Department of Oral Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina; Department of Otolaryngology/Head and Neck Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2022 Jun 1;113(2):320-330. doi: 10.1016/j.ijrobp.2021.11.021. Epub 2021 Dec 5.
To elucidate long-term sequelae of radiation therapy (RT) in head and neck cancer (HNC) patients, a multicenter, prospective study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), was established with tooth failure as its primary outcome. We report tooth failure and associated risk factors.
Demographics and cancer and dental disease characteristics were documented in 572 HNC patients at baseline and 6, 12, 18, and 24 months after RT. Eligible patients were aged 18 or older, diagnosed with HNC, and receiving RT to treat HNC. Tooth failure during follow-up was defined as losing a tooth or having a tooth deemed hopeless. Analyses of time to first tooth-failure event and number of teeth that failed used Kaplan-Meier estimators, Cox regression, and generalized linear models.
At 2 years, the estimated fraction of tooth failure was 17.8% (95% confidence interval, 14.3%-21.3%). The number of teeth that failed was higher for those with fewer teeth at baseline (P < .0001), greater reduction in salivary flow rate (P = .013), and noncompliance with daily oral hygiene (P = .03). Patients with dental caries at baseline had a higher risk of tooth failure with decreased salivary flow. Patients who were oral-hygiene noncompliant at baseline but compliant at all follow-up visits had the fewest teeth that failed; greatest tooth failure occurred in participants who were noncompliant at baseline and follow-up.
Despite pre-RT dental management, substantial tooth failure occurs within 2 years after RT for HNC. Identified factors may help to predict or reduce risk of post-RT tooth failure.
为了阐明头颈部癌症（HNC）患者放射治疗（RT）的长期后遗症，建立了一个多中心、前瞻性研究，即头颈部癌症患者牙科结局临床登记（OraRad），以牙齿失败为主要结局。我们报告了牙齿失败及其相关的危险因素。
在 RT 后 6、12、18 和 24 个月，对 572 名 HNC 患者的人口统计学、癌症和牙科疾病特征进行了记录。符合条件的患者年龄在 18 岁或以上，诊断为 HNC，并接受 RT 治疗 HNC。随访期间牙齿失败定义为失去一颗或多颗牙齿或认为牙齿无望保留。使用 Kaplan-Meier 估计器、Cox 回归和广义线性模型分析首次牙齿失败事件的时间和失败牙齿的数量。
在 2 年时，牙齿失败的估计比例为 17.8%（95%置信区间，14.3%-21.3%）。失败的牙齿数量随着基线时牙齿数量较少（P<.0001）、唾液流量减少更大（P=.013）和日常口腔卫生不依从（P=.03）而增加。基线时有龋齿的患者唾液流量减少时牙齿失败的风险更高。基线时不遵守口腔卫生但在所有随访时都遵守的患者失败的牙齿最少；在基线和随访时均不遵守的参与者牙齿失败最多。
尽管进行了 RT 前的牙科管理，但 HNC 患者在 RT 后 2 年内仍会发生大量牙齿失败。确定的因素可能有助于预测或降低 RT 后牙齿失败的风险。
