Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

MD Anderson Head and Neck Cancer Symptom Working Group

doi:10.1016/j.radonc.2017.06.026

Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

Radiother Oncol. 2017 Aug;124(2):232-239. doi: 10.1016/j.radonc.2017.06.026. Epub 2017 Jul 18.

Author

MD Anderson Head and Neck Cancer Symptom Working Group

Collaborators

MD Anderson Head and Neck Cancer Symptom Working Group:
Abdallah S R Mohamed¹, Brian P Hobbs², Katherine A Hutcheson³, Michael S Murri⁴, Naveen Garg⁵, Juhee Song², G Brandon Gunn⁴, Vlad Sandulache⁶, Beth M Beadle⁴, Jack Phan⁴, William H Morrison⁴, Steven J Frank⁴, Pierre Blanchard⁷, Adam S Garden⁴, Hesham El-Halawani⁸, Mona Kamal⁸, Mark S Chambers³, Jan S Lewin³, Renata Ferrarotto⁹, X Ronald Zhu¹⁰, Xiaodong Zhang¹⁰, Theresa M Hofstede³, Richard C Cardoso³, Ann M Gillenwater³, Erich M Sturgis³, Randal S Weber³, David I Rosenthal⁴, Clifton D Fuller¹¹, Stephen Y Lai¹²

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
² Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA.
³ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
⁴ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
⁵ Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, USA.
⁶ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, USA.
⁷ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
⁸ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology, Ain Shams University, Cairo, Egypt.
⁹ Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
¹⁰ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, USA.
¹¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt. Electronic address: [email protected].
¹² Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: [email protected].

Abstract

Purpose: To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era.

Material and methods: Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN.

Results: 68 ORN cases and 131 controls were matched. Median follow-up was 41months and median time to development of ORN was 16months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6Gy, p<0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p<0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44≥42% and V58≥25%.

Conclusions: Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44<42% and V58<25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.

Keywords: Dose-volume histogram; Head and neck cancer; Intensity-modulated radiotherapy; Mandible; Oropharynx cancer; Osteoradionecrosis.

MeSH terms

Adult
Aged
Case-Control Studies
Cohort Studies
Dose-Response Relationship, Radiation
Female
Humans
Male
Mandible / pathology
Mandible / radiation effects
Mandibular Diseases
Middle Aged
Oropharyngeal Neoplasms / pathology
Oropharyngeal Neoplasms / radiotherapy*
Osteoradionecrosis / etiology*
Osteoradionecrosis / pathology
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated / adverse effects

Abstract

MeSH terms

Grants and funding