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We are grateful to the authors of the study by Castagnola et al., which sought to ascertain the prevalence of tooth necrosis in patients undergoing mandibulotomy or mandibulectomy for head and neck cancer. In order to prevent surgical problems, the researchers suggested doing root canal therapy on the teeth next to the surgical site prior to surgery. Although the results offer insightful information about tooth necrosis in patients with head and neck cancer who have had mandibulotomies or mandibulectomy, we would like to voice our concerns about the reported data in order to give a stronger basis for future studies in this field. [ABSTRACT FROM AUTHOR]

Background: This retrospective study aimed to investigate whether the pretreatment hemoglobin-to-platelet ratio (HPR) could predict the risk of osteoradionecrosis (ORN) in patients receiving concurrent chemoradiotherapy (C-CRT) for locally advanced nasopharyngeal carcinoma (LA-NPC). Methods: ORN cases were reported from the records of LA-NPC patients who had oral examinations before and after C-CRT. The pretreatment HPR values were calculated on the first day of C-CRT. The connection between HPR values and ORN occurrences was determined using receiver operating characteristic curve analysis. The primary endpoint was the relationship between the pretreatment HPR values and post-C-CRT ORN incidence rates, while secondary endpoints included the identification of other putative ORN risk factors. Results: We distinguished 10.9% incidences of ORN during the post-C-CRT follow-up period among 193 LA-NPC patients. The optimal cutoff for pre-C-CRT HPR was 0.48 that grouped the patients into two HPR groups with fundamentally different post-C-CRT ORN incidence rates: Group 1: HPR ≤ 0.48 (N = 60), and Group 2: HPR > 0.48 (N = 133). The comparative analysis indicated a significantly higher ORN incidence in HPR ≤ 0.48 group (30%; P < 0.001). The other factors associated with meaningfully increased ORN rates included the presence of pre-C-CRT ≥ 5 teeth extractions, mandibular volume receiving ≥ 64 Gy, post-C-CRT tooth extractions, mean mandibular dose ≥ 50.6 Gy, and C-CRT to tooth extraction interval > 5.5 months. Conclusion: Low pretreatment HPR levels were independently and unequivocally linked to significantly increased incidence of ORN post-C-CRT. Pre-C-CRT HPR levels may be used to estimate the incidence of ORN and be useful for taking preventive and therapeutic measures in these patients such as monitoring oral hygiene with strict follow-up, avoidance of unnecessary tooth extractions, particularly after C-CRT, and use of more rigorous mandibular RT dose limits. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5–6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the "organ at risk" safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted by Katz et al. on the prevalence of acute periapical abscesses (PA) in head and neck cancer patients who received radiation therapy (RT). The study found that patients with a history of oropharyngeal cancer (OPC) had a significantly higher likelihood of developing acute PA, and this risk was further increased if they had received RT. The article suggests that dosimetric data should be included to determine safer RT dosages and stratify patients into PA risk categories. It also highlights the potential development of osteoradionecrosis (ORN) in patients with PA and the need to consider pre-existing PA before RT. The article commends the study for contributing to our understanding of this treatment complication. [Extracted from the article]

This document is a letter to the editor of the Journal of Contemporary Brachytherapy regarding a study on adjuvant pulse-dose-rate brachytherapy for oral cavity and oropharynx carcinoma. The study found that 11% of patients had local recurrences and 20% had regional recurrences, with no identified factors for predicting these recurrences. Soft tissue necrosis was found in 7.6% of patients and osteoradionecrosis in 3.0% of patients. The authors concluded that brachytherapy is safe and effective for certain indications. However, the letter raises concerns about the dosage discrepancies between different treatment groups and the need for more specific information on the rates of complications in each group. [Extracted from the article]

This document is a letter to the editor commenting on a study that evaluated the use of accelerated hypofractionated chemoradiotherapy (AHCRT) for locally advanced head and neck squamous cell cancer (HNSCC) during the COVID-19 pandemic. The study found that AHCRT, which involved delivering 60 Gy in 2.4 Gy per fraction, was feasible and resulted in comparable local control and manageable toxicities. However, the letter raises concerns about potential late complications such as tooth loss, radiation-induced trismus, and osteoradionecrosis, which could significantly impact the quality of life and survival of HNSCC patients. The authors recommend delineating critical structures and using predetermined tolerance dose limits to minimize the incidence of these severe complications. [Extracted from the article]

The article addresses the impact of the timing between tooth extraction and head and neck radiotherapy on the risk of osteoradionecrosis (ORN), suggesting that a waiting period of 2-8 weeks may be more suitable than the commonly accepted 2-week gap. It discusses the division of patients into groups based on the waiting period and the importance of considering mandible-related dosimetric information to better understand ORN prevalence rates.

This article discusses a review on the effectiveness of dental implants in patients with head and neck cancer who have undergone radiotherapy. The study found that dental implants have a success rate of 86.2% in patients who received radiotherapy and 95.5% in those who did not. However, the review highlights two important factors that can impact the success of dental implants in these patients. First, the dosage of radiotherapy received by the implant bed is a significant factor in implant loss. Second, the timing of implant placement relative to radiotherapy is crucial, with a suggested window of 6 to 12 months post-radiotherapy. The article suggests further research to clarify the impact of the interval between radiotherapy and implant placement. [Extracted from the article]

This article discusses a study conducted on elderly patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) who underwent chemoradiotherapy (CRT). The study found that the 5-year progression-free survival (PFS), overall survival (OS), and local control (LC) rates were 57%, 52%, and 91%, respectively. The study also identified the Charlson Comorbidity Index (CCI) as a predictive factor for OS. However, the article points out that the study did not address certain late toxicities, such as radiation-induced trismus (RIT) and radiation-induced tooth loss (RITL), which can significantly impact patients' quality of life. Additionally, the article suggests that the small sample size and lack of data on salvage therapies may have influenced the study's results. Overall, the study provides valuable insights for clinicians and researchers working in head and neck oncology. [Extracted from the article]

Background: To evaluate the utility of pretreatment systemic immune-inflammation index (SII) in predicting the teeth caries and need for tooth extraction after concurrent chemoradiotherapy (C-CRT) for locally advanced squamous-cell head and neck cancer (LA-SCHNC) patients.Methods: The records of LA-SCHNC patients who underwent formal dental evaluations at pre- and post-C-CRT periods were retrospectively analyzed. The pretreatment SII values were calculated using the platelet, neutrophil, and lymphocyte measures acquired on the first day of C-CRT: SII=Platelets×neutrophils/lymphocytes. Receiver operating characteristic (ROC) curve analysis was employed to identify the ideal pre-C-CRT SII cutoff that may predict the teeth caries and the need for tooth extraction after the C-CRT. The primary endpoint was the link between the pre-C-CRT SII and the need for tooth extraction during the follow-up period.Results: A sum of 126 patients were included. Median follow-up was 4.9 years (range: 2.7-7.8). Nasopharyngeal and laryngeal cancers comprised the majority (75.4%) study cohort. Post-treatment teeth extractions were reported in 62.7% patients. The optimal cutoff was 558 [Area under the curve (AUC): %76.8 sensitivity: 72.3%; and specificity: 70.9%] that grouped the patients into two subgroups with significantly different post-C-CRT tooth extraction rates: Group 1: SII≤558 (n = 70) and SII>558 (n = 56), respectively. Correlation analysis revealed a significant relationship between the pretreatment SII and the tooth extraction rates after the C-CRT (rs:0.89: P = 0.001). The comparative analysis displayed that the teeth extractions rates were significantly higher in the SII>558 group (77.1% versus 51.4% for SII≤558; Hazard ratio: 1.68; P = 0.001). Further analyses showed that the pre-C-CRT SII>558 was the unique factor associated with meaningfully higher necessities for post-C-CRT teeth extractions.Conclusion: The present outcomes intimated that high pretreatment SII levels were linked to significantly increased post-treatment teeth extractions in LA-SCHNC patients undergoing definitive C-CRT. [ABSTRACT FROM AUTHOR]

This letter is a comment on a research article that explores the predictive value of health-related quality of life (HRQOL) scores on radiotherapy-related toxicities in patients with head and neck cancer (HNC). The authors of the comment commend the researchers for their study and findings, but also identify two issues that need to be addressed. Firstly, the authors suggest the need for assessment instruments that specifically evaluate the impact of radiation-induced toxicities on HRQOL, such as osteoradionecrosis of the jaw (ORNJ) and trismus. Secondly, they highlight the heterogeneity of the study cohort in terms of cancer types and treatment-related factors, which may have influenced the observed HRQOL outcomes. The authors suggest that future research should focus on developing tailored quality-of-life surveys for homogeneous patient populations to provide a more accurate representation of the impact of HNC and its treatments on quality of life. [Extracted from the article]

Keywords: Dental care; Osteoradionecrosis; Head and neck cancer; Radiotherapy EN Dental care Osteoradionecrosis Head and neck cancer Radiotherapy 2735 2736 2 08/25/23 20230901 NES 230901 Dear Editor, The article by Nath et al. (1) on the topic of dental care and treatment for patients with head and neck cancer (HNC) before, during, and after radiotherapy (RT) caught our attention and earned our respect (RT). Second, Nath et al. [[1]] identified pre-RT tooth extraction as a significant risk factor for ORN development; however, the increasing significance of the pre-RT traumatic load, measured by the number of extracted teeth, was not addressed. Patients with >= 4 extractions had a significantly higher risk of ORN than those with < 4 extractions (15.0-2.3%; P = 0.005), emphasizing the essence of preserving repairable teeth as far as is attainable. [Extracted from the article]

To illustrate, in a patient with an initial maximum mouth opening (MMO) of 46 mm and potential post-RT MMOs of 32 and 17 mm, the QoL measures would certainly be impacted very differently by these two post-treatment MMOs, with the latter MMO measure reflecting a significantly worse condition and QoL metric.[5] As a result of these concerns, we argue that, besides being simple and easily applicable, QoL questionnaires should be specifically designed to address cancer, treatment, and complication types in an individualised manner to accurately reveal the exact impact of the condition on QoL measures. Patient preference for commonly-used, head and neck cancer-specific quality of life questionnaires in the follow-up setting (Determin): A multi-centre randomised controlled trial and mixed methods study. Although the study's findings provide valuable information in this field by focusing on the QoL of HNC patients, we have two contributions to make to the study's findings. [Extracted from the article]

Keywords: Head and neck cancer; Overall survival; Antibiotic treatment; Radiotherapy; Microbiome EN Head and neck cancer Overall survival Antibiotic treatment Radiotherapy Microbiome 3041 3042 2 05/17/23 20230601 NES 230601 This comment refers to the article available online at https://doi.org/10.1007/s00405-023-07868-3. B Dear Editor, b We commend Rühle et al. for examining a neglected but critically important topic: the impact of antibiotic treatment on the outcomes of head and neck squamous cell carcinoma (HNSCC) patients undergoing definitive chemoradiotherapy (CRT) [[1]]. [Extracted from the article]

Based on these findings, the authors concluded that their review confirms that patients undergoing PT for oral and/or oropharyngeal cancer had sustained treatment outcomes with a vastly better acute toxicity profile. Second, although the ORNJ has been presented as one of the acute PT toxicities by Sethi et al.,[1] it is typically a late-onset complication of RT since it usually manifests after 6-months of RT in the absence of predisposing risk factors like previous mandibular surgery. First, RT-associated toxicity is classified according to time following treatment: acute toxicity occurs during or within 6 weeks to 3 months of therapy completion; early-delayed (subacute) toxicity appears up to 6 months after treatment completion; and late effects are present at least 6 months after therapy completion. [Extracted from the article]

A letter to the editor discusses a study on the incidence of osteoradionecrosis (ORN) in patients with head and neck cancers who underwent tooth extractions before radiotherapy. The study found that osteotomy and high radiation dose at the extraction site were significantly associated with an increased risk of developing ORN. However, the letter raises concerns about the study's findings, suggesting that the unexpected results may be due to random chance or the convergence of unfavorable factors in individual patients. The letter also questions the relationship between smoking status and ORN, as well as the paradoxical findings regarding diabetes status. The authors recommend providing more detailed patient characteristics to better interpret the study outcomes and prevent ORN. [Extracted from the article]