Osteoradionecrosis was once considered a dreaded complication following Radiotherapy for Head and Neck Malignancies, is rarely seen now a days, thanks to the new techniques of radiotherapy and the prophylaxis taken before therapy. Is this complication still be considered among the complications of Radiotherapy?
Absolutely yes. There is some evidence that the complication may occur more often in patients who have received concurrent chemotherapy with radiotherapy. Appropriate dental management is prerequisite to prevention. Additionally, the role of actinomyces and fungal pathogens has been observe, but the role of the organisms is poorly understood. The evidence basis for hyperbaric oxygen is weak. The role of Vitamin E and rheological agents such as pentoxyfyline (Trental) is proposed and may be helpful, though there is only low level evidence supporting this approach. Surgical resection and vascularized bone and/or soft tissue reconstruction is often required in severe cases (i.e pathologic fracture).
I clearly agree with Jeffrey. One main risk factor is the dental status of the patients, which is often poor.
Thank you Jeffrey Bumpous and Oliver Micke for your responses.. In comparison to the older Radiotherapy machines(Cobalt 60), this complication seems to be less, as we have not seen this for last six six years.. off course we do take care of the dental hygiene before subjecting to radiotherapy.. Superficial fungal infections are seen more often even with the advanced techniques of RT. what i wonder is do these newer techniques have an upperhand over the older ones in osteoradionecrosis..
Sir, I feel there is a considerable decrease in the occurence of osteoradionecrosis in the magnitude as it used to be seen in earlier times. And as rightly pointed out the importance given to pre radiotherapy and pre surgical dental prophylaxis have brought down a drastic decrease in the post radiotherapy dental / alveolar ridge related procedures / extractions which evidentally are important for this.
And definitely the newer techniques of 3D IMRT techniques ensure that only the lesion area gets the requisite dose of radiation with the other structures in the path getting lesser radiation which relates to the lesser risk of radionecrosis of the jaws.
Another important consideration is the patient education and importance that is being given to post radiation physiotherapy to maintain the oral opening adequate after the RT therapy to decrease the effects of radiation induced fibrosis related mandibular hypomobility. With a decent oral opening, oral hygiene procedures are also better achieved. I think the new techniques with the wide spread knowledge about the need for dental prophylaxis and extractions prior to RT as well as the newer techniques of RT delivery - all have a hand in the decreased osteoradionecrosis.
Regards,
Dr. Akilesh. R
yes osteoradionecrosis is complication of radiotherapy. and one should prepare patient accordingly. such as planning for radiotherapy for sparing normal tissues. newrer techniques helps in dose reduction and as well as better delivary of radiation such as IMRT, IGRT or IPRT. where these facilities are available it is these are best. but these are not available everywhere and they are costly so not for everybody.
so patient education by doctor and compliance by patient regarding oral hygiene are still important in prevention of osteoradionecrosis.
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