Issues
Osteoradionecrosis of the facial skull: current evidence (literature review)
«Radiation and Risk», 2023, vol. 32, No. 2, pp.142-156
DOI: 0.21870/0131-3878-2023-32-2-142-156
Authors
Polkin V.V. – Head of Dep., C. Sc., Med. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249035. Tel.: +79108637283; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .Isaev P.A. – Lead. Researcher, MD
Plugar A.K. – Oncologist, Postgraduate Student
Ilyin A.A. – Lead. Researcher, MD
Rozhnov V.A. – Lead. Researcher, MD
Spirin P.I. – Jun. Researcher
Panaseykin Y.A. – Jun. Researcher
Ivanov S.A. – Director, Corr. Member of RAS, MD, Prof. of PFUR Dep. A. Tsyb MRRC.
Kaprin A.D. – General Director, Director of P. Hertsen MORI, Head of PFUR Dep., Academician of RAS, MD, Prof. NMRRC.
1 A. Tsyb MRRC, Obninsk
2 NMRRC, Obninsk
3Peoples' Friendship University of Russia, Moscow
4 P. Hertsen MORI, Moscow
Abstract
Despite recent advances in radiation therapy, osteoradionecrosis remains a common and severe complication of radiation therapy in patients with head and neck cancer. Modern methods of treatment are developed with regard to the disease severity and pathophysiology complexity, as well as theories of the osteoradionecrosis development. The following theories of osteoradionecrosis patho-physiology are currently considered: "radiation-induced osteomyelitis", "hypoxic, hypocellular, hypo-vascular" and "fibroatrophic". Prior to radiation therapy, the patient is provided with restorative dental treatment and radiation therapy planning. Treatments range from conservative «watch and wait» to more radical surgical interventions. Currently, there is no approved standard for the care of osteora-dionecrosis patients, however, the activity in this direction is underway. Currently state-of-the-art treatment strategies are available with limited evidence. The review aims to assess the literature on osteoradionecrosis of the jaw with an emphasis on available treatment options.
Key words
classification, head and neck cancer, osteoradionecrosis, pathophysiology, treatment, radiation therapy, review, theory of pathogenesis, malignant neoplasm, radiotherapy with intensity modulation (IMRT).
References
1. Terapevticheskaya radiologiya: natsional'noe rukovodstvo [Therapeutic radiology: national guidelines]. Eds.: A.D. Kaprin, Yu.S. Mardynsky. Moscow: GeotarMedia, 2018. 704 p.
2. Reuther T., Schuster T., Mende U., Kubler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients – a report of a thirty year retrospective review. Int. J. Oral Maxillofac. Surg., 2003, vol. 32, no. 3, pp. 289-295.
3. Shaw R.J., Dhanda J. Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: treatment. Br. J. Oral Maxillofac. Surg., 2011, vol. 49, no. 1, pp. 2-8.
4. He Y., Liu Z., Tian Z., Dai T., Qiu W., Zhang Z. Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system. Int. J. Oral Maxillofac. Surg., 2015, vol. 44, no. 12, pp. 1547-1557.
5. Store G., Boysen M. Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin. Otolaryngol. Allied Sci., 2000, vol. 25, no. 5, pp. 378-384.
6. Beumer J.3rd, Silverman S.Jr., Benak S.B.Jr. Hard and soft tissue necroses following radiation therapy for oral cancer. J. Prosthet. Dent., 1972, vol. 27, no. 6, pp. 640-644.
7. Epstein J.B., Wong F.L., Dickens A., Szasz I., Lepawsky M. Bone and gallium scans in postradiotherapy osteonecrosis of the jaw. Head Neck, 1992, vol. 14, no. 4. pp. 288-292.
8. Marx R.E. A new concept in the treatment of osteoradionecrosis. J. Oral Maxillofac. Surg., 1983, vol. 41, no. 6, pp. 351-357.
9. Beumer J.3rd, Harrison R., Sanders B., Kurrasch M. Postradiation dental extractions: a review of the literature and a report of 72 episodes. Head Neck Surg., 1983, vol. 6, no. 1, pp. 581-586.
10. Harris M. The conservative management of osteoradionecrosis of the mandible with ultrasound therapy. Br. J. Oral Maxillofac. Surg., 1992, vol. 30, no. 5, pp. 313-318.
11. Schwartz H.C., Kagan A.R. Osteoradionecrosis of the mandible: scientific basis for clinical staging. Am. J. Clin. Oncol., 2002, vol. 25, no. 2, pp. 168-171.
12. Notani K., Yamazaki Y., Kitada H., Sakakibara N., Fukuda H., Omori K., Nakamura M. Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radio-therapy. Head Neck, 2003, vol. 25, no. 3, pp. 181-186.
13. Nabil S., Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg. Oral Med. Oral Pathol. Oral Radiol., 2012, vol. 113, no. 1, pp. 54-69.
14. Jiang Y.-m., Zhu X.-d., Qu S. Incidence of osteoradionecrosis in patients who have undergone dental extraction prior to radiotherapy: a systematic review and meta-analysis. J. Oral Maxillofac. Surg. Med. Pathol., 2014, vol. 26, no. 3, pp. 269-275.
15. Wang T.H., Liu C.J., Chao T.F., Chen T.J., Hu Y.W. Risk factors for and the role of dental extractions in osteo-radionecrosis of the jaws: a national-based cohort study. Head Neck, 2017, vol. 39, no. 7, pp. 1313-1321.
16. Kluth E.V., Jain P.R., Stuchell R.N., Frich J.C.Jr. A study of factors contributing to the development of osteoradionecrosis of the jaws. J. Prosthet. Dent., 1988, vol. 59, no. 2, pp. 194-201.
17. David L.A., Sandor G.K., Evans A.W., Brown D.H. Hyperbaric oxygen therapy and mandibular osteoradi-onecrosis: a retrospective study and analysis of treatment outcomes. J. Can. Dent. Assoc., 2001, vol. 67, no. 7, pp. 384.
18. Shaw R.J., Butterworth C. Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part II: prevention. Br. J. Oral Maxillofac. Surg., 2011, vol. 49, no. 1, pp. 9-13.
19. Hehr T., Classen J., Welz S., Ganswindt U., Scheithauer H., Koitschev A., Bamberg M., Budach W. Hyperfractionated, accelerated chemoradiation with concurrent mitomycin-C and cisplatin in locally advanced head and neck cancer, a phase I/II study. Radiother. Oncol., 2006, vol. 80, no. 1, pp. 33-38.
20. Studer G., Studer S.P., Zwahlen R.A., Huguenin P., Grätz K.W., Lütolf U.M., Glanzmann C. Osteoradi-onecrosis of the mandible: minimized risk profile following intensity-modulated radiation therapy (IMRT). Strahlenther. Onkol., 2006, vol. 182, no. 5, pp. 283-288.
21. Teng M.S., Futran N.D. Osteoradionecrosis of the mandible. Curr. Opin. Otolaryngol. Head Neck Surg., 2005, vol. 13, no. 4, pp. 217-221.
22. Lyons A.J., West C.M., Risk J.M., Slevin N.J., Chan C., Crichton S., Rinck G., Howell D., Shaw R.J. Osteoradionecrosis in head and neck cancer has a distinct genotype-dependent cause. Int. J. Radiat. Oncol. Biol. Phys., 2012, vol. 82, no. 4, pp. 1479-1484.
23. Leemans C.R., Braakhuis B.J., Brakenhoff R.H. The molecular biology of head and neck cancer. Nat. Rev. Cancer, 2011, vol. 11, no. 1, pp. 9-22.
24. Cutler M. The problem of extractions in relation to osteoradionecrosis complicating radiotherapy for intraoral cancer. Oral Surg. Oral Med. Oral Pathol., 1951, vol. 4, no. 9, pp. 1077-1090.
25. Meyer I. Infectious diseases of the jaws. J. Oral Surg., 1970, vol. 28, no. 1, pp. 17-26.
26. Titterington W.P. Osteomyelitis and osteoradionecrosis of the jaws. J. Oral Med., 1971, vol. 26, no. 1, pp. 7-16.
27. Gowgiel J.M. Experimental radio-osteonecrosis of the jaws. J. Dent. Res., 1960, vol. 39, pp. 176-197.
28. Rudolph R., Tripuraneni P., Koziol J.A., McKean-Matthews M., Frutos A. Normal transcutaneous oxygen pressure in skin after radiation therapy for cancer. Cancer, 1994, vol. 74, no. 11, pp. 3063-3070.
29. Delanian S., Lefaix J.L. The radiation-induced fibroatrophic process: therapeutic perspective via the anti-oxidant pathway. Radiother. Oncol., 2004, vol. 73, no. 2, pp. 119-131.
30. Vozenin-Brotons M.C., Milliat F., Sabourin J.C., de Gouville A.C., François A., Lasser P., Morice P., Haie-Meder C., Lusinchi A., Antoun S., Bourhis J., Mathé D., Girinsky T., Aigueperse J. Fibrogenic sig-nals in patients with radiation enteritis are associated with increased connective tissue growth factor expres-sion. Int. J. Radiat. Oncol. Biol. Phys., 2003, vol. 56, no. 2, pp. 561-572.
31. Dambrain R. The pathogenesis of osteoradionecrosis. Rev. Stomatol. Chir. Maxillofac., 1993, vol. 94, no. 3, pp. 140-147.
32. Niezgoda J.A., Serena T.E., Carter M.J. Outcomes of radiation injuries using hyperbaric oxygen therapy: an observational cohort study. Adv. Skin Wound Care, 2016, vol. 29, no. 1, pp. 12-19.
33. Peterson D.E., Doerr W., Hovan A., Pinto A., Saunders D., Elting L.S., Spijkervet F.K., Brennan M.T. Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies. Support Care Cancer, 2010, vol. 18, no. 8, pp. 1089-1098.
34. Studer G., Bredell M., Studer S., Huber G., Glanzmann C. Risk profile for osteoradionecrosis of the mandi-ble in the IMRT era. Strahlenther. Onkol., 2016, vol. 192, no. 1, pp. 32-39.
35. Owosho A.A., Tsai C.J., Lee R.S., Freymiller H., Kadempour A., Varthis S., Sax A.Z., Rosen E.B., Yom S.K., Randazzo J., Drill E., Riedel E., Patel S., Lee N.Y., Huryn J.M., Estilo C.L. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): the Memorial Sloan Kettering Cancer Center experience. Oral Oncol., 2017, vol. 64, pp. 44-51.
36. De Felice F., Musio D., Tombolini V. Osteoradionecrosis and intensity modulated radiation therapy: an overview. Criti. Rev. Oncol. Hematol., 2016, vol. 107, pp. 39-43.
37. Gomez D.R., Estilo C.L., Wolden S.L., Zelefsky M.J., Kraus D.H., Wong R.J., Shaha A.R., Shah J.P., Mechalakos J.G., Lee N.Y. Correlation of osteoradionecrosis and dental events with dosimetric parameters in intensity-modulated radiation therapy for head-and-neck cancer. Int. J. Radiat. Oncol. Biol. Phys., 2011, vol. 81, no. 4, pp. 207-213.
38. Eisbruch A., Ten Haken R.K., Kim H.M., Marsh L.H., Ship J.A. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int. J. Radiat. Oncol. Biol. Phys., 1999, vol. 45, no. 3, pp. 577-587.
39. Deasy J.O., Moiseenko V., Marks L., Chao K.S., Nam J., Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int. J. Radiat. Oncol. Biol. Phys., 2010, vol. 76, no. 3, pp. 58-63.
40. Tsai C.J., Hofstede T.M., Sturgis E.M., Garden A.S., Lindberg M.E., Wei Q., Tucker S.L., Dong L. Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int. J. Radiat. Oncol. Biol. Phys., 2013, vol. 85, no. 2, pp. 415-420.
41. Marx R.E., Johnson R.P., Kline S.N. Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. J. Am. Dent. Assoc., 1985, vol. 111, no. 1, pp. 49-54.
42. Kanatas A.N., Lowe D., Harrison J., Rogers S.N. Survey of the use of hyperbaric oxygen by maxillofacial oncologists in the UK. Br. J. Oral Maxillofac. Surg., 2005, vol. 43, no. 3, pp. 219-225.
43. Epstein J., van der Meij E., McKenzie M., Wong F., Lepawsky M., Stevenson-Moore P. Postradiation osteonecrosis of the mandible: a long-term follow-up study. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 1997, vol. 83, no. 6, pp. 657-662.
44. Gal T.J., Yueh B., Futran N.D. Influence of prior hyperbaric oxygen therapy in complications following microvascular reconstruction for advanced osteoradionecrosis. Arch. Otolaryngol. Head Neck Surg., 2003, vol. 129, no. 1, pp. 72-76.
45. Lee M., Chin R.Y., Eslick G.D., Sritharan N., Paramaesvaran S. Outcomes of microvascular free flap reconstruction for mandibular osteoradionecrosis: a systematic review. J. Craniomaxillofac. Surg., 2015, vol. 43, no. 10, pp. 2026-2033.
46. Mainous E.G., Boyne P.J., Hart G.B. Elimination of sequestrum and healing of osteoradionecrosis of the mandible after hyperbaric oxygen therapy: report of case. J. Oral Surg., 1973, vol. 31, no. 5, pp. 336-339.
47. Sulaiman F., Huryn J.M., Zlotolow I.M. Dental extractions in the irradiated head and neck patient: a retro-spective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. J. Oral Maxillofac. Surg., 2003, vol. 61, no. 10, pp. 1123-1131.
48. McKenzie M.R., Wong F.L., Epstein J.B., Lepawsky M. Hyperbaric oxygen and postradiation osteonecrosis of the mandible. Eur. J. Cancer B Oral Oncol., 1993, vol. 29B, no. 3, pp. 201-207.
49. Mounsey R.A., Brown D.H., O’Dwyer T.P., Gullane P.J., Koch G.H. Role of hyperbaric oxygen therapy in the management of mandibular osteoradionecrosis. Laryngoscope, 1993, vol. 103, no. 6, pp. 605-608.
50. Dhanda J., Durrani L., Beshara E., Machon L., Parmar S. Comparisons between UK and European proto-cols used in the treatment of osteoradionecrosis with hyperbaric oxygen therapy. Br. J. Oral Maxillofac. Surg., 2009, vol. 47, no. 7, pp. e25-e26.
51. Dhanda J., Hall T.J., Wilkins A., Mason V., Catling J. Patterns of treatment of osteoradionecrosis with hyper-baric oxygen therapy in the United Kingdom. Br. J. Oral Maxillofac. Surg., 2009, vol. 47, no. 3, pp. 210-213.
52. Shaw R., Forner L., Butterworth C., Jansen E., Hillerup S., Nutting C., Overgaard J. Randomised con-trolled trials in HBO: “A call to arms” for HOPON & DAHANCA-21. Br. J. Oral Maxillofac. Surg., 2011, vol. 49, no. 1, pp. 76-77.
53. Bennett M.H., Feldmeier J., Hampson N., Smee R., Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst. Rev., 2012, vol. 4, no. 4, pp. CD005005.
54. Delanian S., Depondt J., Lefaix J.L. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck, 2005, vol. 27, no. 2, pp. 114-123.
55. Delanian S. Striking regression of radiation-induced fibrosis by a combination of pentoxifylline and toco-pherol. Br. J. Radiol., 1998, vol. 71, no. 848, pp. 892-894.
56. Delanian S., Porcher R., Balla-Mekias S., Lefaix J.L. Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. J. Clin. Oncol., 2003, vol. 21, no. 13, pp. 2545-2550.
57. Patel V., Gadiwalla Y., Sassoon I., Sproat C., Kwok J., McGurk M. Prophylactic use of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of the head and neck. Br. J. Oral Maxillofac. Surg., 2016, vol. 54, no. 5, pp. 547-550.
58. Delanian S., Chatel C., Porcher R., Depondt J., Lefaix J.L. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int. J. Radiat. Oncol. Biol. Phys., 2011, vol. 80, no. 3, pp. 832-839.
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