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Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies

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Abstract

Purpose

The purpose of this study is to review the evidence base from 1990 to 2008 to (1) clarify the impact of cancer therapies on prevalence of osteoradionecrosis (ORN) in head and neck cancer patients, and to (2) evaluate management strategies and their consequences on quality of life and cost of care.

Methods

Articles were selected for the time period beginning after 1989, excluding the 1990 NCI monograph articles from the 1989 NIH-sponsored Oral Complications in Cancer Therapy Symposium that was published in 1990. The search included both Medline/PubMed and Embase and was limited to humans. The search was limited to publications in the English language. No abstracts were utilized in the current review. Each article was evaluated by two reviewers. A weighted prevalence was calculated for the prevalence of ORN while incorporating predetermined quality measures. The level of evidence, recommendation grade, and guideline (if possible) were provided for published preventive and management strategies for ORN.

Results

A total of 43 articles between 1990 and 2008 were reviewed. The weighted prevalence for ORN included conventional radiotherapy (RT) = 7.4%, intensity modulated RT (IMRT) = 5.1%, chemoradiotherapy (CRT) = 6.8%, and brachytherapy = 5.3%. Hyperbaric oxygen may contribute a role in management of ORN. However, no clear guideline recommendations could be established for the prevention or treatment of ORN based on the literature reviewed.

Conclusions

New cancer treatment modalities such as IMRT and concomitant CRT have had minimal effect on prevalence of ORN. No studies to date have systematically addressed impact of ORN on either quality of life or cost of care.

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Acknowledgement

The authors thank Ms. Tainika Williams, Department of Oral Medicine, Carolinas Medical Center, North Carolina, USA, for her excellent administrative assistance.

Conflicts of interest

The authors declared that they have no potential conflicts of interests.

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Authors and Affiliations

  1. Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA

    Douglas E. Peterson

  2. Program in Head & Neck Cancer and Oral Oncology, Neag Comprehensive Cancer Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-1605, USA

    Douglas E. Peterson

  3. Department of Radiotherapy and Radiation Oncology and OncoRay, Medical Faculty Carl Gustav Carus, Dresden University of Technology, Dresden, Germany

    Wolfgang Doerr

  4. Radiobiology Laboratory, Department of Radiation Oncology, Oral Care Program, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany

    Wolfgang Doerr

  5. Program of Oral Oncology/Dentistry, British Columbia Cancer Agency, Vancouver, BC, Canada

    Allan Hovan

  6. Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Andres Pinto

  7. Oral Medicine Center, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 240 S. 40th St, Suite 214, Philadelphia, PA, 19104, USA

    Andres Pinto

  8. Dental Oncology, Sudbury Regional Hospital Regional Cancer Program, Sudbury, ON, Canada

    Debbie Saunders

  9. Section of Health Services Research, Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit 447, Houston, TX, 77030-4009, USA

    Linda S. Elting

  10. Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700, RG, Groningen, The Netherlands

    Fred K. L. Spijkervet

  11. Department of Oral Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC, 28232, USA

    Michael T. Brennan

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  1. Douglas E. Peterson
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  2. Wolfgang Doerr
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  3. Allan Hovan
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  4. Andres Pinto
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  5. Debbie Saunders
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  6. Linda S. Elting
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  7. Fred K. L. Spijkervet
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  8. Michael T. Brennan
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Corresponding author

Correspondence to Douglas E. Peterson.

Additional information

All authors are members of the Oral Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO).

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Peterson, D.E., Doerr, W., Hovan, A. et al. Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies. Support Care Cancer 18, 1089–1098 (2010). https://doi.org/10.1007/s00520-010-0898-6

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  • DOI: https://doi.org/10.1007/s00520-010-0898-6

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