Risk of Osteoradionecrosis of the Jaws according to Type of Radiotherapy
Keywords:
osteoradionecrosis, head and neck neoplasms radiotherapy, intensity-modulated radiotherapy, proton therapy.Abstract
Introduction: Head and neck cancer is the seventh most common cancer worldwide. Therapeutic options for its management include radiotherapy, which should seek a balance between tumor elimination and preservation of healthy tissue because its application implies the risk of developing osteoradionecrosis of the jaws.
Objective: To assess whether the risk of developing osteoradionecrosis of the jaws varies according to the type of radiotherapy.
Methods: Documentary, retrospective design based on the principles of exploratory systematic reviews as established by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed, LILACS, ScienceDirect, Tripdatabase and Epistemonikos were searched in English and Spanish.
Results: In total, 12 studies published between 2016 and 2022 with various research designs were included; the retrospective cohort study had the highest representation. Different radiotherapy options and their protocols were analyzed, including intensity-modulated radiotherapy, intensity-modulated proton therapy, stereotactic body radiotherapy, and three-dimensional radiotherapy. The literature refers that protocols involving lower total doses represent a lower risk of osteoradionecrosis.
Conclusions: The risk of osteoradionecrosis of the jaws should be attributed, to a greater extent, to the total radiation dose received by the patient and the dose per fraction than to the type of radiotherapy.
Downloads
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. DOI: https://doi.org/10.3322/caac.21492
Alfouzan AF. Radiation therapy in head and neck cancer. Saudi Med J. 2021;42(3):247-54. DOI: https://doi.org/10.15537/smj.2021.42.3.20210660
Chow LQM. Head and neck cancer. Longo DL, editor. N Engl J Med. 2020;382(1):60-72. DOI: https://www.nejm.org/doi/10.1056/NEJMra1715715
Saloura V, Langerman A, Rudra S, Chin R, Cohen EEW. Multidisciplinary care of the patient with head and neck cancer. Surg Oncol Clin N Am. 2013;22(2):179-215. DOI: https://doi.org/10.1016/j.soc.2012.12.001
Rivero JA, Shamji O, Kolokythas A. Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, α-tocopherol, and clodronate. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;124(5):464-71. DOI: https://doi.org/10.1016/j.oooo.2017.08.004
Kubota H, Miyawaki D, Mukumoto N, Ishihara T, Matsumura M, Hasegawa T, et al. Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma. Radiat Oncol. 2021;16(1):1. DOI: https://doi.org/10.1186/s13014-020-01701-5
Ribeiro GH, Chrun ES, Dutra KL, Daniel FI, Grando LJ. Osteonecrosis of the jaws: a review and update in etiology and treatment. Braz J Otorhinolaryngol. 2018 [acceso 18/05/22];84(1):102-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S1808869417300976
De Felice F, Tombolini V, Musio D, Polimeni A. Radiation therapy and mandibular osteoradionecrosis: state of the art. Curr Oncol Rep. 2020;22(89):1-8. DOI: https://doi.org/10.1007/s11912-020-00954-3
Renda L, Tsai TY, Huang JJ, Ito R, Hsieh WC, Kao HK, et al. A nomogram to predict osteoradionecrosis in oral cancer after marginal mandibulectomy and radiotherapy. Laryngoscope. 2020;130(1):101-7. DOI: https://doi.org/10.1002/lary.27870
Kün-Darbois JD, Fauvel F. Medication-related osteonecrosis and osteoradionecrosis of the jaws: update and current management. Morphologie. 2021;105(349):170-87. DOI: https://doi.org/10.1016/j.morpho.2020.11.008
Chronopoulos A, Zarra T, Ehrenfeld M, Otto S. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. Int Dent J. 2018 [acceso 18/05/22];68(1):22-30. Disponible en: https://www.sciencedirect.com/science/article/pii/S0020653920318815
Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws—a current overview—part 1. Oral Maxillofac Surg. 2010 [acceso 18/05/22];14(1):3-16. Disponible en: http://link.springer.com/10.1007/s10006-009-0198-9
Habib S, Sassoon I, Thompson I, Patel V. Risk factors associated with osteoradionecrosis. Oral Surg. 2021;14(3):227-35. DOI: https://doi.org/10.1111/ors.12597
Ratko T, Douglas GW, Souza J De, Belinson SE, Aronson N. Radiotherapy treatments for head and neck cancer update. Eff Heal Care Progr Comp Eff Rev. 2014 [acceso 18/05/22];144:1-163. Disponible en: http://www.ncbi.nlm.nih.gov/books/nbk269018/
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-73. DOI: https://doi.org/10.7326/m18-0850
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. 2nd ed. Chichester: John Wiley & Sons; 2019;694 p. DOI: https://onlinelibrary.wiley.com/doi/book/10.1002/9781119536604
Balermpas P, van Timmeren JE, Knierim DJ, Guckenberger M, Ciernik IF. Dental extraction, intensity-modulated radiotherapy of head and neck cancer, and osteoradionecrosis: A systematic review and meta-analysis. Strahlentherapie und Onkol. 2022;198(3):219-28. DOI: https://doi.org/10.1007/s00066-02101896-w
Nguyen ML, Cantrell JN, Ahmad S, Henson C. Intensity-modulated proton therapy (IMPT) versus intensity-modulated radiation therapy (IMRT) for the treatment of head and neck cancer: a dosimetric comparison. Med Dosim. 2021;46(3):259-63. DOI: https://doi.org/10.1016/j.meddos.2021.02.001
Rosenfeld E, Eid B, Masri D, Popovtzer A, Mizrachi A, Chaushu G. Is the risk to develop osteoradionecrosis of the jaws following IMRT for head and neck cancer related to co-factors? Med. 2021;57(468):1-11. DOI: https://doi.org/10.3390/medicina57050468
Swain M, Ghosh-Laskar S. Stereotactic body radiotherapy (SBRT) for primary non-metastatic head and neck cancer: when less is enough. Oral Oncol. 2021;116(3):105265. DOI: https://doi.org/10.1016/j.oraloncology.2021.105265
Moreno AC, Frank SJ, Garden AS, Rosenthal DI, Fuller CD, Gunn GB, et al. Intensity modulated proton therapy (IMPT)–The future of IMRT for head and neck cancer. Oral Oncol. 2019;88:66-74. DOI: https://doi.org/10.1016/j.oraloncology.2018.11.015
Aarup-Kristensen S, Hansen CR, Forner L, Brink C, Eriksen JG, Johansen J. Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations. Acta Oncol (Madr). 2019;58(10):1373-7. DOI: https://doi.org/10.1080/0284186X.2019.1643037
Willaert R, Nevens D, Laenen A, Batstone M, Politis C, Nuyts S. Does intensity-modulated radiation therapy lower the risk of osteoradionecrosis of the jaw? A long-term comparative analysis. Int J Oral Maxillofac Surg. 2019;48(11):1387-93. DOI: https://doi.org/10.1016/j.ijom.2019.04.018
Caparrotti F, Huang SH, Lu L, Bratman S V, Ringash J, Bayley A, et al. Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy. Cancer. 2017;123(19):3691-700. DOI: https://doi.org/10.1002/cncr.30803
Zhang W, Zhang X, Yang P, Blanchard P, Garden AS, Gunn B, et al. Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer. Radiother Oncol. 2017;123(3):401-5. DOI: http://dx.doi.org/10.1016/j.radonc.2017.05.006
Maesschalck T de, Dulguerov N, Caparrotti F, Scolozzi P, Picardi C, Mach N, et al. Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity-modulated radiotherapy. Head Neck. 2016;38(11):1695-702. DOI: https://doi.org/10.1002/hed.24505
Studer G, Bredell M, Studer S, Huber G, Glanzmann C. Risk profile for osteoradionecrosis of the mandible in the IMRT era. Strahlentherapie und Onkol. 2016;192(1):32-9. DOI: https://doi.org/10.1007/s00066-015-0875-6
De Cicco D, Tartaro G, Ciardiello F, Fasano M, Rauso R, Fiore F, et al. Health-related quality of life in oral cancer patients: Scoping review and critical appraisal of investigated determinants. Cancers (Basel). 2021;13(17):1-32. DOI: https://doi.org/10.3390/cancers13174398
Alterio D, Marvaso G, Ferrari A, Volpe S, Orecchia R, Jereczek-Fossa BA. Modern radiotherapy for head and neck cancer. Semin Oncol. 2019;46(3):233-45. DOI: https://doi.org/10.1053/j.seminoncol.2019.07.002
Alterio D, Gugliandolo SG, Augugliaro M, Marvaso G, Gandini S, Bellerba F, et al. IMRT versus 2D/3D conformal RT in oropharyngeal cancer: A review of the literature and meta-analysis. Oral Dis. 2021;27(7):1644–53. DOI: https://doi.org/10.1111/odi.13599
Beaumont S, Bhatia N, McDowell L, Fua T, McCullough M, Celentano A, et al. Timing of dental extractions in patients undergoing radiotherapy and the incidence of osteoradionecrosis: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2021;59(5):511-23. DOI: https://doi.org/10.1016/j.bjoms.2020.10.006
Khoo SC, Nabil S, Fauzi AA, Yunus SSM, Ngeow WC, Ramli R. Predictors of osteoradionecrosis following irradiated tooth extraction. Radiat Oncol. 2021 [acceso 18/05/22];16(1):130. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34261515
Lajolo C, Rupe C, Gioco G, Troiano G, Patini R, Petruzzi M, et al. Osteoradionecrosis of the jaws due to teeth extractions during and after radiotherapy: A systematic review. Cancers (Basel). 2021;13(22):1-12. DOI: https://doi.org/10.3390/cancers13225798
Sathasivam HP, Davies GR, Boyd NM. Predictive factors for osteoradionecrosis of the jaws: A retrospective study. Head Neck. 2018;40(1):46-54. DOI: https://doi.org/10.1002/hed.24907
Published
How to Cite
Issue
Section
License
Authors retain all rights to their works, which they can reproduce and distribute as long as they cite the primary source of publication.
The Rev Cubana Estomatol is subject to the Creative Commons Attribution-Non-Commercial 4.0 International License (CC BY-NC 4.0) and follows the publication model of SciELO Publishing Schema (SciELO PS) for publication in XML format.
You are free to:
- Share — copy and redistribute the material in any medium or format.
- Adapt — remix, transform, and build upon the material.
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
- You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
- No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
Download PDF
