vinita Takiar³³, Juliette Thariat³⁴, Gerda M Verduijn³⁵, Alessandro Villa³⁶, Nick West³⁷, Max Jh Witjes³⁸, Alex Won²⁰, Mark E Wong¹⁷, Christopher Mkl Yao³⁹, Simon W Young¹⁷, Kamal Al-Eryani⁴⁰, Carly Ea Barbon²⁰, Doke Jm Buurman^{8

41}, François J Dieleman⁴², Theresa M Hofstede²⁰, Abdul Ahad Khan⁴³, Adegbenga O Otun²⁰, John C Robinson⁴⁴, Lauren Hum¹⁷, Jorgen Johansen⁴⁵, Rajesh Lalla⁴⁶, Alexander Lin⁴⁷, Vinod Patel⁴⁸, Richard J Shaw⁴⁹, Mark S Chambers²⁰, Daniel Ma⁵⁰, Mabi Singh⁵¹, Noam Yarom⁵², Abdallah Sherif Radwan Mohamed^{1

53}, Katherine A Hutcheson^{1

20}, Stephen Y Lai^{1

20

54}, Clifton David Fuller¹

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
² Department of Dental Oncology/Faculty of Dentistry, Princess Margaret Cancer Centre; University Health Network; University of Toronto, Toronto, CA.
³ Oral Health and Diagnostic Sciences, University of Connecticut, Farmington, USA.
⁴ Department of Radiation Oncology, University Medical Center Groningen, Groningen, NL.
⁵ Oncology Department, Guy's and St Thomas NHS Trust/King's College London, London, UK.
⁶ Department of Radiation Oncology, Princess Margaret Cancer Centre; University Health Network; University of Toronto, Toronto, CA.
⁷ Radiation Oncology, Lowell General Hospital, Lowell, USA.
⁸ Department of Radiation Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, NL.
⁹ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
¹⁰ Department of Radiation Oncology, Winship Cancer Institute/Emory University, Atlanta, USA.
¹¹ Medical Oncology, Department of Medical and Surgical Specialties, Humanitas University; IRCCS Humanitas Research Hospital, Milan, IT.
¹² Oral Medicine Department, University of Pennsylvania School of Dental Medicine, Philadelphia, USA.
¹³ Radiotherapy Department, Institut de Cancérologie de l'Ouest, Saint Herblain, FR.
¹⁴ Centro de Oncologia Molecular, Hospital Sírio-Libanês, São Paulo, BR.
¹⁵ Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA.
¹⁶ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
¹⁷ Katz Department of Oral and Maxillofacial Surgery, UTHealth Houston School of Dentistry, Houston, USA.
¹⁸ Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
¹⁹ Department of General Practice and Dental Public Health, UTHealth Houston School of Dentistry, Houston, USA.
²⁰ Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
²¹ Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, NL.
²² Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DK.
²³ Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, FI.
²⁴ Faculty of Dentistry, Oral Pathology and Oral Medicine, faculty of Dentistry, University of Toronto, Toronto, CA.
²⁵ Department of Radiation Oncology, UPMC Hillman Cancer Center/University of Pittsburgh, Pittsburgh, USA.
²⁶ Medical Physics and Radiation Protection, Catalan Institute of Oncology-Girona, Girona, ES.
²⁷ Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia/Clinical Department, National Center for Oncological Hadrontherapy (Fondazione CNAO), Pavia, IT.
²⁸ Department of Restorative Dentistry, Leeds Teaching Hospitals Trust, Leeds, UK.
²⁹ Department Dental Oncology, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, CA.
³⁰ Department of Radiation Oncology, Dana Farber-Cancer Institute and Brigham and Women's Hospital, Boston, USA.
³¹ Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, TR.
³² Department of Oral And Maxillofacial Surgery, Baskent University, Ankara, TR.
³³ Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, USA.
³⁴ Department of Radiation Oncology, Comprehensive Cancer Centre François Baclesse, Caen, FR.
³⁵ Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, NL.
³⁶ Oral Medicine, Oral Oncology, Miami Cancer Institute, Baptist Heath South Florida, Miami, USA.
³⁷ Northern Centre for Cancer Care, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals Trust, Newcastle, UK.
³⁸ Oral & Maxillofacial Surgery, University Medical Center Groningen, Groningen, NL.
³⁹ Department of Otolaryngology Head and Neck Surgery, University Health Network, Princess Margaret Cancer Center/University Health Network, Toronto, CA.
⁴⁰ Oral Medicine, Oral Pathology, and Oral Radiology, University of California, San Francisco, San Francisco, USA.
⁴¹ Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Centre, Maastricht, NL.
⁴² Department of Oral and Maxillofacial Surgery and Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, NL.
⁴³ Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, DK.
⁴⁴ Orofacial Sciences, University of California, San Francisco, San Francisco, USA.
⁴⁵ Department of Oncology, Odense University Hospital, Odense, DK.
⁴⁶ Oral and Maxillofacial Diagnostics Sciences, University of Connecticut, Farmington, USA.
⁴⁷ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
⁴⁸ Oral Surgery, Guy's and St Thomas NHS Trust, London, UK.
⁴⁹ Head & Neck Surgery, Molecular & Clinical Cancer Medicine, The University of Liverpool Cancer Research Centre/Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
⁵⁰ Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
⁵¹ Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, USA.
⁵² Department of Oral Medicine, Sheba Medical Center, Tel-Hashomer; School of Dental Medicine, Tel-Aviv University, Tel-Aviv, IL.
⁵³ Department of Radiation Oncology, Baylor College of Medicine , Houston, USA.
⁵⁴ Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

PMID: 38645105
PMCID: PMC11030490
DOI: 10.1101/2024.04.07.24305400

Update in

International Expert-Based Consensus Definition, Classification Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Interdisciplinary Modified Delphi Study.
Moreno AC, Watson EE, Humbert-Vidan L, Peterson DE, van Dijk LV, Urbano TG, Bosch LVD, Hope AJ, Katz MS, Hoebers FJP, Wesson RAA, Bates JE, Bossi P, Dayo AF, Doré M, Fregnani ER, Galloway TJ, Gelblum DY, Hanna IA, Henson CE, Kiat-Amnuay S, Korfage A, Lee NY, Lewis CM, Lynggaard CD, Mäkitie AA, Magalhaes M, Mowery YM, Muñoz-Montplet C, Myers JN, Orlandi E, Patel J, Rigert JM, Saunders D, Schoenfeld JD, Selek U, Somay E, Takiar V, Thariat J, Verduijn GM, Villa A, West NS, Witjes MJH, Won AM, Wong ME, Yao CMKL, Young SW, Al-Eryani K, Barbon CEA, Buurman DJM, Dieleman FJ, Hofstede TM, Khan AA, Otun AO, Robinson JC, Hum L, Johansen J, Lalla R, Lin A, Patel V, Shaw RJ, Chambers MS, Ma D, Singh M, Yarom N, Mohamed ASR, Hutcheson KA, Lai SY, Fuller CD. Moreno AC, et al. Int J Radiat Oncol Biol Phys. 2025 Jun 1;122(2):341-354. doi: 10.1016/j.ijrobp.2024.12.017. Epub 2025 Jan 16. Int J Radiat Oncol Biol Phys. 2025. PMID: 39826846 Free PMC article.

Abstract

Purpose: Osteoradionecrosis of the jaw (ORNJ) is a severe iatrogenic disease characterized by bone death after radiation therapy (RT) to the head and neck. With over 9 published definitions and at least 16 diagnostic/staging systems, the true incidence and severity of ORNJ are obscured by lack of a standard for disease definition and severity assessment, leading to inaccurate estimation of incidence, reporting ambiguity, and likely under-diagnosis worldwide. This study aimed to achieve consensus on an explicit definition and phenotype of ORNJ and related precursor states through data standardization to facilitate effective diagnosis, monitoring, and multidisciplinary management of ORNJ.

Methods: The ORAL Consortium comprised 69 international experts, including representatives from medical, surgical, radiation oncology, and oral/dental disciplines. Using a web-based modified Delphi technique, panelists classified descriptive cases using existing staging systems, reviewed systems for feature extraction and specification, and iteratively classified cases based on clinical/imaging feature combinations.

Results: The Consortium ORNJ definition was developed in alignment with SNOMED-CT terminology and recent ISOO-MASCC-ASCO guideline recommendations. Case review using existing ORNJ staging systems showed high rates of inability to classify (up to 76%). Ten consensus statements and nine minimum data elements (MDEs) were outlined for prospective collection and classification of precursor/ORNJ stages.

Conclusion: This study provides an international, consensus-based definition and MDE foundation for standardized ORNJ reporting in cancer survivors treated with RT. Head and neck surgeons, radiation, surgical, medical oncologists, and dental specialists should adopt MDEs to enable scalable health information exchange and analytics. Work is underway to develop both a human- and machine-readable knowledge representation for ORNJ (i.e., ontology) and multidisciplinary resources for dissemination to improve ORNJ reporting in academic and community practice settings.

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Conflict of interest statement

The individual contributors/collaborators declare the following competing interests: National Institutes of Health (grants, travel, honoraria); Padagis (honoraria); NPi (honoraria); Castle Biosciences (consulting); Galera Therapeutics (consulting, grants); EMD Serono (advisory board, in-kind support, consulting, grants); UpToDate Inc (royalties); Cardinal Health (grants, consulting); Guy’s and St Thomas’ NHS Foundation Trust (grants); King’s College London (grants); Canadian Institutes of Health Research (grants); Canadian Foundation for Innovation (grants);Cancer Research Society (grants); Merck (advisory service, consulting, honoraria, travel, grants); Pfizer (stock, consulting, honoraria). Moderna (stock); Healthcare Services Group (stock); Dr. Reddy’s Laboratories (stock); CVS Health (stock). Organon (stock); Myomo (stock); Rewalk Robotics (stock); Elekta AB (grants, in-kind support, honoraria, travel); Philips Medical System (honoraria, travel); Varian/Siemens Healthineers (honoraria, travel). Kallsio, Inc. (royalties, licenses);Nanobiotix (consulting); LEO SAB (consulting, stock options);Shanghai JoAnn Medical Company(consulting); Yingming (consulting); Sanofi-Regeneron (honoraria); Merck Sharp & Dohme (honoraria); Glaxo Smith Kline (honoraria); Merus (honoraria); Sun Pharma (honoraria); Angelini (honoraria, consulting); MeiraGtx (grants);PCCA (grants); Mureva (grants); K pharmaceuticals (honoraria, consulting); Lipella Pharmaceuticals (honoraria, consulting); Amgen (honoraria, consulting); Bristol Myers Squibb (grants); Debiopharm (grants);ACI Clinical (consulting);Genentech (consulting); Astellas (consulting); Immunitas (consulting, stock); SIRPant (consulting); LEK (consulting); Burns and White (expert testimony); Doximity (stock).

Figures

**Figure 1.**
Delphi Consensus Process Flow Chart. Abbreviations: ORN: Osteoradionecrosis

**Figure 2.**
Time Feature and ORNJ Diagnosis Scenario (A) and Expert Panel Consensus (B).

**Figure 3.**
Three Case Classification Using Existing Staging Systems. Magenta bars represent ‘unable to classify’ across all staging systems.

**Figure 4.**
Stage and Bone Extent Classifications and Specialty-Based Levels of Confidence During Round 3.

See this image and copyright information in PMC

References

1. Watson E. E. et al. Development and Standardization of a Classification System for Osteoradionecrosis: Implementation of a Risk-Based Model. medRxiv 2023.09.12.23295454 (2023) doi: 10.1101/2023.09.12.23295454. - DOI
1. Wilde D. C. et al. Early detection of mandible osteoradionecrosis risk in a high comorbidity veteran population. Am J Otolaryngol 44, (2023). - PMC - PubMed
1. Treister N. S. et al. Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad). Cancer 128, 487–496 (2022). - PMC - PubMed
1. Mohamed A. S. R. et al. Dose-volume correlates of mandibular osteoradionecrosis in oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison. Radiother Oncol 124, 232 (2017). - PMC - PubMed
1. Dijk L. V. van et al. Normal Tissue Complication Probability (NTCP) prediction model for osteoradionecrosis of the mandible in head and neck cancer patients following radiotherapy: Large-scale observational cohort. medRxiv 2021.03.04.21252505 (2021) doi: 10.1101/2021.03.04.21252505. - DOI - PMC - PubMed

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This is a preprint.

International Expert-Based Consensus Definition, Staging Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study

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Affiliations

International Expert-Based Consensus Definition, Staging Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study

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