Risk Factors for Osteoradionecrosis of the Jaw in the Era of Modern Head and Neck Radiotherapy
Erkan Topkan1*, Efsun Somay2, Busra Yilmaz3, Berrin Pehlivan4, Ugur
1Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana,
2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent
University, Ankara, Turkey
3Department of Oral and Maxillofacial Radiology, School of Dental Medicine,
4Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey
15Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey
*Corresponding Author: Erkan Topkan, Department of Radiation Oncology, Faculty
of Medicine, Baskent University, Adana, Turkey.
Received: July 11, 2023; Published: July 29, 2023
Radiotherapy is an essential component of curative treatment for head and neck cancer, either as a neoadjuvant or adjuvant treatment to surgery or as a definitive treatment with or without chemotherapy, depending on the stage of the disease and general health. However, aggressive RT or chemoradiotherapy can result in radiation-induced severe late toxicities, including the severely debilitating osteoradionecrosis of the jaws (ORNJ), which may affect a relatively small but significant proportion of this patient population. ORNJ is characterized by necrosis of bone tissue and failure to heal for at least three months. In the majority of cases, ORNJ progresses gradually, worsening and becoming more painful, which results in infection and pathological fracture. In the absence of a proven curative treatment other than aggressive surgeries, the prevalence of ORNJ could theoretically be decreased by implementing a well-organized multidisciplinary oral care program and reducing the ORNJ-related risk factors. These risk factors include the patient, the tumor, pre-radiotherapy mandibular surgery, tooth extractions, implant placement, radiation modality, and radiation dosimetry-related factors. Therefore, the present paper provides a literature review and update on the established and frequently disputed risk factors underlying ORNJ and their radiobiological bases.
Keywords: Head and Neck Cancer; Toxicity; Osteoradionecrosis; Risk Factors
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