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Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based Model.
Watson, Erin E; Hueniken, Katrina; Lee, Junhyung; Huang, Shao Hui; El Maghrabi, Amr; Xu, Wei; Moreno, Amy C; Tsai, C Jillian; Hahn, Ezra; McPartlin, Andrew J; Yao, Christopher M K L; Goldstein, David P; De Almeida, John R; Waldon, John N; Fuller, Clifton D; Hope, Andrew J; Ruggiero, Salvatore L; Glogauer, Michael; Hosni, Ali A.
Afiliação
  • Watson EE; Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON.
  • Hueniken K; Faculty of Dentistry, University of Toronto, Toronto, ON.
  • Lee J; Department of Biostatistics, University Health Network, Toronto, ON.
  • Huang SH; Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON.
  • El Maghrabi A; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • Xu W; Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON.
  • Moreno AC; Department of Biostatistics, University Health Network, Toronto, ON.
  • Tsai CJ; MD Anderson Cancer Centre, Houston, TX.
  • Hahn E; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • McPartlin AJ; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • Yao CMKL; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • Goldstein DP; Department of Otolaryngology-Head & Neck Surgery, University Health Network/University of Toronto, Toronto, ON.
  • De Almeida JR; Department of Otolaryngology-Head & Neck Surgery, University Health Network/University of Toronto, Toronto, ON.
  • Waldon JN; Department of Otolaryngology-Head & Neck Surgery, University Health Network/University of Toronto, Toronto, ON.
  • Fuller CD; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
  • Hope AJ; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • Ruggiero SL; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • Glogauer M; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON.
  • Hosni AA; Department of Oral and Maxillofacial Surgery, Stony Brook University, Stony Brook, NY.
J Clin Oncol ; 42(16): 1922-1933, 2024 Jun 01.
Article em En | MEDLINE | ID: mdl-38691822
ABSTRACT

PURPOSE:

Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN.

METHODS:

Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection).

RESULTS:

ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% (P < .001) with an AUC of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, ClinRad, was proposed on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems.

CONCLUSION:

We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Osteorradionecrose / Radioterapia de Intensidade Modulada / Neoplasias de Cabeça e Pescoço Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Osteorradionecrose / Radioterapia de Intensidade Modulada / Neoplasias de Cabeça e Pescoço Idioma: En Ano de publicação: 2024 Tipo de documento: Article