Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
School of Medicine, National Defense Medical Center, Taipei, Taiwan.
Clin Otolaryngol. 2020 Nov;45(6):896-903. doi: 10.1111/coa.13624. Epub 2020 Sep 17.
Radiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national healthcare database, we reviewed the contraindications and analysed other risk factors for ORNJ.
A retrospective cohort study.
By using Taiwan's National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1-21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1-7 days and 8-21 days.
Taiwanese patients with head and neck cancer.
Univariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ.
The overall incidence of ORNJ in the included patients was 1.03% (mean follow-up duration, 4.07 ± 3.01 years; range, 1.00-13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio [HR] =0.734; P = .312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488) and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all P < .001).
In a mean follow-up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7-21 days before RT.
头颈部癌症(HNC)患者在拔牙后 7 天内进行放射治疗(RT)是禁忌的,因为这可能会增加颌骨放射性骨坏死(ORNJ)的风险。然而,延迟 RT 可能会影响 HNC 患者的生存。本研究通过使用国家医疗保健数据库,回顾了 ORNJ 的禁忌证,并分析了其他危险因素。
回顾性队列研究。
通过使用台湾全民健康保险研究数据库,纳入了 2000 年至 2013 年间至少有一颗牙齿在第一次 RT 日(索引日)前 1-21 天拔除且在 RT 期间或之后无任何拔牙的 5062 例 HNC 患者。根据拔牙时间,将患者分为两组:索引日前 1-7 天和 8-21 天。
台湾头颈部癌症患者。
采用单变量和多变量 Cox 比例风险回归模型评估 ORNJ 的危险因素。
纳入患者的 ORNJ 总发生率为 1.03%(平均随访时间为 4.07±3.01 年;范围为 1.00-13.99 年)。拔牙后 7 天内进行 RT 与 ORNJ 风险增加无关(风险比[HR]=0.734;P=0.312)。ORNJ 的显著危险因素包括口腔癌(调整后的 HR=3.961)、RT 前 3 个月内进行的肿瘤切除术(调整后的 HR=3.488)和 RT 前 3 个月内行下颌骨切除术(调整后的 HR=5.985;均 P<0.001)。
在平均 4 年的随访中,与拔牙后 7-21 天进行 RT 相比,拔牙后 7 天内进行 HNC 治疗不会增加 ORNJ 风险。