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Title: A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients

Abstract

Purpose: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. Methods and Materials: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. Results: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. Conclusions: More serious maxillary ORN tended to occur inmore » cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes.« less

Authors:
 [1];  [2];  [1];  [2];  [3];  [4];  [1];  [2];  [1];  [2];  [1];  [2];  [1];  [2];  [5]
  1. Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China)
  2. (China)
  3. Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China)
  4. Department of Dentistry, Cathay General Hospital, Taipei, Taiwan (China)
  5. Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China) and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China). E-mail: kok@ha.mc.ntu.edu.tw
Publication Date:
OSTI Identifier:
20788271
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2005.06.021; PII: S0360-3016(05)01151-X; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; FAILURES; IRRADIATION; OSTEORADIONECROSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SKELETON; SURGERY; TEETH

Citation Formats

Cheng, S.-J., Department of Dentistry, Sun-Yat-San Cancer Center, Taipei, Taiwan, Lee, J.-J., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Ting, L.-L., Tseng, I.-Y., Chang, H.-H., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Chen, H.-M., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Kuo, Y.-S., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Hahn, L.-J., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, and Kok, S.-H.. A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Cheng, S.-J., Department of Dentistry, Sun-Yat-San Cancer Center, Taipei, Taiwan, Lee, J.-J., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Ting, L.-L., Tseng, I.-Y., Chang, H.-H., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Chen, H.-M., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Kuo, Y.-S., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Hahn, L.-J., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, & Kok, S.-H.. A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients. United States. doi:10.1016/J.IJROBP.2005.0.
Cheng, S.-J., Department of Dentistry, Sun-Yat-San Cancer Center, Taipei, Taiwan, Lee, J.-J., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Ting, L.-L., Tseng, I.-Y., Chang, H.-H., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Chen, H.-M., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Kuo, Y.-S., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, Hahn, L.-J., School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan, and Kok, S.-H.. Sun . "A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20788271,
title = {A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients},
author = {Cheng, S.-J. and Department of Dentistry, Sun-Yat-San Cancer Center, Taipei, Taiwan and Lee, J.-J. and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan and Ting, L.-L. and Tseng, I.-Y. and Chang, H.-H. and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan and Chen, H.-M. and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan and Kuo, Y.-S. and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan and Hahn, L.-J. and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan and Kok, S.-H.},
abstractNote = {Purpose: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. Methods and Materials: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. Results: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. Conclusions: More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 64,
place = {United States},
year = {Sun Jan 01 00:00:00 EST 2006},
month = {Sun Jan 01 00:00:00 EST 2006}
}