[PMID]: | 28608925 |
[Au] Autor: | Caparrotti F; Huang SH; Lu L; Bratman SV; Ringash J; Bayley A; Cho J; Giuliani M; Kim J; Waldron J; Hansen A; Tong L; Xu W; O'Sullivan B; Wood R; Goldstein D; Hope A |
[Ad] Endereço: | Department of Radiation Oncology, the Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. |
[Ti] Título: | Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy. |
[So] Source: | Cancer;123(19):3691-3700, 2017 Oct 01. |
[Is] ISSN: | 1097-0142 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | BACKGROUND: Osteoradionecrosis (ORN) of the mandible is a late toxicity affecting patients treated with radiotherapy for head and neck malignancies. To the authors' knowledge, ORN has no standardized grading system and its reporting is based on retrospective findings in heterogeneous patient populations. The rate of ORN in the era of intensity-modulated radiotherapy (IMRT) still is unknown. METHODS: The authors report the incidence of ORN from prospectively collected data regarding 1196 patients who were diagnosed with squamous cell carcinoma of the oropharynx and treated with curative-intent IMRT, with or without concomitant systemic treatment, from January 2005 to December 2014. Each case of ORN was graded according to its severity. Clinical and dosimetric comparisons were performed between patients with ORN and a matched control cohort of patients without ORN. RESULTS: The actuarial rate of ORN of the mandible was 3% at 1 year, 5% at 3 years, and 7% at 5 years. On multivariable analysis, smoking (hazard ratio, 1.9; 95% confidence interval, 1.07-3.4 [P = .03]) and T classification (hazard ratio, 1.78; 95% confidence interval, 1.02-3.1 [P = .041]) were found to be statistically significant risk factors. The presence of cardiovascular comorbidities, use of bisphosphonates, and pre-IMRT dental extractions were found to be different between the matched cohorts. The mandibular volume receiving 50 grays (Gy) (in cm ) and the volume receiving 60 Gy (in cm ) were found to be associated with ORN on multivariable analysis in the matched cohort patients receiving an IMRT regimen of 2 Gy per fraction. CONCLUSIONS: ORN is relatively uncommon among patients with oropharyngeal carcinoma who are treated with IMRT, but continues to occur beyond 5 years after treatment. Modifiable risk factors that are associated with higher rates of ORN include smoking and the use of bisphosphonates. Minimizing the volumes of the mandible receiving >50 Gy or > 60 Gy also may have an effect on the ORN rate. Cancer 2017;123:3691-3700. © 2017 American Cancer Society. |
[Mh] Termos MeSH primário: |
Carcinoma de Células Escamosas/radioterapia Doenças Mandibulares/epidemiologia Neoplasias Orofaríngeas/radioterapia Osteorradionecrose/epidemiologia Radioterapia de Intensidade Modulada/efeitos adversos
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[Mh] Termos MeSH secundário: |
Adulto Idoso Idoso de 80 Anos ou mais Conservadores da Densidade Óssea/efeitos adversos Estudos de Casos e Controles Feminino Seres Humanos Incidência Masculino Mandíbula/efeitos da radiação Doenças Mandibulares/etiologia Meia-Idade Osteorradionecrose/etiologia Dosagem Radioterapêutica Estudos Retrospectivos Fatores de Risco Fumar/efeitos adversos Fatores de Tempo
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[Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Nm] Nome de substância:
| 0 (Bone Density Conservation Agents) |
[Em] Mês de entrada: | 1709 |
[Cu] Atualização por classe: | 170927 |
[Lr] Data última revisão:
| 170927 |
[Sb] Subgrupo de revista: | AIM; IM |
[Da] Data de entrada para processamento: | 170614 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1002/cncr.30803 |
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