Oropharyngeal cancer and osteoradionecrosis in a novel radiation era: a single institution analysis
Dipesh Patel, Sonam Haria, Vinod Patel
Abstract
Abstract Aim This study investigates the incidence of osteoradionecrosis (ORN) in patients with oropharyngeal cancer (OPC) since the use of intensity‐modulating radiation therapy (IMRT). Materials and methods The multi‐disciplinary log for head and neck cancer (HNC) at Guys & St Thomas’ NHS Foundation Trust was used to identify and collect data on all patients with OPC and treated with a curative intent. Basic and oncology‐related demographic data were collected retrospectively. The presence and absence of ORN along with the causative factor was recorded. Results A total of 361 patients were available for analysis 1‐year post‐IMRT with the number decreasing to 129 patients at ≥5 years post‐IMRT. Thirty‐eight cases of ORN were identified from which 29 patients had necrotic areas in the region of pre‐RT dental extractions. The occurrence of spontaneous ORN was most evident within the first 2 years following RT while induced causes appear a steady lifelong threat particularly in the human papilloma virus (HPV)‐positive OPC group. Conclusions The introduction of novel targeted IMRT has not seen a significant reduction in the incidence of ORN with the condition of concern particularly evident in the HPV‐positive OPC group. These patients present with a relatively intact dentition receiving RT doses above the threshold for development of ORN. Additionally, the favourable long‐term survival of the HPV‐positve OPC population is likely to be contributory to the rise of cases seen which provides a clinical challenge the dental sector will have to proactively manage.