Otolaryngology, Head and Neck Surgery Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Otolaryngol Head Neck Surg. 2011 May;144(5):726-32. doi: 10.1177/0194599810396290.
Mandibular osteoradionecrosis (ORN) is a serious complication of radiotherapy (RT) in head and neck cancer patients. The aim of this study was to analyze the incidence of and risk factors for mandibular ORN in squamous cell carcinoma (SCC) of the oral cavity and oropharynx.
Case series with chart review.
University tertiary care center for head and neck oncology.
Seventy-three patients treated for stage I to IV SCC of the oral cavity and oropharynx between 2000 and 2007, with a minimum follow-up of 2 years, were included in the study. Treatment modalities included both RT with curative intent and adjuvant RT following tumor surgery. The log-rank test and Cox model were used for univariate and multivariate analyses.
The incidence of mandibular ORN was 40% at 5 years. Using univariate analysis, the following risk factors were identified: oral cavity tumors (P < .01), bone invasion (P < .02), any surgery prior to RT (P < .04), and bone surgery (P < .0001). By multivariate analysis, mandibular surgery proved to be the most important risk factor and the only one reaching statistical significance (P < .0002).
Mandibular ORN is a frequent long-term complication of RT for oral cavity and oropharynx cancers. Mandibular surgery before irradiation is the only independent risk factor. These aspects must be considered when planning treatment for these tumors.
下颌放射性骨坏死（ORN）是头颈部癌症患者放疗（RT）的严重并发症。本研究旨在分析口腔和口咽鳞状细胞癌（SCC）患者下颌 ORN 的发生率和危险因素。
病例系列，回顾性图表分析。
头颈肿瘤大学三级治疗中心。
本研究纳入了 2000 年至 2007 年间接受 I 期至 IV 期口腔和口咽 SCC 治疗的 73 例患者，随访时间至少 2 年。治疗方式包括根治性 RT 和肿瘤手术后辅助 RT。采用对数秩检验和 Cox 模型进行单因素和多因素分析。
5 年时下颌 ORN 的发生率为 40%。单因素分析发现以下危险因素：口腔肿瘤（P <.01）、骨侵犯（P <.02）、RT 前有任何手术（P <.04）和骨手术（P <.0001）。多因素分析显示，下颌手术是最重要的危险因素，也是唯一有统计学意义的因素（P <.0002）。
下颌 ORN 是口腔和口咽 SCC 患者 RT 的常见长期并发症。RT 前的下颌手术是唯一的独立危险因素。在为这些肿瘤制定治疗计划时，必须考虑这些方面。
