A retrospective review: risk factors associated with osteoradionecrosis in Head and Neck cancer
Theresa O'Donovan,
Ireland
PO-1189
Abstract
A retrospective review: risk factors associated with osteoradionecrosis in Head and Neck cancer
Authors: Theresa O'Donovan1, Kate Fitzgerald2, Dr. Ciara Lyons2, Dr. Andrew England1, Professor Mark McEntee1, Annemarie Devine1, Professor Aisling Barry1,1, Dr. Eleanor O' Sullivan3
1University College Cork, Medical Imaging and Radiation Therapy, Co. Cork, Ireland; 2Cork University Hospital, Radiation Oncology, Co. Cork, Ireland; 3Cork University Dental School & Hospital, Dental School, Co. Cork, Ireland
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Purpose or Objective
Osteoradionecrosis (ORN) is a serious complication of radiotherapy (RT) in patients with head and neck cancer (HNC). This study aimed to investigate potential precipitating factors that may contribute to the development of ORN to aid in the identification of potential targets for prevention.
Material and Methods
Ethical approval was obtained from the local Clinical Research Ethics Committee (CREC). A database of 1,074 patients who received curative-intent radiation therapy treatment for HNC between 2010 and 2021 was reviewed. 47 patients who developed ORN as per the Notani classification were identified. Medical, dental and RT records of patients were reviewed retrospectively. Descriptive and statistical analysis was performed using SPSS.
Results
The incidence rate of ORN was 4.4%. The majority of patients were smokers (76.6%), drank alcohol (89.4%) and had no history of bisphosphonate therapy, with primary cancer of the oral cavity (68%). 36.4% of patients underwent pre-RT surgery involving bone. All patients were assessed by the dental hospital prior to treatment. Treatment intent was adjuvant (51%) or definitive (49%) and the mandible received ≥60Gy in 83% of patients.
The median time for ORN development, which was predominantly in the mandible, was 21 (range 1 – 100) months. ORN was graded as Notani grade 1, 2 and 3 in 48.9, 8.5, 42.6% respectively. On comparison of patients with ORN who underwent pre-RT surgery versus no surgery, higher Notani grade (3 vs 1) (p<0.02), shorter time to development since RT (<12-months)) p=0.044) and less likelihood of resolution (p=0.019) was statistically significantly associated with patients who underwent pre-RT surgery.
Conclusion
This study is the first study to investigate the incidence of ORN in HNC patients in Ireland. These findings may further aid in the clinical management and prevention of ORN in HNC patients.