Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, Farmington, CT, USA.
Support Care Cancer. 2010 Aug;18(8):1089-98. doi: 10.1007/s00520-010-0898-6. Epub 2010 Jun 6.
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.
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.
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.
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.
本研究旨在回顾 1990 年至 2008 年的证据基础，以（1）阐明癌症治疗对头颈部癌症患者放射性骨坏死（ORN）发生率的影响，以及（2）评估管理策略及其对生活质量和护理成本的影响。
选择的文章时间范围始于 1989 年之后，不包括 1989 年 NIH 赞助的癌症治疗口腔并发症研讨会的 1990 年 NCI 专论文章，该文章发表于 1990 年。搜索包括 Medline/PubMed 和 Embase，且仅针对人类。搜索仅限于英语出版物。当前审查未使用摘要。每篇文章均由两位评审员进行评估。在纳入预定质量指标的情况下，针对 ORN 的发生率计算加权发生率。为 ORN 的预防和管理策略提供已发表的证据水平、推荐等级和指南（如果可能）。
共审查了 1990 年至 2008 年间的 43 篇文章。ORN 的加权发生率包括常规放疗（RT）=7.4%、调强放疗（IMRT）=5.1%、放化疗（CRT）=6.8%和近距离放疗=5.3%。高压氧可能在 ORN 的治疗中发挥作用。然而，根据审查的文献，无法为 ORN 的预防或治疗制定明确的指南建议。
新的癌症治疗方式，如 IMRT 和同时进行的 CRT，对 ORN 的发生率影响很小。迄今为止，尚无研究系统地探讨 ORN 对生活质量或护理成本的影响。
