Kojima Yuka, Otsuru Mitsunobu, Hasegawa Takumi, Ueda Nobuhiro, Kirita Tadaaki, Yamada Shin-Ichi, Kurita Hiroshi, Shibuya Yasuyuki, Funahara Madoka, Umeda Masahiro
Department of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan.
Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Dent Sci. 2022 Apr;17(2):1024-1029. doi: 10.1016/j.jds.2021.10.019. Epub 2021 Nov 20.
BACKGROUND/PURPOSE: Osteoradionecrosis of the jaw (ORN) often occurs in patients with head and neck cancer undergoing radiotherapy (RT). It has been recommended to extract the tooth before RT that may become source of infection, but in recent years, some investigators have reported that tooth extraction before RT increase the risk of developing ORN and therefore should be avoided. The purpose of the study is to evaluate the risk factors for ORN including tooth extraction before RT.
This was a retrospective study of 366 patients with oral or oropharyngeal cancer who underwent RT of 50 Gy or more at six university hospitals, with follow-up of at least six months post-RT. The relationship between each factor and ORN incidence was analyzed using the Cox proportional hazard model.
Periapical lesions, more than 50% loss of alveolar bone, and tooth extraction after RT significantly correlated with ORN. Intensity-modulated RT showed a lower incidence than three-dimensional conformal RT, although not statistically different. Tooth extraction before RT significantly reduced ORN incidence, after adjusting the background factors using propensity score matching.
In patients with oral or oropharyngeal cancer who underwent RT, periapical lesions, more than 50% loss of alveolar bone, and tooth extraction after RT significantly increased the risk for ORN. Infected tooth extraction before RT significantly reduced the risk.
背景/目的:颌骨放射性骨坏死(ORN)常发生于接受放疗(RT)的头颈癌患者。曾有人建议在放疗前拔除可能成为感染源的牙齿,但近年来,一些研究者报告称放疗前拔牙会增加发生ORN的风险,因此应避免。本研究的目的是评估包括放疗前拔牙在内的ORN危险因素。
这是一项对366例口腔或口咽癌患者的回顾性研究,这些患者在六所大学医院接受了50 Gy或更高剂量的放疗,并在放疗后至少随访6个月。使用Cox比例风险模型分析各因素与ORN发生率之间的关系。
根尖周病变、牙槽骨丧失超过50%以及放疗后拔牙与ORN显著相关。调强放疗的发生率低于三维适形放疗,尽管无统计学差异。在使用倾向评分匹配调整背景因素后,放疗前拔牙显著降低了ORN发生率。
在接受放疗的口腔或口咽癌患者中,根尖周病变、牙槽骨丧失超过50%以及放疗后拔牙显著增加了ORN的风险。放疗前拔除感染牙齿显著降低了风险。