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Title: Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions

Abstract

Purpose: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. Results: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received {>=}65 Gy and {>=}70 Gy to {>=}1% of the mandibular volume, respectively. Falloff across the mandible characterized the dosemore » distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). Conclusion: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.« less

Authors:
 [1];  [2];  [1];  [1];  [1];  [2];  [2];  [3]
  1. Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI (United States)
  2. Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI (United States)
  3. Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI (United States). E-mail: eisbruch@med.umich.edu
Publication Date:
OSTI Identifier:
20951658
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2006.11.059; PII: S0360-3016(06)03646-7; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, 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; BIOLOGICAL RECOVERY; EVALUATION; GLANDS; HEAD; JAW; NECK; NEOPLASMS; OSTEORADIONECROSIS; PATIENTS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; TEETH

Citation Formats

Ben-David, Merav A., Diamante, Maximiliano, Radawski, Jeffrey D., Vineberg, Karen A., Stroup, Cynthia, Murdoch-Kinch, Carol-Anne, Zwetchkenbaum, Samuel R., and Eisbruch, Avraham. Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.11.059.
Ben-David, Merav A., Diamante, Maximiliano, Radawski, Jeffrey D., Vineberg, Karen A., Stroup, Cynthia, Murdoch-Kinch, Carol-Anne, Zwetchkenbaum, Samuel R., & Eisbruch, Avraham. Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions. United States. doi:10.1016/j.ijrobp.2006.11.059.
Ben-David, Merav A., Diamante, Maximiliano, Radawski, Jeffrey D., Vineberg, Karen A., Stroup, Cynthia, Murdoch-Kinch, Carol-Anne, Zwetchkenbaum, Samuel R., and Eisbruch, Avraham. Fri . "Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions". United States. doi:10.1016/j.ijrobp.2006.11.059.
@article{osti_20951658,
title = {Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions},
author = {Ben-David, Merav A. and Diamante, Maximiliano and Radawski, Jeffrey D. and Vineberg, Karen A. and Stroup, Cynthia and Murdoch-Kinch, Carol-Anne and Zwetchkenbaum, Samuel R. and Eisbruch, Avraham},
abstractNote = {Purpose: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. Results: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received {>=}65 Gy and {>=}70 Gy to {>=}1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). Conclusion: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.},
doi = {10.1016/j.ijrobp.2006.11.059},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 68,
place = {United States},
year = {Fri Jun 01 00:00:00 EDT 2007},
month = {Fri Jun 01 00:00:00 EDT 2007}
}