Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma

Radiat Oncol. 2021 Jan 5;16(1):1. doi: 10.1186/s13014-020-01701-5.


Background: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.

Methods: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation.

Results: Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001).

Conclusions: V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.

Keywords: Dose-volume histogram; Head and neck squamous cell carcinoma; Osteoradionecrosis of the jaw.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Incidence
  • Jaw / radiation effects
  • Jaw Diseases / epidemiology
  • Jaw Diseases / etiology*
  • Male
  • Middle Aged
  • Osteoradionecrosis / epidemiology
  • Osteoradionecrosis / etiology*
  • Radiotherapy Dosage
  • Radiotherapy, Intensity-Modulated / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Squamous Cell Carcinoma of Head and Neck / radiotherapy*