• 沒有找到結果。

Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:54-69

N/A
N/A
Protected

Academic year: 2022

Share "Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:54-69"

Copied!
9
0
0

加載中.... (立即查看全文)

全文

(1)

口腔病理科 On-Line KMU Student Bulletin

原文題目(出處): Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:54-69

原文作者姓名: Syed Nabil,Nabil Samman

通訊作者學校: Prince Philip Dental Hospital, Hong Kong 報告者姓名(組別): 温易宏 Intern L 組

報告日期: 101.08.06

內文:

I. Introduction:

1. Acute toxicity of RT: moist desquamation, skin erythema, loss of taste, and mucositis (resolve with time;Late toxicity: radiation caries, trismus, xerostomia, myelitis, skin fibrosis, and osteoradionecrosis (ORN);recurrent

& ORN are the most dreaded thing,

2. New advances in RT;CCRT ;new delivery of RT;

3. Historic ORN incidence:



4. Aims: clarify the effects of different radiation protocols on the risk of developing ORN of the jaws in the irradiated head andneck cancer population.

II. MATERIALS AND METHODS:

1. Objective: using systemic literature to answer the clinical question, “What is the current risk of developing ORN of the jaws among irradiated head and neck cancer patients?

2. Study identification:“head and neck cancer,” “radiotherapy,” “radiotherapy late toxicity,” and “osteoradionecrosis” as key word in Medline & Embase

(2)

3. Study selection:

4. Type of study:randomized controlled trials (RCTs) involving RT on head and neck cancer patients with a minimum sample size of 20 patients

i. Participants. Consecutive groups of adult patients who had radiation to the

(3)

口腔病理科 On-Line KMU Student Bulletin

excluded. Palliative radiation was excluded

ii. Intervention. Any RT regimes performed as a curativeor adjunctive therapy with surgery in the management of head and neck cancer were included iii. Outcome measures.Radiation Therapy Oncology Group/European

Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema (RTOG/EORTC), Late Effects of Normal Tissue/Somatic Objective Management Analytic (LENT/SOMA), or the National Cancer Institute Common Toxicity Criteria (NCICTC).

5. Eligibility assessment

i. Actual number of cases of bone toxicity/bone necrosis/ORN reported.

ii. Treatment regimen uniform within each arm.

iii. Original data (no secondary analysis).

iv. Reported follow-up of _5 years or median/mean follow-up of surviving patients _3 years.

v. Patient recruitment beginning from 1985 onward.

6. Data collection: The data were collected in Microsoft Excel table form

III.Result:

1. Article selection:

2. Primary outcome: an incidence rate of 2%

(4)

3. Risk of ORN for different tumor locations:

i. 18 articles reported the outcome of RT treatment within the region of the

“head and neck cancer” without subdividing to a more specific; one

“nasopharyngeal carcinoma,”; 2 oropharynx and 1 tongue carcinoma ii. No selected articles reported the outcome of RT treatment in the sinonasal

region

4. Risk of developing ORN when CT agents were used:Overall, 10 articles compared the outcome of RT alone to that of CRT. 5 articles reported higher incidence of ORN when CRT was used,26,28,30,31,37 3 when RT alone was used,22,29,38 whereas 2 articles reported no difference

(5)

口腔病理科 On-Line KMU Student Bulletin

5. Risk of developing ORN in curative RT or adjunctive RT with surgery:similar risk of developing ORN was seen

6. Incidence with different delivery techniques:

7. Difference in risk with different dose rates and treatment time:

8. Risk for the mandible and maxilla: none reported the occurrence of ORN in the maxilla within reported location.

(6)

9. Reporting of dental evaluation: 7 articles reported IV.DISCUSSION:

1. Criteria:

i. spontaneously occurring ORN extent of radiation damage to bone; high dose high rate, between 6M~2Y(Marx and Johnson)

ii. trauma-induced ORN the dental health, dental traumatic event, forever iii. present review to be _5 years of follow-up or a median/mean follow-up of

_3 years. (short survival rate of head and neck cancer),90% or more of ORN cases occur within the first 3 years after RT

iv. ORN is defined as an area of exposed devitalized irradiated bone that fails to heal over a period of 3-6 months in the absence of local neoplastic disease

(7)

口腔病理科 On-Line KMU Student Bulletin

2. ORN rate: 2 out of 100 irradiated head and neck cancer patients at risk of developing ORN; 1968 Clayman find out RT dose change & systematic dental program contribute; may inclusion of all head and neck cancer sites &

exclusion of reirradiation subjects

(8)

3. Some that have been suggested include gender, tobacco and alcohol, tumor site or stage, invasion or proximity of tumor to bone, dental health status, treatment type (EBRT, brachytherapy, neutron beam), chemoradiotherapy, radiation dose,trauma to the bone (extraction, denture-related, cancer surgery), and dose rate/fractionation. But this review aimed on location of tumor, radiation delivery methods, curative or adjunctive therapy, different fractionation schedules, the use of CRT, and dental evaluation before RT .

4. Risk of ORN for different tumor locations:

i. tongue, floor of mouth, alveolar ridge, or retromolar region, are sites with the highest risk of developing ORN after irradiation

ii. sinonasal or nasopharyngeal areas present a higher risk for developing ORN in the maxilla. Reuther et al., who reviewed a series of 830 patients of oral cavity, lip, and oropharyngeal tumors, noted that only 1 out of 68 ORN cases developed in the maxilla. But Homma et al. of 5 maxillary and 1 mandibular ORN observed in a series of 47 sinonasal tumor patients

5. Risk of developing ORN when CT agents were used: Five studies reported worse ORN outcome when CRT was used compared with 3 when RT alone was used. Two other studies reported no difference.This variable outcome indicates that the addition of CT agents to RT does not appear to increase the risk of developing ORN.

6. Risk of developing ORN in curative RT or adjunctive RT with surgery:

Marx and Johnson found that among 536 ORN cases, 48 of them were considered

to be directly caused by the ablative surgery before radiation, and Thorn et al.

observed that 10% of ORN in their series were initiated by the tumor surgery. This review: no difference,

7. Incidence with different delivery techniques i. conventional

ii. Brachytherapy occurrence rate↑

iii. 3D-CRT or IMRT 6% ORN(for xerostomia)

8. Difference in risk with different dose rates and treatment time

(9)

口腔病理科 On-Line KMU Student Bulletin

total dose reductiondecrease 9.risk for the mandible and maxilla: high risk of mandibuleblood supply no article on nasopharynx or sinonasal no maxillary ORN

10. reporting of dental evaluation: most reported ORN owing dental causeno difference

V conclusion:

1.2/100 incidence due to OH awareness, better radiation technology, inclusion of low-risk & high-risk tumor sites, and exclusion of reirradiation patient.

2.6.88/100 in post-RT tooth extraction

3.adjunctive RT, accelerated fractionation, CRTno definitive increase 4.hyperfractionation possible increased risk

5.suggest confirm tumor site, preradiotherapy dental assessment on the risk of developing ORN

題號 題目

1 本回顧中認為甚麼因素跟 ORN 沒有相關

(A) Hyperfractionation RT

(B) 上顎或是下顎

(C) dental evaluation (D) Oral hygein

答 案

( C)

出處:本文獻

題號 題目

2 最讓病人困擾的 POST-RT PROBLEM

(A) ORN

(B) RECURRENCE (C) 以上皆是 (D) 以上皆非

答 案

( C)

出處:本文獻

參考文獻

相關文件

原文題目(出處): C-reactive protein levels: a prognostic marker for patients with head and neck cancer?. Head & Neck

a gradual worsening of diffuse unilateral headaches and scalp tenderness, facial pain or sore throat without headache, temporal artery abnormalities, chest pain, fever,

Iwaki et al., “Oral malignant melanoma in Japan,” Oral Surgery, Oral Medicine, Oral Pathology, vol.. Myers, “Melanoma of the head and neck: current concepts in staging, diagnosis,

Accurate identification of the microscopic risk factors of oral and oropharyngeal (OP) squamous cell carcinomas (SCC) and their morphologic variants is of at most importance, as

The proliferative rate can also be assessed on the basis of the number of mitoses per unit area of tumor (mitoses per 10 hpf or per 2 mm2). Ki67 is the biologic marker of

On magnetic resonance imaging (MRI), the presentation is less specific. The lesion demonstrates hypointense signals on both T1- and T2-weighted images, without gadolinium

The acquisition slab was oriented in the transverse direction on the sagittal and coronal scout images so that both sides of the trigeminal nerve could be included in the image.

Background: Gold standard for the diagnosis of oral dysplasia (OD) oral squamous cell carcinoma (OSCC) and malignant lesions is the histological examination.. Several