Department of Oncology, University of Ostrava, Ostrava, Czech Republic; Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK.
Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Clin Oncol (R Coll Radiol). 2023 Sep;35(9):e498-e505. doi: 10.1016/j.clon.2023.06.013. Epub 2023 Jun 27.
Osteoradionecrosis (ORN) is a serious toxicity of head and neck radiotherapy. It predominantly affects the mandible. Extra-mandibular ORN is rare. The aim of this study was to report the incidence and outcomes of extra-mandibular ORNs from a large institutional database.
In total, 2303 head and neck cancer patients were treated with radical or adjuvant radiotherapy. Of these, extra-mandibular ORN developed in 13 patients (0.5%).
Maxillary ORNs (n = 8) were a consequence of the treatment of various primaries (oropharynx = 3, sinonasal = 2, maxilla = 2, parotid = 1). The median interval from the end of radiotherapy to the development of ORN was 7.5 months (range 3-42 months). The median radiotherapy dose in the centre of the ORN was 48.5 Gy (range 22-66.5 Gy). Four patients (50%) healed in 7, 14, 20 and 41 months. All temporal bone ORNs (n = 5) developed after treatment to the parotid gland (of a total of 115 patients who received radiotherapy for parotid gland malignancy). The median interval from the end of radiotherapy to the development of ORN was 41 months (range 20-68 months). The median total dose in the centre of the ORN was 63.5 Gy (range 60.2-65.3 Gy). ORN healed in only one patient after 32 months of treatment with repeated debridement and topical betamethasone cream.
Extra-mandibular ORN is a rare late toxicity and this current study provides useful information on its incidence and outcome. The risk of temporal bone ORN should be considered in the treatment of parotid malignancies and patients should be counselled. More research is required to determine the optimal management of extra-mandibular ORN, particularly on the role of the PENTOCLO regimen.
放射性骨坏死（ORN）是头颈部放射治疗的一种严重毒性反应。它主要影响下颌骨。颌外 ORN 很少见。本研究的目的是从大型机构数据库报告颌外 ORN 的发生率和结果。
共有 2303 例头颈部癌症患者接受根治性或辅助性放疗。其中，13 例（0.5%）发生颌外 ORN。
上颌 ORN（n=8）是治疗各种原发灶（口咽=3、鼻旁窦=2、上颌=2、腮腺=1）的结果。从放疗结束到 ORN 发生的中位间隔时间为 7.5 个月（范围 3-42 个月）。ORN 中心的中位放疗剂量为 48.5Gy（范围 22-66.5Gy）。4 例（50%）在 7、14、20 和 41 个月时愈合。所有颞骨 ORN（n=5）均在腮腺放疗后（共 115 例接受腮腺恶性肿瘤放疗的患者）发生。从放疗结束到 ORN 发生的中位间隔时间为 41 个月（范围 20-68 个月）。ORN 中心的中位总剂量为 63.5Gy（范围 60.2-65.3Gy）。1 例患者在接受重复清创和局部倍他米松乳膏治疗 32 个月后 ORN 愈合。
颌外 ORN 是一种罕见的晚期毒性反应，本研究提供了其发生率和结果的有用信息。在治疗腮腺恶性肿瘤时应考虑颞骨 ORN 的风险，并对患者进行咨询。需要更多的研究来确定颌外 ORN 的最佳治疗方法，特别是 PENTOCLO 方案的作用。
