下颌骨放射性骨坏死的长期随访。

Long-term follow-up of osteoradionecrosis of the mandible.

机构信息

Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Department of Oncology, Institute of Clinical Sciences at Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden.

出版信息

Acta Odontol Scand. 2024 Jan;82(1):48-54. doi: 10.1080/00016357.2023.2257316. Epub 2023 Dec 28.

DOI:10.1080/00016357.2023.2257316

PMID:37772879

Abstract

AIM

Investigating the prevalence of mandibular ORN in a single Swedish Oncology Center.

METHODS

A total of 450 patients, treated with radiotherapy for squamous cell carcinoma in the oropharynx between 2004 and 2014 were included. Three different techniques of radiotherapy were studied. ORN diagnosis was set when clinical signs according to Marx were observed, or if radiological signs were staged according to Schwartz and Kagan.

RESULTS

Using the staging system, 90 patients (20%) were diagnosed with ORN. The mean age of the ORN patients was 56.6 years, the older the patient the lower the risk of developing ORN ( = .01). The risk of developing ORN for patients receiving Intensity Modulated Radiotherapy was lower compared to patients treated with the other techniques in the multivariable analysis. Brachytherapy significantly increases the risk of ORN. The risk of ORN increased by 8% each year after radiation ( = .04). The mean time to the ORN diagnosis was 3.9 years. In the multivariate analysis, the risk of ORN increased by 13% each year after radiation ( = .0013).

CONCLUSION

The mean radiation dose was of greater importance for the risk of ORN than the maximum dose. Elderly people with oropharyngeal cancer were less prone to develop ORN.

摘要

目的

调查单一瑞典肿瘤中心下颌骨放射性骨坏死（ORN）的患病率。

方法

共纳入 450 例于 2004 年至 2014 年间因口咽鳞癌接受放射治疗的患者。研究了三种不同的放射治疗技术。当根据 Marx 的临床表现观察到 ORN 诊断，或根据 Schwartz 和 Kagan 的影像学分期时，诊断为 ORN。

结果

使用分期系统，90 例（20%）患者被诊断为 ORN。ORN 患者的平均年龄为 56.6 岁，年龄越大，发生 ORN 的风险越低（ = .01）。在多变量分析中，与接受其他技术治疗的患者相比，接受调强放射治疗的患者发生 ORN 的风险较低。近距离放射治疗显著增加 ORN 的风险。放射治疗后每年 ORN 的风险增加 8%（ = .04）。ORN 诊断的平均时间为 3.9 年。在多变量分析中，放射治疗后 ORN 的风险每年增加 13%（ = .0013）。