title: The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline.
abstract: Osteoradionecrosis of the jaw (ORN) is an infrequent yet potentially devastating complication of radiation therapy to the head and neck region. Treatment options include antimicrobial therapy, local sequestrectomy, resection, and the use of hyperbaric oxygen (HBO). Published data on ORN are difficult to compare because of the lack of a universally accepted classification and staging system, and the literature on the use of HBO to either prevent or successfully manage ORN is controversial and inconclusive. Therefore, we aimed to establish a standard approach for using HBO at our institution.
  
  
  
  A literature search was conducted of articles published in the English language between January 1980 and January 2016. Retrieved articles were evaluated by two independent reviewers. Isolated case reports, abstracts, case series, review articles, and cohort studies without a control group were excluded; summary data were extracted from the remaining studies. A panel of experts from Head and Neck Oncology and Oral Medicine from the Dana-Farber Cancer Institute and Brigham and Women's Hospital reviewed the summary data and established multidisciplinary guidelines on the use of HBO for the prevention and management of ORN.
  
  
  
  Seven studies were evaluated and reviewed by the multidisciplinary panel. There was no consistent evidence in support of HBO for either the prevention or management of ORN.
  
  
  
  Based on the available evidence and expert opinion, routine use of HBO for the prevention or management of ORN is not recommended and is rarely used at our institution.The Oncologist2017;22:343-350 IMPLICATIONS FOR PRACTICE: The Division of Head and Neck Oncology of Dana-Farber/Brigham and Women's Cancer Center does not recommend the routine use of HBO for the prevention or management of ORN. Adjunctive HBO may be considered for use on a case-by-case basis in patients considered to be at exceptionally high risk who have failed conservative therapy and subsequent surgical resection.
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Hanna
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Margalit
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org
authors.forename: Nicole
authors.initials: N
authors.lastname: Chau
authors.affiliation: Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org
authors.forename: Guilherme
authors.initials: G
authors.lastname: Rabinowits
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Schoenfeld
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.|Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Sonis
authors.affiliation: Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Thomas
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.|Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Treister
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.|Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Villa
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.|Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
authors.forename: Sook-Bin
authors.initials: SB
authors.lastname: Woo
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org|Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Haddad
authors.affiliation: Department of Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia|Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
authors.forename: Hani
authors.initials: H
authors.lastname: Mawardi
mesh_terms: D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007568:Jaw / Q000473:pathology / Q000528:radiation effects; D010025:Osteoradionecrosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Hyperbaric oxygen; Management; Osteoradionecrosis; Prevention