Professor Emeritus, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University and VCU Medical Center, Richmond, VA.
Associate Professor, Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, VA.
J Oral Maxillofac Surg. 2022 Sep;80(9):1557-1563. doi: 10.1016/j.joms.2022.04.009. Epub 2022 Apr 25.
Oral and maxillofacial surgeons frequently encounter patients who require extractions following exposure to head and neck radiation, and they must assess the risk of extraction and consider alternatives such as deliberate root retention. The purpose of this study was to determine whether dose volume would be a better predictor for osteoradionecrosis (ORN) than total dose.
This is a retrospective cohort study of patients diagnosed with ORN following head and neck radiation (administered between January 2006 and December 2018) and a comparison group selected based on site and dosage who did not develop ORN. The predictor variables were total radiation dose and mandibular dose volume, and the outcome variable was ORN occurrence. Covariates included age, sex, cancer stage and site, radiation therapy type, smoking status, alcohol use, adjuvant chemotherapy use, medical comorbidities, and concomitant tumor surgery. Logistic regression models were employed and area under receiver operating characteristic curve (AUROC) and model accuracy (Acc) were used to determine the better predictor.
A total of 56 patients were included in the study: 27 ORN positive (ORN+) and 29 matched controls who did not develop ORN (ORN-). Most patients were male (76.8%), considered smokers (78.6%), used alcohol (80.4%), were in stage IV (66.1%), received chemotherapy (75.0%), and received intensity modulated radiation therapy radiation (55.4%). The statistical models with V50 Gy (cc) and V65 Gy (cc) dosage variables exhibited greater predictability of ORN occurrence than total dose (AUROC: 0.90 vs 0.76 and model accuracy: 0.82 vs 0.75, respectively).
The results suggest that following head and neck radiation, dose volume may be a better predictor of ORN risk than total dose. This finding is significant, both for the oral and maxillofacial surgeon who is preoperatively assessing ORN risk following radiation exposure, and for the radiation oncologist striving to minimize the risk associated with their treatment.
口腔颌面外科医生经常会遇到因头颈部放疗而需要拔牙的患者，他们必须评估拔牙风险，并考虑其他替代方案，如故意保留牙根。本研究旨在确定剂量体积是否比总剂量更能预测放射性骨坏死（ORN）。
这是一项回顾性队列研究，纳入了 2006 年 1 月至 2018 年 12 月期间因头颈部放疗后诊断为 ORN 的患者（ORN+），并根据部位和剂量选择了未发生 ORN 的对照组（ORN-）。预测变量为总放射剂量和下颌骨剂量体积，结局变量为 ORN 发生情况。协变量包括年龄、性别、癌症分期和部位、放疗类型、吸烟状况、饮酒情况、辅助化疗使用、合并症和伴发肿瘤手术。采用逻辑回归模型，计算并比较了接受者操作特征曲线下面积（AUROC）和模型准确性（Acc），以确定更好的预测因子。
共有 56 例患者纳入研究：27 例 ORN 阳性（ORN+），29 例匹配的对照组未发生 ORN（ORN-）。大多数患者为男性（76.8%），被认为是吸烟者（78.6%），饮酒者（80.4%），处于 IV 期（66.1%），接受化疗（75.0%），并接受调强放疗（55.4%）。V50 Gy（cc）和 V65 Gy（cc）剂量变量的统计模型对 ORN 发生的预测能力强于总剂量（AUROC：0.90 比 0.76 和模型准确性：0.82 比 0.75）。
结果表明，头颈部放疗后，剂量体积可能比总剂量更能预测 ORN 风险。这一发现对于术前评估因放疗暴露导致 ORN 风险的口腔颌面外科医生和努力降低治疗相关风险的放射肿瘤学家都具有重要意义。
