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Radiother Oncol. 2017 Aug;124(2):232-239. doi: 10.1016/j.radonc.2017.06.026. Epub 2017 Jul 18.

Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison.

Author information

1
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
2
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA.
3
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
4
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
5
Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, USA.
6
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, USA.
7
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
8
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology, Ain Shams University, Cairo, Egypt.
9
Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
10
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, USA.
11
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt. Electronic address: cdfuller@mdanderson.org.
12
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: sylai@mdanderson.org.

Abstract

PURPOSE:

To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era.

MATERIAL AND METHODS:

Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN.

RESULTS:

68 ORN cases and 131 controls were matched. Median follow-up was 41months and median time to development of ORN was 16months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6Gy, p<0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p<0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44≥42% and V58≥25%.

CONCLUSIONS:

Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44<42% and V58<25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.

KEYWORDS:

Dose-volume histogram; Head and neck cancer; Intensity-modulated radiotherapy; Mandible; Oropharynx cancer; Osteoradionecrosis

PMID:
28733053
PMCID:
PMC5572506
DOI:
10.1016/j.radonc.2017.06.026
[Indexed for MEDLINE]
Free PMC Article

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