scholarly journals Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma

2020 ◽  
Author(s):  
Hikaru Kubota ◽  
Daisuke Miyawaki ◽  
Naritoshi Mukumoto ◽  
Takeaki Ishihara ◽  
Megumi Matsumura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Oral Cancer ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Primary Tumor ◽  
Tooth Extraction ◽  
Tumor Site ◽  
Primary Tumor Site ◽  
Factors Associated

Abstract Background: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.Methods: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008–2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy–70 Gy [V10–70]) were investigated and compared between patients with and without ORNJ. The Mann–Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan–Meier analyses were performed for cumulative ORNJ incidence estimation. Results: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range, 3–145) months. The median time to ORNJ development was 27 (range, 2–127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 >14% were identified as important factors. In multivariate analyses, V60 >14% (p=0.0065) and primary tumor site (p=0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤14% and >14%, respectively (p<0.0001), and 1.4% and 9.3% in patients with oropharyngeal or oral cancer and other cancers, respectively (p<0.0001). Conclusions: V60 >14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

scholarly journals Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Squamous Cell Carcinoma

2020 ◽  
Author(s):  
Hikaru Kubota ◽  
Daisuke Miyawaki ◽  
Naritoshi Mukumoto ◽  
Takeaki Ishihara ◽  
Megumi Matsumura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Oral Cancer ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Primary Tumor ◽  
Tooth Extraction ◽  
Tumor Site ◽  
Primary Tumor Site ◽  
Factors Associated

Abstract Background: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.Methods: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008–2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy–70 Gy [V10–70]) were investigated and compared between patients with and without ORNJ. The Mann–Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan–Meier analyses were performed for cumulative ORNJ incidence estimation. Results: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range, 3–145) months. The median time to ORNJ development was 27 (range, 2–127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 >14% were identified as important factors. In multivariate analyses, V60 >14% (p=0.0065) and primary tumor site (p=0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤14% and >14%, respectively (p<0.0001), and 1.4% and 9.3% in patients with oropharyngeal or oral cancer and other cancers, respectively (p<0.0001). Conclusions: V60 >14%, and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

scholarly journals Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hikaru Kubota ◽  
Daisuke Miyawaki ◽  
Naritoshi Mukumoto ◽  
Takeaki Ishihara ◽  
Megumi Matsumura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Oral Cancer ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Primary Tumor ◽  
Tooth Extraction ◽  
Tumor Site ◽  
Primary Tumor Site ◽  
Factors Associated

Abstract Background To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose–volume histogram (DVH) parameters. Methods We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008–2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy–70 Gy [V10–70]) were investigated and compared between patients with and without ORNJ. The Mann–Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan–Meier analyses were performed for cumulative ORNJ incidence estimation. Results Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3–145) months. The median time to ORNJ development was 27 (range 2–127) months. DVH analysis revealed that V30–V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). Conclusions V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

scholarly journals Regional disease in head and neck cutaneous squamous cell carcinoma: the role of primary tumor characteristics and number of nodal metastases

2021 ◽  
Author(s):  
Alberto Grammatica ◽  
Michele Tomasoni ◽  
Milena Fior ◽  
Emanuela Ulaj ◽  
Tommaso Gualtieri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Primary Tumor ◽  
Multivariable Analysis ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Tumor Characteristics ◽  
Curative Intent

Abstract Purpose To identify potential risk factors impacting on overall survival (OS) of patients affected by lymph node metastasis from cutaneous squamous cell carcinoma (cSCC) of the head and neck (HN), with special emphasis on primary tumor characteristics and pattern of nodal recurrence (intraparotid and/or cervical). Methods A bi-institutional retrospective study on consecutive patients affected by cervical and/or intraparotid NM from HN cSCC and surgically treated with curative intent from May 2010 to January 2020 was conducted. OS was considered the outcome of interest. Results The study included 89 patients (M:F = 3.4:1; median age, 78 years; range, 22–99). Among the primary tumor characteristics, the most relevant prognostic factors were diameter ≥ 4 cm (hazard ratio [HR] = 2.56, p = 0.010) and depth of infiltration ≥ 6 mm (HR = 3.54, p = 0.027). Cervical NM was associated with worse OS (HR = 2.09, p = 0.016) compared to purely intraparotid NM (5-year OS: 60.9% vs. 28.1%, p = 0.014). At multivariable analysis, age, immunosuppression, pT3-T4 categories and a high burden of nodal disease (> 2 NM) confirmed to be independent risk factors, whereas adjuvant radiotherapy was independently associated with better outcome. Conclusion This study confirms the association of several independent prognosticators related to the patient, primary tumor, and nodal burden status. Patients with cervical NM should be considered at risk for harboring a higher number of metastatic lymph nodes.

Squamous Cell Carcinoma of Head and Neck in Vajira Hospital: The Outcomes in a Real-World Practice

2020 ◽  
Vol 103 (7) ◽  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Primary Tumor ◽  
Tnm Staging ◽  
Primary Site ◽  
Definitive Treatment ◽  
Primary Tumor Site

Background: Squamous cell carcinoma of the head and neck (SCCHNC) is the fifth most common cancer in Thailand. Even though the multi-modality treatment including surgery, radiotherapy, and chemotherapy is the standard practice, the survival outcomes are not impressive. Objective: The primary objectives were to determine the overall survival (OS) and 3-year OS of all patients with SCCHNC and as analysis according to the primary site of the primary tumor. The secondary objectives were progression-free survival (PFS), outcomes of induction chemotherapy (IC), prevalence of serious toxicities from treatments, and independent factors of survival. Materials and Methods: Retrospective analyses were conducted in patients who had SCCHNC confirmed by histology with complete details of staging and treatment, excluding nasopharyngeal carcinoma, carcinoma of the salivary glands, carcinoma of paranasal sinuses, and cutaneous squamous cell carcinoma. Results: There were 216 eligible patients. OS of all participants was 24.1 months (IQR 14.3 to 50.1). At the median follow-up of 51.49 months, 3-year OS was 52.2% (95% CI 45 to 95). The patients with primary tumor site at the glottic larynx had the longest OS of 45 months (IQR 21.2 to 64.8). The patients with primary sites at the oral cavity (OS 20.1 months, IQR 13.4 to 45.8), oropharynx (OS 20.05 months, IQR 12.4 to 48.5), hypopharynx (OS 23.3 months, IQR 13.3 to 44.6), and supraglottic or transglottic larynx (OS 25.15, IQR 19.55 to 37.8) had nearly equally worst OS. Stratified by primary site of tumor, the investigators found that PFS of patients with glottic larynx was the longest (23.6 months, IQR 17.5 to 53.4). On the other hand, PFS of patients with supraglottic or transglottic laryngeal cancer, oral cavity cancer, oropharynx, hypopharynx was only 11.35 months (IQR 5.8 to 28.65), 12.5 months (IQR 6.2 to 31.3 months), 13.2 months (IQR 6.3 to 27.8), and 15.1 (IQR 8.9 to 29.3), respectively. The IC did not improve the patients’ outcomes. Thirty patients (22.4%) had serious (grade 3 to 4) adverse effects from definitive treatment, mostly from severe mucositis. The primary sites at the oral cavity and hypopharynx, T4 diseases, and failure to primary definitive treatment were the independent predictors of early deaths. Conclusion: Due to the very late stage at presentation, the OS of the participants was only two years. The primary sites at the oral cavity and hypopharynx, T4 diseases rather than the composite TNM staging, and failure to primary definitive treatment were the independent prognostic factors of short survival. Keywords: Squamous cell carcinoma of the head and neck, Multi-modality treatment, Outcomes, Survival

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