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Correlation of Osteoradionecrosis and Dental Events With Dosimetric Parameters in Intensity-Modulated Radiation Therapy for Head-and-Neck Cancer
- Source :
- International Journal of Radiation Oncology*Biology*Physics. 81:e207-e213
- Publication Year :
- 2011
- Publisher :
- Elsevier BV, 2011.
-
Abstract
- Purpose Osteoradionecrosis (ORN) is a known complication of radiation therapy to the head and neck. However, the incidence of this complication with intensity-modulated radiation therapy (IMRT) and dental sequelae with this technique have not been fully elucidated. Methods and Materials From December 2000 to July 2007, 168 patients from our institution have been previously reported for IMRT of the oral cavity, nasopharynx, larynx/hypopharynx, sinus, and oropharynx. All patients underwent pretreatment dental evaluation, including panoramic radiographs, an aggressive fluoride regimen, and a mouthguard when indicated. The median maximum mandibular dose was 6,798 cGy, and the median mean mandibular dose was 3,845 cGy. Patient visits were retrospectively reviewed for the incidence of ORN, and dental records were reviewed for the development of dental events. Univariate analysis was then used to assess the effect of mandibular and parotid gland dosimetric parameters on dental endpoints. Results With a median clinic follow-up of 37.4 months (range, 0.8–89.6 months), 2 patients, both with oral cavity primaries, experienced ORN. Neither patient had preradiation dental extractions. The maximum mandibular dose and mean mandibular dose of the 2 patients were 7,183 and 6,828 cGy and 5812 and 5335 cGy, respectively. In all, 17% of the patients (n = 29) experienced a dental event. A mean parotid dose of >26 Gy was predictive of a subsequent dental caries, whereas a maximum mandibular dose >70 Gy and a mean mandibular dose >40 Gy were correlated with dental extractions after IMRT. Conclusions ORN is rare after head-and-neck IMRT, but is more common with oral cavity primaries. Our results suggest different mechanisms for radiation-induced caries versus extractions.
- Subjects :
- Larynx
Cancer Research
medicine.medical_specialty
business.product_category
Osteoradionecrosis
Radiography
medicine.medical_treatment
Dentistry
Dental Caries
stomatognathic system
medicine
Humans
Parotid Gland
Mandibular Diseases
Radiology, Nuclear Medicine and imaging
Mouthguard
Retrospective Studies
Analysis of Variance
Univariate analysis
Radiation
business.industry
Head and neck cancer
Radiotherapy Dosage
medicine.disease
Parotid gland
Radiation therapy
stomatognathic diseases
medicine.anatomical_structure
Oncology
Head and Neck Neoplasms
Tooth Extraction
Radiotherapy, Intensity-Modulated
Radiology
business
Subjects
Details
- ISSN :
- 03603016
- Volume :
- 81
- Database :
- OpenAIRE
- Journal :
- International Journal of Radiation Oncology*Biology*Physics
- Accession number :
- edsair.doi.dedup.....662d3eb18fc9de57cd58359387608449