(P143) Multisite Review of Twenty-Six Head and Neck Cancer Patients Who Have Developed Osteoradionecrosis: Location, Etiology, and Treatment

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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

All patients in this review developed ORN in the posterior aspect of the mandible. Neither the specific systemic agent (Erbitux or chemotherapy) nor the manner in which the agent was delivered (induction vs concurrent) appeared to increase the risk of ORN. It is hoped that having a better understanding as to the location, etiology, and treatment of ORN will help to minimize this potentially devastating complication for future generations of head and neck cancer patients.

Rex Hoffman, MD, Daniel Copps, DDS, Earl Freymiller, MD, DDS, Sopirios Tetradis, DDS, PhD; Roy and Patricia Disney Family Cancer Center, Providence Saint Joseph Medical Center; private practice; UCLA School of Dentistry

INTRODUCTION: Osteoradionecrosis (ORN) is felt to be secondary to decreased blood flow through the inferior alveolar artery to the mandible. It has been well documented that if the dose of radiation exceeds a certain threshold, patients are at increased risk for this devastating treatment-related side effect. The effect that systemic therapy has on this altered blood flow is less clear. The medical and dental literature has conflicting reports that the rate of ORN increases or decreases when systemic therapy (chemotherapy or Erbitux) has been given with radiation. Here, the authors review 26 head and neck cancer patients who have developed ORN to see if systemic therapy increased their risk during radiation.

MATERIALS: A total of 26 head and neck cancer patients, treated at six different radiation oncology departments, were diagnosed with ORN by a single maxillofacial prosthodontist (DC), a dental radiologist, and a maxillofacial oral surgeon. ORN was defined as a condition of nonviable bone in the site of radiation injury. Diagnosis of ORN was made by both physical exam and radiographic imaging, which consisted of both a Panorex and a cone-beam computed tomography (CT) scan. For the purpose of this study, the patients’ records were reviewed, looking specifically at how radiation and systemic therapy had been delivered (induction vs concurrent), as well as what systemic agent(s) they received during radiation.

RESULTS: Median time to diagnosis of ORN after treatment by both physical exam and radiographic imaging was 77 months (range: 12–147 mo). Of the 26 patients, 5 had received radiation therapy alone, 7 had received induction chemotherapy followed by concurrent chemotherapy and radiation, and 14 had been treated with concurrent therapy (either Erbitux or platinum-based chemotherapy) and radiation. In each case, necrosis of the bone occurred in the posterior aspect of the mandible. None of the cases was iatrogenic. After the diagnosis was made, treatment consisted of either pharmacologic treatment or hyperbaric oxygen, followed by conservative oral surgery or hemimandibulectomy.

CONCLUSION: The medium time from the completion of treatment to diagnosis of ORN was over 6 years. All patients in this review developed ORN in the posterior aspect of the mandible. Neither the specific systemic agent (Erbitux or chemotherapy) nor the manner in which the agent was delivered (induction vs concurrent) appeared to increase the risk of ORN. It is hoped that having a better understanding as to the location, etiology, and treatment of ORN will help to minimize this potentially devastating complication for future generations of head and neck cancer patients.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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