Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible?
Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible?
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DOI：
10.1002/hed.20538
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发表时间：
2007-06-01
影响因子：
2.9
通讯作者：
Mendenhall, William M.
中科院分区：
文献类型：
--
作者：
Chang, Daniel T.;Sandow, Pamela R.;Mendenhall, William M.
背景本研究旨在确定放疗前拔牙是否能降低放射性骨坏死的风险。1987年至2004年，413例口咽癌患者在佛罗里达大学接受了明确的FIT治疗。有齿患者接受治疗前牙科评估。如果认为牙科疾病的长期预后不良，通常会拔除RT视野中的牙齿。使用改良的分期系统，终点为≥ 2级ORN。患者被排除局部复发，额外的RT以上的锁骨，或头部和颈部手术，除了neck disinfect.Results，ORN率如下：缺牙，<1%;牙齿在外地与RT前提取，15%;和牙齿在外地没有RT前提取，9%。与没有进行RT前拔牙的患者相比，具有较差的现场牙齿和FIT前拔牙的患者的ORIN的5年发生率更高（16% vs 6%，p = 0.48）。同样，对于那些在现场牙齿状况良好和RT前拔除的患者，5年ORN发生率高于未进行拔除的患者（15% vs 2%，p = 0.42）。多变量分析显示，剂量> 70戈伊、每日一次分割或近距离放射治疗的ORIN风险增加。RT前拔牙似乎不能降低ORN的风险。(c)2007 Wiley Periodicals，Inc.
Background. This study was done to determine if pre-radiotherapy (pre-RT) dental extractions reduce the risk of osteoradionecrosis (ORN).Methods. Between 1987 and 2004, 413 patients with oropharyngeal carcinomas were treated with definitive FIT at the University of Florida. Dentate patients underwent pretreatment dental evaluation. Teeth in the RT field were usually extracted if thought to have poor long-term prognosis from dental disease. The endpoint was >= grade 2 ORN using a modified staging system. Patients were excluded for local recurrence, additional RT above the clavicles, or head and neck surgery besides neck dissection.Results, ORN rates were as follows: edentulous, < 1 %; teeth in-field with pre-RT extractions, 15%; and teeth in-field without pre-RT extractions, 9%. Patients with poor in-field teeth and pre-FIT extractions had a higher 5-year incidence of ORIN than those who did not have pre-RT extractions (16% vs 6%, p = .48). Likewise, for those with in-field teeth in good condition and pre-RT extractions, the 5-year ORN incidence was higher than for those who did not undergo extractions (15% vs 2%, p = .42). Multivariate analysis revealed increased ORIN risk with doses of > 70 Gy, once-daily fractionation, or brachytherapy.Conclusion. Pre-RT extractions do not appear to reduce the risk of ORN. (c) 2007 Wiley Periodicals, Inc.