Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer.
Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer.
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DOI：
10.1186/s13014-016-0679-6
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发表时间：
2016-07-30
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影响因子：
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通讯作者：
Hey J
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作者：
Kuhnt T;Stang A;Wienke A;Vordermark D;Schweyen R;Hey J
探讨新诊断头颈癌患者在3d适形放疗（3D-CRT）和调强放疗（IMRT）后颌骨骨放射性坏死（ORN）发生的潜在危险因素。这项研究包括2003年至2013年间在哈雷-维滕贝格大学医院放射治疗部门接受3D-CRT或IMRT治疗头颈癌的776名患者。记录每位患者的性别、放射治疗前的牙齿状况、肿瘤部位、肿瘤切除期间的骨手术、伴随化疗和进展性ORN。根据放射治疗肿瘤组/欧洲癌症研究和治疗组织的分类，ORN分为3级、4级或5级；根据正常组织的后期效应/主观、客观、管理和分析量表，ORN分为3级或4级。估计ORN的累积发生率。采用Cox回归分析确定ORN发生的预后危险因素。51例发生晚期ORN（相对发生率6.6%，累计发生率12.4%）。肿瘤切除术中接受过原发性骨手术的患者风险最高（风险比[HR] = 5.87； 95%可信区间[CI]: 3.09-11.19）和肿瘤位于口腔的患者（风险比[HR] = 4.69; 95% CI: 1.33-16.52）。性别、牙列（有牙列vs无牙列）和化疗没有临床相关的影响。与之前的大多数研究相反，我们注意到晚期ORN的累积发生率较低。肿瘤位于口腔的患者以及在RT前肿瘤切除期间进行骨手术的患者可能被认为是发生ORN的高危人群。
To identify potential risk factors for the development of jaw osteoradionecrosis (ORN) after 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) among patients with newly diagnosed head and neck cancer. This study included 776 patients who underwent 3D-CRT or IMRT for head and neck cancer at the Department of Radiotherapy at the University Hospital Halle-Wittenberg between 2003 and 2013. Sex, dental status prior to radiotherapy, tumor site, bone surgery during tumor resection, concomitant chemotherapy, and the development of advanced ORN were documented for each patient. ORN was classified as grade 3, 4, or 5 according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer classification or grade 3 or 4 according to the late effects in normal tissues/subjective, objective, management, and analytic scale. The cumulative incidence of ORN was estimated. Cox regression analysis was used to identify prognostic risk factors for the development of ORN. Fifty-one patients developed advanced ORN (relative frequency 6.6 %, cumulative incidence 12.4 %). The highest risk was found in patients who had undergone primary bone surgery during tumor resection (hazard ratio [HR] = 5.87; 95 % confidence interval [CI]: 3.09–11.19) and in patients with tumors located in the oral cavity (HR = 4.69; 95 % CI: 1.33–16.52). Sex, dentition (dentulous vs. edentulous), and chemotherapy had no clinically relevant influence. In contrast to most previous studies, we noted a low cumulative incidence of advanced ORN. Patients with tumors located in the oral cavity and those who undergo bone surgery during tumor resection prior to RT may be considered a high-risk group for the development of ORN.