RESUMEN
OBJECTIVES: To analyze clinical features, dosimetric parameters, and outcomes of osteoradionecrosis (ORN). STUDY DESIGN: Thirty-six patients with ORN who had been previously treated with radiotherapy (RT) were retrospectively identified between January 2009 and April 2014. ORN volumes were contoured on planning computed tomography (CT) scans. Near maximum dose (D2%), minimum dose (Dmin), mean dose (Dmean), and percentage of bone volume receiving 50 Gy (V50) were examined. Clinical and dosimetric variables were considered to compare ORN resolution versus ORN persistence. RESULTS: Median interval time from end of RT to development of ORN was 6 months. Of the ORN cases, 61% were located in the mandible. Dmean to affected bone was 57.6 Gy, and 44% had a D2% 65 Gy or greater. Smoking was associated with ORN persistence on univariate analysis, but no factors were found to impact ORN resolution or progression on logistic regression. CONCLUSIONS: Prevention strategies for ORN development should be prioritized. Dose-volume parameters could have a role in preventing ORN.
Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Osteorradionecrosis/diagnóstico por imagen , Osteorradionecrosis/etiología , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Dimensión del Dolor , Radiometría , Dosificación Radioterapéutica , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND AND PURPOSE: The standard of care to reconstruct segmental oro-mandibular defects following head and neck oncological resection is to use osseocutaneous free-tissue transfer. Some patients however are not suitable for this type of complex reconstruction. The purpose of this paper is to study our results of soft-tissue flap reconstruction for segmental hemi-mandibular defects. PATIENTS AND METHODS: Ten patients were included in the study, all had advanced squamous cell carcinoma of the oropharynx or oral cavity and all had hemimandibulectomies. RESULTS: In eight cases a vertical rectus abdominis myocutaneous (VRAM) free flap was used and in two cases a pectoralis major myocutaneous pedicled flap was used. Normal oral feeding was achieved in six patients with a mean time for discontinuation of tube feeding of 18 days. CONCLUSION: In selected patients with severe comorbidity and advanced oro-mandibular cancer, soft tissue flaps may be used for segmental hemi-mandibular defects. KEY WORDS: Oral cavity cancer - Free tissue transfer.