title: Establishing a targeted plan for prophylactic dental extractions in patients with laryngeal cancer receiving adjuvant radiotherapy.
abstract: OBJECTIVE
  The purpose of this study was to determine dose delivered to individual mandibular tooth-bearing regions during adjuvant intensity-modulated radiotherapy for laryngeal cancers.
  
  
  METHODS
  Twenty patients with laryngeal cancer treated with intensity-modulated radiotherapy were included. Individual mandibular tooth-borne areas were manually contoured. Average doses were calculated for individual teeth.
  
  
  RESULTS
  Doses to individual teeth increased with more posterior location. Highest dose was observed for third molar (M3) (43.1 Gy; P < .001). Doses to molars and premolars correlated with T- and N-stage (P = .007; P < .001, respectively). For ipsilateral nodal disease, there was no difference between the doses to ipsilateral teeth and contralateral teeth. Only in N2 c tumors, dose was above our threshold for extraction for M3 only (51.5 Gy).
  
  
  CONCLUSIONS
  T- and N-stage drive dose to individual mandibular tooth-borne areas. With the exception of the posterior molars, particularly in node-positive patients, radiation exposure falls below the threshold reported for pre-RT tooth extractions (50 Gy). We concluded that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of osteoradionecrosis in patients with laryngeal cancer receiving adjuvant RT.
authors.affiliation: Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Hentz
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Aidnag Z
authors.initials: AZ
authors.lastname: Diaz
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Borrowdale
authors.affiliation: Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Bahman
authors.initials: B
authors.lastname: Emami
authors.affiliation: Department of Dental Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kase
authors.affiliation: Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address: Mechoi@lumc.edu.
authors.forename: Mehee
authors.initials: M
authors.lastname: Choi
mesh_terms: D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000528:radiation effects*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014070:Tooth / Q000528:radiation effects*; D014081:Tooth Extraction