A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients.
OBJECTIVE
To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients.


METHODS
The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed.


RESULTS
The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively.


CONCLUSIONS
More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes.
Cheng
Shih-Jung
SJ
Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
Lee
Jang-Jaer
JJ
Ting
Lai-Lei
LL
Tseng
I-Yun
IY
Chang
Hao-Hueng
HH
Chen
Hsin-Ming
HM
Kuo
Ying-Shiung
YS
Hahn
Liang-Jiunn
LJ
Kok
Sang-Heng
SH
D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008439:Maxillary Diseases / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000473:pathology / Q000628:therapy*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic