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Article: Osteoradionecrosis of the mandible: Minimized risk profile following intensity-modulated radiation therapy (IMRT)

TitleOsteoradionecrosis of the mandible: Minimized risk profile following intensity-modulated radiation therapy (IMRT)
Authors
Issue Date2006
Citation
Strahlentherapie Und Onkologie, 2006, v. 182 n. 5, p. 283-288 How to Cite?
AbstractBackground and Purpose: Osteoradionecrosis (ON) of the mandible is a serious late complication of high-dose radiation therapy for tumors of the oropharynx and oral cavity. After doses between 60 and 72 Gy using standard fractionation, an incidence of ON between 5% and 15% is reported in a review from 1989, whereas in more recent publications using moderately accelerated or hyperfractionated irradiation and doses between 69 and 81 Gy, the incidence of ON is between < 1% and ∼ 6%. Intensity-modulated radiation therapy (IMRT) is expected to translate into a further important reduction of ON. The aim of this descriptive study was to assess absolute and relative bone volumes exposed to high IMRT doses, related to observed bone tolerance. Patients and Methods: Between December 2001 and November 2004, 73 of 123 patients treated with IMRT were identified as subgroup "at risk" for ON (> 60 Gy for oropharyngeal or oral cavity cancer). 21/73 patients were treated in a postoperative setting, 52 patients underwent primary definitive irradiation. In 56 patients concomitant cisplatin-based chemotherapy was applied. Mean follow-up time was 22 months (12-46 months). Oral cavity including the mandible bone outside the planning target volume was contoured and dose-volume constraints were defined in order to spare bone tissue. Dose-volume histograms were obtained from contoured mandible in each patient and were analyzed and related to clinical mandible bone tolerance. Results: Using IMRT with doses between 60 and 75 Gy (mean 67 Gy), on average 7.8, 4.8, 0.9, and 0.3 cm3 were exposed to doses > 60, 65, 70, and 75 Gy, respectively. These values are substantially lower than when using three-dimensional conformal radiotherapy. The difference has been approximately quantified by comparison with a historic series. Additional ON risk factors of the patients were also analyzed. Only one grade 3 ON of the lingual horizontal branch, treated with lingual decortication, was observed. Conclusion: Using IMRT, only very small partial volumes of the mandibular bone are exposed to high radiation doses. This is expected to translate into a further reduction of ON and improved osseointegration of dental implants. © Urban & Vogel.
Persistent Identifierhttp://hdl.handle.net/10722/154406
ISSN
2015 Impact Factor: 2.898
2015 SCImago Journal Rankings: 1.069
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorStuder, Gen_US
dc.contributor.authorStuder, SPen_US
dc.contributor.authorZwahlen, RAen_US
dc.contributor.authorHuguenin, Pen_US
dc.contributor.authorGrätz, KWen_US
dc.contributor.authorLütolf, UMen_US
dc.contributor.authorGlanzmann, Cen_US
dc.date.accessioned2012-08-08T08:25:08Z-
dc.date.available2012-08-08T08:25:08Z-
dc.date.issued2006en_US
dc.identifier.citationStrahlentherapie Und Onkologie, 2006, v. 182 n. 5, p. 283-288en_US
dc.identifier.issn0179-7158en_US
dc.identifier.urihttp://hdl.handle.net/10722/154406-
dc.description.abstractBackground and Purpose: Osteoradionecrosis (ON) of the mandible is a serious late complication of high-dose radiation therapy for tumors of the oropharynx and oral cavity. After doses between 60 and 72 Gy using standard fractionation, an incidence of ON between 5% and 15% is reported in a review from 1989, whereas in more recent publications using moderately accelerated or hyperfractionated irradiation and doses between 69 and 81 Gy, the incidence of ON is between < 1% and ∼ 6%. Intensity-modulated radiation therapy (IMRT) is expected to translate into a further important reduction of ON. The aim of this descriptive study was to assess absolute and relative bone volumes exposed to high IMRT doses, related to observed bone tolerance. Patients and Methods: Between December 2001 and November 2004, 73 of 123 patients treated with IMRT were identified as subgroup "at risk" for ON (> 60 Gy for oropharyngeal or oral cavity cancer). 21/73 patients were treated in a postoperative setting, 52 patients underwent primary definitive irradiation. In 56 patients concomitant cisplatin-based chemotherapy was applied. Mean follow-up time was 22 months (12-46 months). Oral cavity including the mandible bone outside the planning target volume was contoured and dose-volume constraints were defined in order to spare bone tissue. Dose-volume histograms were obtained from contoured mandible in each patient and were analyzed and related to clinical mandible bone tolerance. Results: Using IMRT with doses between 60 and 75 Gy (mean 67 Gy), on average 7.8, 4.8, 0.9, and 0.3 cm3 were exposed to doses > 60, 65, 70, and 75 Gy, respectively. These values are substantially lower than when using three-dimensional conformal radiotherapy. The difference has been approximately quantified by comparison with a historic series. Additional ON risk factors of the patients were also analyzed. Only one grade 3 ON of the lingual horizontal branch, treated with lingual decortication, was observed. Conclusion: Using IMRT, only very small partial volumes of the mandibular bone are exposed to high radiation doses. This is expected to translate into a further reduction of ON and improved osseointegration of dental implants. © Urban & Vogel.en_US
dc.languageengen_US
dc.relation.ispartofStrahlentherapie und Onkologieen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshAntineoplastic Agents - Therapeutic Useen_US
dc.subject.meshCisplatin - Therapeutic Useen_US
dc.subject.meshCombined Modality Therapyen_US
dc.subject.meshDental Implantsen_US
dc.subject.meshDose-Response Relationship, Radiationen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHead And Neck Neoplasms - Drug Therapy - Radiotherapyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMandible - Radiation Effectsen_US
dc.subject.meshMandibular Diseases - Etiology - Prevention & Controlen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshOsteoradionecrosis - Etiology - Prevention & Controlen_US
dc.subject.meshRadiotherapy Dosageen_US
dc.subject.meshRadiotherapy Planning, Computer-Assisteden_US
dc.subject.meshRadiotherapy, Intensity-Modulated - Adverse Effectsen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshTime Factorsen_US
dc.titleOsteoradionecrosis of the mandible: Minimized risk profile following intensity-modulated radiation therapy (IMRT)en_US
dc.typeArticleen_US
dc.identifier.emailZwahlen, RA:zwahlen@hku.hken_US
dc.identifier.authorityZwahlen, RA=rp00055en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s00066-006-1477-0en_US
dc.identifier.pmid16673062-
dc.identifier.scopuseid_2-s2.0-33646574947en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33646574947&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume182en_US
dc.identifier.issue5en_US
dc.identifier.spage283en_US
dc.identifier.epage288en_US
dc.identifier.isiWOS:000237719700005-
dc.publisher.placeGermanyen_US
dc.identifier.scopusauthoridStuder, G=16231684900en_US
dc.identifier.scopusauthoridStuder, SP=7004653526en_US
dc.identifier.scopusauthoridZwahlen, RA=7004217269en_US
dc.identifier.scopusauthoridHuguenin, P=7006103080en_US
dc.identifier.scopusauthoridGrätz, KW=7005383755en_US
dc.identifier.scopusauthoridLütolf, UM=7003995840en_US
dc.identifier.scopusauthoridGlanzmann, C=7005122985en_US

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