Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies

• Published in: Supportive care in cancer Vol. 18; no. 8; pp. 1089 - 1098
• Main Authors: Peterson, Douglas E., Doerr, Wolfgang, Hovan, Allan, Pinto, Andres, Saunders, Debbie, Elting, Linda S., Spijkervet, Fred K. L., Brennan, Michael T.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.08.2010; Springer; Springer Nature B.V
• Subjects: Analysis; Cancer patients; Care and treatment; Chemotherapy; Combined Modality Therapy; Evidence-Based Medicine; Head & neck cancer; Head and Neck Neoplasms - radiotherapy; Health aspects; Health Care Costs; Health care expenditures; Humans; Medicine; Medicine & Public Health; Nuclear radiation; Nursing; Nursing Research; Oncology; Osteoradionecrosis - economics; Osteoradionecrosis - etiology; Osteoradionecrosis - therapy; Pain Medicine; Practice Guidelines as Topic; Prevalence; Quality of Life; Radiotherapy; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Rehabilitation Medicine; Review Article; Side effects; Strategic planning (Business); Head and neck radiation; Osteoradionecrosis; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-010-0898-6

Purpose The purpose of this study is to review the evidence base from 1990 to 2008 to (1) clarify the impact of cancer therapies on prevalence of osteoradionecrosis (ORN) in head and neck cancer patients, and to (2) evaluate management strategies and their consequences on quality of life and cost of care. Methods Articles were selected for the time period beginning after 1989, excluding the 1990 NCI monograph articles from the 1989 NIH-sponsored Oral Complications in Cancer Therapy Symposium that was published in 1990. The search included both Medline/PubMed and Embase and was limited to humans. The search was limited to publications in the English language. No abstracts were utilized in the current review. Each article was evaluated by two reviewers. A weighted prevalence was calculated for the prevalence of ORN while incorporating predetermined quality measures. The level of evidence, recommendation grade, and guideline (if possible) were provided for published preventive and management strategies for ORN. Results A total of 43 articles between 1990 and 2008 were reviewed. The weighted prevalence for ORN included conventional radiotherapy (RT) = 7.4%, intensity modulated RT (IMRT) = 5.1%, chemoradiotherapy (CRT) = 6.8%, and brachytherapy = 5.3%. Hyperbaric oxygen may contribute a role in management of ORN. However, no clear guideline recommendations could be established for the prevention or treatment of ORN based on the literature reviewed. Conclusions New cancer treatment modalities such as IMRT and concomitant CRT have had minimal effect on prevalence of ORN. No studies to date have systematically addressed impact of ORN on either quality of life or cost of care.