title: Factors predictive of severity of osteoradionecrosis of the mandible.
abstract: BACKGROUND
  An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition.
  
  
  METHODS
  We retrospectively analyzed 46 patients diagnosed between June 2002 and March 2009: 93% had mandibular ORN, which was staged 0 to III (Store and Boysen). Patient, tumor, treatment-related, and other variables were analyzed for association with mandibular ORN severity.
  
  
  RESULTS
  Oral or oropharyngeal tumors comprised 85% of our primary tumors, 80% were stage IV, and 91% were squamous cell carcinomas. Most patients (87%) received 3-dimensional (3D) conformal radiation therapy (RT), with 60 Gray (Gy) median dose; 28% and 72% received primary and adjuvant RT, respectively; 78% received chemotherapy, mostly concurrent (97%) and platinum-based (96%). Median time to development of ORN was 7.5 months. White ethnicity and secondary infection correlated significantly with stage III mandibular ORN (p = .038, p = .0007, respectively). Advanced age, stage IV, RT dose, post-RT, and lack of pre-RT dental extractions appeared predictive of severe mandibular ORN.
  
  
  CONCLUSIONS
  The above-cited factors are predictive of severity and can potentially guide prophylaxis and management.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA. shamitchopra@hotmail.com
authors.forename: Shamit
authors.initials: S
authors.lastname: Chopra
authors.forename: Dev
authors.initials: D
authors.lastname: Kamdar
authors.forename: Ozlem E Tulunay
authors.initials: OE
authors.lastname: Ugur
authors.forename: George
authors.initials: G
authors.lastname: Chen
authors.forename: Brian
authors.initials: B
authors.lastname: Peshek
authors.forename: Mark
authors.initials: M
authors.lastname: Marunick
authors.forename: Harold
authors.initials: H
authors.lastname: Kim
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: John
authors.initials: J
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008336:Mandibular Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D010025:Osteoradionecrosis / Q000453:epidemiology / Q000473:pathology*; D011237:Predictive Value of Tests; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult