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The prevention and management of osteoradionecrosis of the jaw in patients with head and neck cancer: summary of the best evidence

Published on Dec. 05, 2020Total Views: 7745 timesTotal Downloads: 2268 timesDownloadMobile

Author: Yu-Jie SHI 1 Ling GAO 2 Chuan-Yu HU 3 Xia LI 4, 5 Jun-Ying LI 6 Rui LIU 7 Shang XIE 8 Jun-Hui YANG 9 Zhuan-Jun YAN 10 Fan ZHONG 11 Ji-Bin ZHANG 12 Jun SHAO 1, 13*

Affiliation: 1. School of Stomatology Jinan University, Guangzhou 510632, China 2. Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China 3. Stomatology Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 4. School of Stomatology, Foshan University, Foshan 528225, Guangdong Province, China 5. Department of Oral Mucous Disease, Foshan Stomatological Hospital, Foshan 528000, Guangdong Province, China 6. Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, American 7. Department of Stomatology, Daping Hospital, Army Medical University, Chongqing 400042, China 8. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China 9. Department of Oral and Maxillofacial Surgery, Shenzhen Hospital, Peking University, Shenzhen 518036, Guangdong Province, China 10. Department of Prosthodontics, Affiliated Hospital of Qinghai University, Xining 810001, China 11. Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou 510060, China 12. Department of Stomatology, Panyu Central Hospital, Guangzhou 511400, China 13. Department of Stomatology, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou 510800, China

Keywords: Osteoradionecrosis Head and neck cancer Best evidence

DOI: 10.12173/j.issn.1004-5511.2020.06.02

Reference: Shi YJ, Gao L, Hu CY, Li X, Li JY, Liu R, Xie S, Yang HJ, Yan ZJ, Zhong F, Zhang JB, Shao J. The prevention and management of osteoradionecrosis of the jaw in patients with head and neck cancer: Summary of the best evidence[J]. Yixue Xinzhi Zazhi, 2020, 30(6): 415-430. DOI: 10.12173/j.issn.1004-5511.2020.06.02.[Article in Chinese]

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Abstract

Objective  Osteoradionecrosis is a serious complication of radiotherapy for head and neck cancer, which not only leads to severe decrease of life quality of head and neck cancer survivors but also increases the economic burden of patients. Currently, there are no specific guidelines for the prevention and management of osteoradionecrosis worldwide. In this study, we summarized the best evidence of  these problems in order to provide reference for clinical practice. 

Methods  Systematic retrieval from the inception of the database to June 18, 2020 of CNKI, VIP, Wanfang, CBM, PubMed, Web Of Science, Cochrane Library, CINAHL, guideline databases both in domestic and abroad as well as official website of relevant professional institutes was conducted to acquire relevant evidence, including guidelines, expert consensus and systematic review. Appropriate tools of quality evaluation were used to access the included literature and the best evidences for the prevention and management of osteonecrosis were summed up. 

Results  Finally, among the 11 literatures included, 6 are guidelines, 3 are expert consensus and 2 are systematic reviews. In general, The quality of methodology of the included literatures are relatively high. Researchers summarized the risk factor of osteoradionecrosis (including patient factors, tumor factors and treatment factors), the prevention of ORN before radiotherapy (including surgical prevention, the education of oral hygiene and dental examination and treatment), during radiotherapy (including oral and dental monitoring, precautions of radiotherapy) and after radiotherapy (including maintenance of  oral and dental surveillance, the prevention of caries and periodontal diseases and considerations of tooth extraction after radiotherapy).  The management of ORN was also summarized, which including imaging examination, conservative and surgical treatment as well as the efficacy evaluation of treatment of mandibular osteoradionecrosis. For the controversial treatment of hyperbaric oxygen, the available evidence does not recommend the use of hyperbaric oxygen alone or routinely. 

Conclusions  In this study, we summarized the best current evidences about the prevention and management of osteoradionecrosis. The importance of oral hygiene education, oral and dental surveillance, positive prevention and treatment of dental caries and periodontal disease was emphasized. Intensity modulated radiotherapy (IMRT) is recommended to reduce the radiation dose in the field. The treatment of ORN mainly includes conservative treatment and surgical treatment. However, these evidences still have some limitations so that medical workers should take the specific situation into consideration in the clinical application.

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