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. 2014 Apr 3;9(1):92.
doi: 10.1186/1748-717X-9-92.

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy

Go Sasahara, Masashi Koto  1 , Hiroaki Ikawa, Azusa Hasegawa, Ryo Takagi, Yoshitaka Okamoto, Tadashi Kamada
Affiliations

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy

Go Sasahara et al. Radiat Oncol. .

Abstract

Background: Osteoradionecrosis (ORN) is a critical complication after carbon ion (C-ion) or photon radiotherapy (RT) for head and neck tumors. However, the risk factors for ORN after C-ion RT remain unclear. Therefore, the present study aimed to investigate the effects of the dose-volume relationship on and risk factors for ORN development after C-ion RT. We, however, focused on the maxillary bone because most tumors treated with C-ion RT were primarily located in the sinonasal cavity.

Methods: The patients enrolled in this study received more than 10% of the prescribed total dose of 57.6 Gy equivalent (GyE) in 16 fractions to their maxilla. All patients were followed up for more than 2 years after C-ion RT. Those with tumor invasion to the maxilla before C-ion RT or local recurrence after the treatment were excluded from the study to accurately evaluate the effects of irradiation on the bone. Sixty-three patients were finally selected. The severity of ORN was assessed according to the Common Terminology Criteria for Adverse Events version 4.0. The correlation between clinical and dosimetric parameters and ORN incidence was retrospectively analyzed.

Results: The median follow-up period was 79 months. Of the 63 enrolled patients, 26 developed ORN of grade ≥1. Multivariate analysis revealed that the maxilla volume receiving more than 50 GyE (V50) and the presence of teeth within the planning target volume were significant risk factors for ORN. Dose-volume histogram analysis revealed that V10 to V50 parameters were significantly higher in patients with ORN than in those without ORN.

Conclusions: V50 and the presence of teeth within the planning target volume were independent risk factors for the development of ORN after C-ion RT using a 16-fraction protocol.

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Figures

Figure 1
Figure 1
Representative magnetic resonance image (MRI) of the maxillary osteoradionecrosis. T1-weighted axial MRI showed low signal appearance in the left maxilla (red arrows).
Figure 2
Figure 2
Representative contouring of the maxilla. All computed tomography images of the contoured maxilla are shown.
Figure 3
Figure 3
The average maxillary volumes receiving 10 to 50 GyE according to the occurrence of osteoradionecrosis. All DVH parameters were significantly higher in patients with ORN than in those without.
See this image and copyright information in PMC

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