Department of Otolaryngology-Head and Neck Surgery, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA.
Head Neck. 2011 Nov;33(11):1600-5. doi: 10.1002/hed.21654. Epub 2011 Apr 11.
An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition.
We retrospectively analyzed 46 patients diagnosed between June 2002 and March 2009: 93% had mandibular ORN, which was staged 0 to III (Store and Boysen). Patient, tumor, treatment-related, and other variables were analyzed for association with mandibular ORN severity.
Oral or oropharyngeal tumors comprised 85% of our primary tumors, 80% were stage IV, and 91% were squamous cell carcinomas. Most patients (87%) received 3-dimensional (3D) conformal radiation therapy (RT), with 60 Gray (Gy) median dose; 28% and 72% received primary and adjuvant RT, respectively; 78% received chemotherapy, mostly concurrent (97%) and platinum-based (96%). Median time to development of ORN was 7.5 months. White ethnicity and secondary infection correlated significantly with stage III mandibular ORN (p = .038, p = .0007, respectively). Advanced age, stage IV, RT dose, post-RT, and lack of pre-RT dental extractions appeared predictive of severe mandibular ORN.
The above-cited factors are predictive of severity and can potentially guide prophylaxis and management.
需要分析预测下颌骨放射性骨坏死（ORN）严重程度的危险因素，以帮助预防和治疗这种疾病。
我们回顾性分析了 2002 年 6 月至 2009 年 3 月期间诊断的 46 例患者：93%患有下颌骨 ORN，其分期为 0 至 III 期（Store 和 Boysen）。分析了患者、肿瘤、治疗相关以及其他变量与下颌骨 ORN 严重程度的关系。
我们的原发性肿瘤中 85%为口腔或口咽肿瘤，80%为 IV 期，91%为鳞状细胞癌。大多数患者（87%）接受了三维（3D）适形放射治疗（RT），中位剂量为 60 Gray（Gy）；28%和 72%分别接受了原发和辅助 RT；78%接受了化疗，主要是同期（97%）和铂类（96%）。ORN 发生的中位时间为 7.5 个月。白人种族和继发感染与 III 期下颌骨 ORN 显著相关（p =.038，p =.0007）。年龄较大、IV 期、RT 剂量、RT 后以及缺乏 RT 前牙科拔牙似乎是预测严重下颌骨 ORN 的因素。
上述因素是严重程度的预测因素，可能有助于预防和治疗。
