Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers

Dominic H. Moon, Sung Ho Moon, Kyle Wang, Mark C. Weissler, Trevor G. Hackman, Adam M. Zanation, Brian D. Thorp, Samip N. Patel, Jose P. Zevallos, Lawrence B. Marks, Bhishamjit S. Chera

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives To evaluate the incidence of, and risk factors associated with, mandibular osteoradionecrosis (MORN) following radiation therapy (RT) for oral cavity and oropharyngeal cancers. Materials and Methods Patient and treatment records of 252 consecutive patients with oral cavity or oropharynx cancers treated with RT by a single radiation oncologist at a high volume academic institution from August 2009 to December 2015 were retrospectively reviewed. A Cox regression model was used to assess factors associated with the development of MORN. RT dosimetry was compared between patients with MORN and a matched cohort of patients without MORN. Results MORN developed in 14 patients (5.5%), occurring 3–40 (median 8) months post-RT. Factors associated with MORN on univariable analysis included primary diagnosis of oral cavity vs oropharynx cancer (hazard ratio [HR]: 3.0, p = 0.04), smoking at the time of RT (HR: 3.1, p = 0.04), mandibular invasion of the primary (HR: 3.7, p = 0.04), pre-RT tooth extraction (HR: 4.52, p = 0.01), and treatment with 3D-conformal RT vs intensity-modulated RT (HR: 5.1, p = 0.003). On multivariable analysis, pre-RT tooth extractions and RT technique remained significant. A dosimetric comparison between patients with and without MORN showed no significant differences. Conclusions and Relevance The incidence of MORN is low in the modern era at a high volume academic center. Modifiable risk factors including pre-RT tooth extractions, smoking, and RT technique are associated with MORN, and the risk should be minimized with appropriate dental evaluation and treatment, smoking cessation efforts, and the use of intensity-modulated RT.

Original languageEnglish (US)
Pages (from-to)98-103
Number of pages6
JournalOral Oncology
Volume72
DOIs
StatePublished - Sep 2017
Externally publishedYes

Fingerprint

Osteoradionecrosis
Oropharyngeal Neoplasms
Mouth Neoplasms
Mouth
Radiotherapy
Incidence
Tooth Extraction
Smoking
Radiometry
Smoking Cessation
Proportional Hazards Models

Keywords

  • 3D-Conformal radiation therapy (3D-CRT)
  • Intensity-modulated radiation therapy (IMRT)
  • Oral cavity cancer
  • Oropharynx cancer
  • Osteoradionecrosis
  • Radiation therapy
  • Smoking
  • Tooth extraction

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers. / Moon, Dominic H.; Moon, Sung Ho; Wang, Kyle; Weissler, Mark C.; Hackman, Trevor G.; Zanation, Adam M.; Thorp, Brian D.; Patel, Samip N.; Zevallos, Jose P.; Marks, Lawrence B.; Chera, Bhishamjit S.

In: Oral Oncology, Vol. 72, 09.2017, p. 98-103.

Research output: Contribution to journalArticle

Moon, DH, Moon, SH, Wang, K, Weissler, MC, Hackman, TG, Zanation, AM, Thorp, BD, Patel, SN, Zevallos, JP, Marks, LB & Chera, BS 2017, 'Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers', Oral Oncology, vol. 72, pp. 98-103. https://doi.org/10.1016/j.oraloncology.2017.07.014
Moon, Dominic H. ; Moon, Sung Ho ; Wang, Kyle ; Weissler, Mark C. ; Hackman, Trevor G. ; Zanation, Adam M. ; Thorp, Brian D. ; Patel, Samip N. ; Zevallos, Jose P. ; Marks, Lawrence B. ; Chera, Bhishamjit S. / Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers. In: Oral Oncology. 2017 ; Vol. 72. pp. 98-103.
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abstract = "Objectives To evaluate the incidence of, and risk factors associated with, mandibular osteoradionecrosis (MORN) following radiation therapy (RT) for oral cavity and oropharyngeal cancers. Materials and Methods Patient and treatment records of 252 consecutive patients with oral cavity or oropharynx cancers treated with RT by a single radiation oncologist at a high volume academic institution from August 2009 to December 2015 were retrospectively reviewed. A Cox regression model was used to assess factors associated with the development of MORN. RT dosimetry was compared between patients with MORN and a matched cohort of patients without MORN. Results MORN developed in 14 patients (5.5{\%}), occurring 3–40 (median 8) months post-RT. Factors associated with MORN on univariable analysis included primary diagnosis of oral cavity vs oropharynx cancer (hazard ratio [HR]: 3.0, p = 0.04), smoking at the time of RT (HR: 3.1, p = 0.04), mandibular invasion of the primary (HR: 3.7, p = 0.04), pre-RT tooth extraction (HR: 4.52, p = 0.01), and treatment with 3D-conformal RT vs intensity-modulated RT (HR: 5.1, p = 0.003). On multivariable analysis, pre-RT tooth extractions and RT technique remained significant. A dosimetric comparison between patients with and without MORN showed no significant differences. Conclusions and Relevance The incidence of MORN is low in the modern era at a high volume academic center. Modifiable risk factors including pre-RT tooth extractions, smoking, and RT technique are associated with MORN, and the risk should be minimized with appropriate dental evaluation and treatment, smoking cessation efforts, and the use of intensity-modulated RT.",
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T1 - Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers

AU - Moon, Dominic H.

AU - Moon, Sung Ho

AU - Wang, Kyle

AU - Weissler, Mark C.

AU - Hackman, Trevor G.

AU - Zanation, Adam M.

AU - Thorp, Brian D.

AU - Patel, Samip N.

AU - Zevallos, Jose P.

AU - Marks, Lawrence B.

AU - Chera, Bhishamjit S.

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N2 - Objectives To evaluate the incidence of, and risk factors associated with, mandibular osteoradionecrosis (MORN) following radiation therapy (RT) for oral cavity and oropharyngeal cancers. Materials and Methods Patient and treatment records of 252 consecutive patients with oral cavity or oropharynx cancers treated with RT by a single radiation oncologist at a high volume academic institution from August 2009 to December 2015 were retrospectively reviewed. A Cox regression model was used to assess factors associated with the development of MORN. RT dosimetry was compared between patients with MORN and a matched cohort of patients without MORN. Results MORN developed in 14 patients (5.5%), occurring 3–40 (median 8) months post-RT. Factors associated with MORN on univariable analysis included primary diagnosis of oral cavity vs oropharynx cancer (hazard ratio [HR]: 3.0, p = 0.04), smoking at the time of RT (HR: 3.1, p = 0.04), mandibular invasion of the primary (HR: 3.7, p = 0.04), pre-RT tooth extraction (HR: 4.52, p = 0.01), and treatment with 3D-conformal RT vs intensity-modulated RT (HR: 5.1, p = 0.003). On multivariable analysis, pre-RT tooth extractions and RT technique remained significant. A dosimetric comparison between patients with and without MORN showed no significant differences. Conclusions and Relevance The incidence of MORN is low in the modern era at a high volume academic center. Modifiable risk factors including pre-RT tooth extractions, smoking, and RT technique are associated with MORN, and the risk should be minimized with appropriate dental evaluation and treatment, smoking cessation efforts, and the use of intensity-modulated RT.

AB - Objectives To evaluate the incidence of, and risk factors associated with, mandibular osteoradionecrosis (MORN) following radiation therapy (RT) for oral cavity and oropharyngeal cancers. Materials and Methods Patient and treatment records of 252 consecutive patients with oral cavity or oropharynx cancers treated with RT by a single radiation oncologist at a high volume academic institution from August 2009 to December 2015 were retrospectively reviewed. A Cox regression model was used to assess factors associated with the development of MORN. RT dosimetry was compared between patients with MORN and a matched cohort of patients without MORN. Results MORN developed in 14 patients (5.5%), occurring 3–40 (median 8) months post-RT. Factors associated with MORN on univariable analysis included primary diagnosis of oral cavity vs oropharynx cancer (hazard ratio [HR]: 3.0, p = 0.04), smoking at the time of RT (HR: 3.1, p = 0.04), mandibular invasion of the primary (HR: 3.7, p = 0.04), pre-RT tooth extraction (HR: 4.52, p = 0.01), and treatment with 3D-conformal RT vs intensity-modulated RT (HR: 5.1, p = 0.003). On multivariable analysis, pre-RT tooth extractions and RT technique remained significant. A dosimetric comparison between patients with and without MORN showed no significant differences. Conclusions and Relevance The incidence of MORN is low in the modern era at a high volume academic center. Modifiable risk factors including pre-RT tooth extractions, smoking, and RT technique are associated with MORN, and the risk should be minimized with appropriate dental evaluation and treatment, smoking cessation efforts, and the use of intensity-modulated RT.

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KW - Oral cavity cancer

KW - Oropharynx cancer

KW - Osteoradionecrosis

KW - Radiation therapy

KW - Smoking

KW - Tooth extraction

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