Extra-mandibular Osteoradionecrosis after the Treatment of Head and Neck Cancer |
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| Institution: | 1. Department of Oncology, University of Ostrava, Ostrava, Czech Republic;2. Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK;3. Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK;4. Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Olomouc, Czech Republic;5. Department of Oral and Maxillofacial Surgery, Royal Sunderland Hospital, Sunderland, UK;1. Department of Oncology, Molecular Oncology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China;2. Department of Oncology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China;3. Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China;1. Department of Clinical Oncology, Oxford University Hospitals NHS Trust, Oxford, UK;2. Department of Oncology, University of Oxford, Oxford, UK;3. Department of Medical Physics and Clinical Engineering, Oxford University Hospitals NHS Trust, Oxford, UK;4. Department of Medical Physics and Biomedical Engineering, University College London, London, UK;1. University Hospitals Sussex NHS Foundation Trust, West Sussex, United Kingdom;2. Cancer Centre, Addenbrooke''s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom;3. Department of Oncology, The Queen Elizabeth Hospital King''s Lynn, King''s Lynn, United Kingdom;1. Ribeirão Preto Medical School, Department of Medical Imaging, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil;2. Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil;3. Radiation Oncology Department - Americas Oncologia, Rio de Janeiro, Brazil;4. Faculdade de Filosofia, Letras e Ciências Naturais, Universidade de São Paulo, Ribeirão Preto, Brazil;5. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;7. Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen''s University, Kingston, Ontario, Canada;1. Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France;2. Department of Pulmonary Medicine and Oncology, Centre Hospitalier Universitaire de Nice, Nice, France;3. Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France;4. University of Côte D’Azur, Nice, France;5. Department of Radiation Oncology and Research Institute, Tampa, FL, USA;1. Mount Vernon Cancer Centre, Northwood, UK;2. Radiation Medicine Programme, Princess Margaret Cancer Centre, Toronto, Canada;3. Division of Cancer Sciences, University of Manchester, Manchester, UK |
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| Abstract: | AimsOsteoradionecrosis (ORN) is a serious toxicity of head and neck radiotherapy. It predominantly affects the mandible. Extra-mandibular ORN is rare. The aim of this study was to report the incidence and outcomes of extra-mandibular ORNs from a large institutional database.Materials and methodsIn total, 2303 head and neck cancer patients were treated with radical or adjuvant radiotherapy. Of these, extra-mandibular ORN developed in 13 patients (0.5%).ResultsMaxillary ORNs (n = 8) were a consequence of the treatment of various primaries (oropharynx = 3, sinonasal = 2, maxilla = 2, parotid = 1). The median interval from the end of radiotherapy to the development of ORN was 7.5 months (range 3–42 months). The median radiotherapy dose in the centre of the ORN was 48.5 Gy (range 22–66.5 Gy). Four patients (50%) healed in 7, 14, 20 and 41 months.All temporal bone ORNs (n = 5) developed after treatment to the parotid gland (of a total of 115 patients who received radiotherapy for parotid gland malignancy). The median interval from the end of radiotherapy to the development of ORN was 41 months (range 20–68 months). The median total dose in the centre of the ORN was 63.5 Gy (range 60.2–65.3 Gy). ORN healed in only one patient after 32 months of treatment with repeated debridement and topical betamethasone cream.ConclusionExtra-mandibular ORN is a rare late toxicity and this current study provides useful information on its incidence and outcome. The risk of temporal bone ORN should be considered in the treatment of parotid malignancies and patients should be counselled. More research is required to determine the optimal management of extra-mandibular ORN, particularly on the role of the PENTOCLO regimen. |
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| Keywords: | Extra-mandibular head and neck cancer maxilla osteoradionecrosis radiotherapy temporal bone |
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