title: The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience.
abstract: To determine the prevalence and correlation of various risk factors [radiation dose, periodontal status, alcohol and smoking] to the development of osteoradionecrosis (ORN).
  
  
  
  The records of 1023 patients treated with IMRT for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) between 2004 and 2013 were retrospectively reviewed to identify patients who developed ORN. Fisher exact tests were used to analyze patient characteristics between ORN patients with OCC and OPC. Paired Wilcoxon tests were used to compare the dose volumes to the ORN and contralateral non-ORN sites. To evaluate an association between ORN and risk factors, a case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by gender, tumor site and size. General estimation equations models were used to compare the risk factors in ORN cases and matched controls.
  
  
  
  44 (4.3%) patients developed ORN during a median follow-up time of 52.5months. In 82% of patients, ORN occurred spontaneously. Patients with OPC are prone to develop ORN earlier compared to patients with OCC (P=0.03). OPC patients received a higher Dmax compared to OCC patients (P=0.01). In the matched case-control analysis the significant risk factors on univariate analysis were poor periodontal status, history of alcohol use and radiation dose (P=0.03, 0.002 and 0.009, respectively) and on multivariate analysis were alcohol use and radiation dose (P=0.004 and 0.026, respectively).
  
  
  
  In our study, higher radiation dose, poor periodontal status and alcohol use are significantly related to the risk of developing ORN.
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Adepitan A
authors.initials: AA
authors.lastname: Owosho
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: C Jillian
authors.initials: CJ
authors.lastname: Tsai
authors.affiliation: Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, College of Dentistry, New York University, New York, United States.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Lee
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Haley
authors.initials: H
authors.lastname: Freymiller
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Arvin
authors.initials: A
authors.lastname: Kadempour
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Varthis
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Adi Z
authors.initials: AZ
authors.lastname: Sax
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Evan B
authors.initials: EB
authors.lastname: Rosen
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: SaeHee K
authors.initials: SK
authors.lastname: Yom
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Randazzo
authors.affiliation: Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Esther
authors.initials: E
authors.lastname: Drill
authors.affiliation: Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Snehal
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Huryn
authors.affiliation: Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States. Electronic address: estiloc@mskcc.org.
authors.forename: Cherry L
authors.initials: CL
authors.lastname: Estilo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000209:etiology*; D015995:Prevalence; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Head and neck cancer; Intensity-modulated radiation therapy; Oral cancer; Oropharyngeal cancer; Osteoradionecrosis; Prevalence; Risk factors