Leeder Julian, Modabber Ali, Hölzle Frank, Eble Michael J, Mohamed Ahmed Allam
Department of Radiation Oncology, Medical Faculty, RWTH Aachen University, Pauwelstraße 30, Aachen, 52074, Germany.
Center for Integrated Oncology Aachen, Bonn, Cologne, and Duesseldorf (CIO ABCD), Aachen, Germany.
Clin Oral Investig. 2025 May 26;29(6):313. doi: 10.1007/s00784-025-06385-3.
Mandibular osteoradionecrosis (ORN) is a serious complication of radiotherapy (RT) for head and neck cancer (HNC), with an incidence of 3-15%. ORN results from radiation-induced bone necrosis and may require surgical intervention. This study investigates clinical and dosimetric predictors of ORN risk and develops a predictive model for individualized risk assessment.
This retrospective case-control study included 298 HNC patients treated with RT or chemoradiotherapy between January 2012 and May 2020. Dosimetric parameters, including mandibular V10-V60, mean dose (Dmean), and maximum dose (Dmax), were analyzed alongside clinical data such as age, tumor site, smoking history, and dental extractions.
Over a median follow-up of 32.4 months, 20 patients (6.7%) developed ORN, with a 5-year cumulative incidence of 7.4%. Multivariate analysis identified mandibular V50 (HR = 1.05, p = 0.0015) and post-RT dental extractions (HR = 2.51, p < 0.0001) as significant ORN risk factors, while age was protective (HR = 0.96, p = 0.047). A V50 cutoff of 25.4 cm³ was most predictive (p = 0.0016). The multivariate model incorporating V50, age, and dental extractions demonstrated strong accuracy (C-index: 0.815, AUC: 0.8).
V50 and post-RT dental extractions are key predictors of ORN. The developed nomogram enables personalized risk assessment, supporting treatment optimization. These findings emphasize the need for tailored RT planning and dental care to mitigate ORN risk, warranting validation in multi-institutional cohorts.
下颌骨放射性骨坏死（ORN）是头颈部癌（HNC）放射治疗（RT）的一种严重并发症，发病率为3%-15%。ORN由辐射诱导的骨坏死引起，可能需要手术干预。本研究调查ORN风险的临床和剂量学预测因素，并开发一种用于个体化风险评估的预测模型。
这项回顾性病例对照研究纳入了2012年1月至2020年5月期间接受RT或放化疗的298例HNC患者。分析了包括下颌骨V10-V60、平均剂量（Dmean）和最大剂量（Dmax）在内的剂量学参数，以及年龄、肿瘤部位、吸烟史和拔牙等临床数据。
中位随访32.4个月时，20例患者（6.7%）发生ORN，5年累积发病率为7.4%。多因素分析确定下颌骨V50（HR = 1.05，p = 0.0015）和放疗后拔牙（HR = 2.51，p < 0.0001）是ORN的重要风险因素，而年龄具有保护作用（HR = 0.96，p = 0.047）。V50阈值为25.4 cm³时预测性最强（p = 0.0016）。纳入V50、年龄和拔牙情况的多因素模型显示出较高的准确性（C指数：0.815，AUC：0.8）。
V50和放疗后拔牙是ORN的关键预测因素。所开发的列线图能够进行个性化风险评估，支持治疗优化。这些发现强调需要进行个体化的放疗计划和牙齿护理以降低ORN风险，有待在多机构队列中进行验证。
