Lack of Osteoradionecrosis of the Mandible after IMRT for Head and Neck Cancer: Likely Contributions of both Dental Care and Improved Dose Distributions
Identifieur interne : 001B97 ( Ncbi/Merge ); précédent : 001B96; suivant : 001B98Lack of Osteoradionecrosis of the Mandible after IMRT for Head and Neck Cancer: Likely Contributions of both Dental Care and Improved Dose Distributions
Auteurs : Merav A. Ben-David [États-Unis] ; Maximiliano Diamante [États-Unis] ; Jeffrey D. Radawski [États-Unis] ; K. A. Vineberg [États-Unis] ; Cynthia Stroup [États-Unis] ; Carol-Anne Murdoch-Kinch [États-Unis] ; Samuel R. Zwetchkenbaum [États-Unis] ; Avraham Eisbruch [États-Unis]Source :
- International journal of radiation oncology, biology, physics [ 0360-3016 ] ; 2007.
Abstract
To assess the prevalence and the dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck (HN) cancer who underwent pre-therapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity modulated radiation therapy (IMRT).
Between 1996–2005 all patients with HN cancer treated with parotid gland sparing IMRT in prospective studies underwent dental examination and prophylactic treatment according to a uniform policy including extractions of high-risk, periodontally involved and non-restorable teeth in parts of the mandible expected to receive high doses, fluoride supplements, and guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and non-involved oral cavity doses. Retrospective analysis of grade ≥2 (clinical) ORN was performed.
176 patients had minimal follow-up 6 months. Thirty-one (17%) had teeth extractions prior to radiation and 13 (7%) post-radiation. 75% and 50% of the patients received at least 65Gy and 70Gy to ≥ 1% of the mandibular volumes, respectively. Fall-off across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range 1–27Gy, median 8Gy). At median 34 months follow-up there were no cases of ORN (95% CI, 0; 2%).
The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.
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DOI: 10.1016/j.ijrobp.2006.11.059
PubMed: 17321069
PubMed Central: 2702207
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Ben-David</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Diamante, Maximiliano" sort="Diamante, Maximiliano" uniqKey="Diamante M" first="Maximiliano" last="Diamante">Maximiliano Diamante</name><affiliation wicri:level="2"><nlm:aff id="A2"> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Radawski, Jeffrey D" sort="Radawski, Jeffrey D" uniqKey="Radawski J" first="Jeffrey D." last="Radawski">Jeffrey D. 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Vineberg</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Stroup, Cynthia" sort="Stroup, Cynthia" uniqKey="Stroup C" first="Cynthia" last="Stroup">Cynthia Stroup</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Murdoch Kinch, Carol Anne" sort="Murdoch Kinch, Carol Anne" uniqKey="Murdoch Kinch C" first="Carol-Anne" last="Murdoch-Kinch">Carol-Anne Murdoch-Kinch</name><affiliation wicri:level="2"><nlm:aff id="A2"> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Zwetchkenbaum, Samuel R" sort="Zwetchkenbaum, Samuel R" uniqKey="Zwetchkenbaum S" first="Samuel R." last="Zwetchkenbaum">Samuel R. 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Ben-David</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Diamante, Maximiliano" sort="Diamante, Maximiliano" uniqKey="Diamante M" first="Maximiliano" last="Diamante">Maximiliano Diamante</name><affiliation wicri:level="2"><nlm:aff id="A2"> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Radawski, Jeffrey D" sort="Radawski, Jeffrey D" uniqKey="Radawski J" first="Jeffrey D." last="Radawski">Jeffrey D. Radawski</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Vineberg, K A" sort="Vineberg, K A" uniqKey="Vineberg K" first="K. A." last="Vineberg">K. A. Vineberg</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Stroup, Cynthia" sort="Stroup, Cynthia" uniqKey="Stroup C" first="Cynthia" last="Stroup">Cynthia Stroup</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Murdoch Kinch, Carol Anne" sort="Murdoch Kinch, Carol Anne" uniqKey="Murdoch Kinch C" first="Carol-Anne" last="Murdoch-Kinch">Carol-Anne Murdoch-Kinch</name><affiliation wicri:level="2"><nlm:aff id="A2"> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Zwetchkenbaum, Samuel R" sort="Zwetchkenbaum, Samuel R" uniqKey="Zwetchkenbaum S" first="Samuel R." last="Zwetchkenbaum">Samuel R. Zwetchkenbaum</name><affiliation wicri:level="2"><nlm:aff id="A2"> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author><author><name sortKey="Eisbruch, Avraham" sort="Eisbruch, Avraham" uniqKey="Eisbruch A" first="Avraham" last="Eisbruch">Avraham Eisbruch</name><affiliation wicri:level="2"><nlm:aff id="A1"> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor</wicri:cityArea></affiliation></author></analytic><series><title level="j">International journal of radiation oncology, biology, physics</title><idno type="ISSN">0360-3016</idno><idno type="eISSN">1879-355X</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose</title><p id="P2">To assess the prevalence and the dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck (HN) cancer who underwent pre-therapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity modulated radiation therapy (IMRT).</p></sec><sec sec-type="materials|methods" id="S2"><title>Methods and Materials</title><p id="P3">Between 1996–2005 all patients with HN cancer treated with parotid gland sparing IMRT in prospective studies underwent dental examination and prophylactic treatment according to a uniform policy including extractions of high-risk, periodontally involved and non-restorable teeth in parts of the mandible expected to receive high doses, fluoride supplements, and guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and non-involved oral cavity doses. Retrospective analysis of grade ≥2 (clinical) ORN was performed.</p></sec><sec id="S3"><title>Results</title><p id="P4">176 patients had minimal follow-up 6 months. Thirty-one (17%) had teeth extractions prior to radiation and 13 (7%) post-radiation. 75% and 50% of the patients received at least 65Gy and 70Gy to ≥ 1% of the mandibular volumes, respectively. Fall-off across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range 1–27Gy, median 8Gy). At median 34 months follow-up there were no cases of ORN (95% CI, 0; 2%).</p></sec><sec id="S4"><title>Conclusions</title><p id="P5">The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7603616</journal-id><journal-id journal-id-type="pubmed-jr-id">4036</journal-id><journal-id journal-id-type="nlm-ta">Int J Radiat Oncol Biol Phys</journal-id><journal-title>International journal of radiation oncology, biology, physics</journal-title><issn pub-type="ppub">0360-3016</issn><issn pub-type="epub">1879-355X</issn></journal-meta><article-meta><article-id pub-id-type="pmid">17321069</article-id><article-id pub-id-type="pmc">2702207</article-id><article-id pub-id-type="doi">10.1016/j.ijrobp.2006.11.059</article-id><article-id pub-id-type="manuscript">NIHMS23776</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Lack of Osteoradionecrosis of the Mandible after IMRT for Head and Neck Cancer: Likely Contributions of both Dental Care and Improved Dose Distributions</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ben-David</surname><given-names>Merav A.</given-names></name><degrees>M.D.</degrees><xref rid="A1" ref-type="aff">1</xref></contrib><contrib contrib-type="author"><name><surname>Diamante</surname><given-names>Maximiliano</given-names></name><degrees>D.M.D</degrees><xref rid="A2" ref-type="aff">2</xref></contrib><contrib contrib-type="author"><name><surname>Radawski</surname><given-names>Jeffrey D.</given-names></name><degrees>BSc</degrees><xref rid="A1" ref-type="aff">1</xref></contrib><contrib contrib-type="author"><name><surname>Vineberg</surname><given-names>K. A.</given-names></name><degrees>BSc</degrees><xref rid="A1" ref-type="aff">1</xref></contrib><contrib contrib-type="author"><name><surname>Stroup</surname><given-names>Cynthia</given-names></name><degrees>M.S PA-C.</degrees><xref rid="A1" ref-type="aff">1</xref></contrib><contrib contrib-type="author"><name><surname>Murdoch-Kinch</surname><given-names>Carol-Anne</given-names></name><degrees>DDS, PhD</degrees><xref rid="A2" ref-type="aff">2</xref></contrib><contrib contrib-type="author"><name><surname>Zwetchkenbaum</surname><given-names>Samuel R.</given-names></name><degrees>DDS</degrees><xref rid="A2" ref-type="aff">2</xref></contrib><contrib contrib-type="author"><name><surname>Eisbruch</surname><given-names>Avraham</given-names></name><degrees>M.D.</degrees><xref rid="A1" ref-type="aff">1</xref></contrib></contrib-group><aff id="A1"><label>1</label> Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI</aff><aff id="A2"><label>2</label> Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Medical School, Ann Arbor, MI</aff><author-notes><corresp id="FN1">Corresponding Author: Avraham Eisbruch, University of Michigan, Dept. of Radiation Oncology, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0010, Phone: (734) 936-4300, Fax: (734) 936-9340, Email: <email>eisbruch@med.umich.edu</email></corresp><fn id="FN2"><p>Dr Ben-David’s current address is Department of Oncology, Sheba Medical Center Tel Hashomer Israel.</p></fn></author-notes><pub-date pub-type="nihms-submitted"><day>28</day><month>4</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>22</day><month>2</month><year>2007</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>6</month><year>2007</year></pub-date><pub-date pub-type="pmc-release"><day>26</day><month>6</month><year>2009</year></pub-date><volume>68</volume><issue>2</issue><fpage>396</fpage><lpage>402</lpage><related-article journal-id-type="nlm-ta" journal-id="Int J Radiat Oncol Biol Phys" related-article-type="commentary" page="1583" id="N0x1c433c0N0x28ad850" xlink:href="17674994" ext-link-type="pubmed" vol="68"></related-article><abstract><sec id="S1"><title>Purpose</title><p id="P2">To assess the prevalence and the dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck (HN) cancer who underwent pre-therapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity modulated radiation therapy (IMRT).</p></sec><sec sec-type="materials|methods" id="S2"><title>Methods and Materials</title><p id="P3">Between 1996–2005 all patients with HN cancer treated with parotid gland sparing IMRT in prospective studies underwent dental examination and prophylactic treatment according to a uniform policy including extractions of high-risk, periodontally involved and non-restorable teeth in parts of the mandible expected to receive high doses, fluoride supplements, and guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and non-involved oral cavity doses. Retrospective analysis of grade ≥2 (clinical) ORN was performed.</p></sec><sec id="S3"><title>Results</title><p id="P4">176 patients had minimal follow-up 6 months. Thirty-one (17%) had teeth extractions prior to radiation and 13 (7%) post-radiation. 75% and 50% of the patients received at least 65Gy and 70Gy to ≥ 1% of the mandibular volumes, respectively. Fall-off across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range 1–27Gy, median 8Gy). At median 34 months follow-up there were no cases of ORN (95% CI, 0; 2%).</p></sec><sec id="S4"><title>Conclusions</title><p id="P5">The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.</p></sec></abstract><kwd-group><kwd>IMRT</kwd><kwd>intensity modulated radiation therapy</kwd><kwd>osteoradionecrosis</kwd><kwd>head and neck cancer</kwd></kwd-group><contract-num rid="CA1">P01 CA059827-130008</contract-num><contract-sponsor id="CA1">National Cancer Institute : NCI</contract-sponsor></article-meta></front></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>Michigan</li></region></list><tree><country name="États-Unis"><region name="Michigan"><name sortKey="Ben David, Merav A" sort="Ben David, Merav A" uniqKey="Ben David M" first="Merav A." last="Ben-David">Merav A. Ben-David</name></region><name sortKey="Diamante, Maximiliano" sort="Diamante, Maximiliano" uniqKey="Diamante M" first="Maximiliano" last="Diamante">Maximiliano Diamante</name><name sortKey="Eisbruch, Avraham" sort="Eisbruch, Avraham" uniqKey="Eisbruch A" first="Avraham" last="Eisbruch">Avraham Eisbruch</name><name sortKey="Murdoch Kinch, Carol Anne" sort="Murdoch Kinch, Carol Anne" uniqKey="Murdoch Kinch C" first="Carol-Anne" last="Murdoch-Kinch">Carol-Anne Murdoch-Kinch</name><name sortKey="Radawski, Jeffrey D" sort="Radawski, Jeffrey D" uniqKey="Radawski J" first="Jeffrey D." last="Radawski">Jeffrey D. Radawski</name><name sortKey="Stroup, Cynthia" sort="Stroup, Cynthia" uniqKey="Stroup C" first="Cynthia" last="Stroup">Cynthia Stroup</name><name sortKey="Vineberg, K A" sort="Vineberg, K A" uniqKey="Vineberg K" first="K. A." last="Vineberg">K. A. Vineberg</name><name sortKey="Zwetchkenbaum, Samuel R" sort="Zwetchkenbaum, Samuel R" uniqKey="Zwetchkenbaum S" first="Samuel R." last="Zwetchkenbaum">Samuel R. Zwetchkenbaum</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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