Occurrence of Jaw Osteonecrosis and Frequency of Prophylactic Tooth Extractions Prior to Head and Neck Radiotherapy: A Retrospective Study of 497 Irradiated Patients
Abstract
1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Statistical Analysis
3. Results
3.1. JORN Incidence and PTE Association
3.2. Time-Dependent Patterns of JORN Development
3.3. Regression Analyses and Predictors of JORN
- HNR dose (HR = 1.03 per Gy [95% CI, 1.01–1.05], p = 0.007; OR = 1.03 [95% CI, 1.00–1.05], p = 0.03)
- Primary tumor site (pharynx) (HR = 0.52 [95% CI, 0.31–0.87], p = 0.03; OR = 0.33 [95% CI, 0.13–0.81], p = 0.02)
- Primary tumor site (larynx) (HR = 0.51 [95% CI, 0.14–0.77], p = 0.01; OR = 0.51 [95% CI, 0.29–0.90], p = 0.02)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Parameter | Overall | PTE Group | Non-PTE Group | p-Value (OR; 95% CI) |
---|---|---|---|---|
Study sample | 497 (100) | 228 (45.9) | 269 (54.0) | N/A |
Age | 61 ± 10.95 | 61 ± 10.35 | 62 ± 11.39 | 0.125 (N/A) |
(14–92) | (30–92) | (14–91) | ||
Median: 61 | Median: 60 | Median: 62 | ||
Male gender | 382 (76.9) | 177 (77.6) | 205 (76.2) | 0.708 (1.084; 0.712–1.648) |
Smoking status | ||||
Smoker | 217 (43.6) | 106 (46.5) | 111 (41.3) | 0.198 (1.265; 0.884–1.810) |
Non-smoker | 272 (54.8) | 117 (51.3) | 155 (57.6) | |
No data | 8 (1.6) | 5 (2.2) | 3 (1.1) | |
Alcohol consumption | ||||
Alcohol abuse | 101 (20.3) | 57 (32.9) | 44 (9.7) | 0.017 (1.705; 1.095–2.649) |
No alcohol abuse | 396 (79.7) | 171 (75.0) | 225 (84.0) | |
Comorbidities | ||||
Cardiovascular disease | 212 (42.7) | 84 (36.8) | 128 (47.6) | 0.023 (0.652; 0.455–0.935) |
Diabetes mellitus | 63 (12.7) | 30 (13.2) | 33 (12.3) | 0.788 (1.084; 0.638–1.840) |
Liver disease | 14 (2.8) | 4 (1.75) | 10 (3.71) | 0.187 (0.463; 0.143–1.495) |
Renal failure | 24 (4.8) | 14 (6.1) | 10 (3.71) | 0.209 (1.694; 0.738–3.891) |
Respiratory disease | 59 (11.9) | 28 (12.3) | 31 (11.5) | 0.696 (1.115; 0.645–1.930) |
Rheumatic disease | 5 (1) | 3 (1.3) | 2 (0.7) | 0.665 (1.780; 0.295–10.746) |
Tumor histological types | ||||
Squamous cell carcinoma (SCC) | 456(91.8) | 211 (92.5) | 245 (91.1) | |
NonSCC | 25 (5) | 13 (5.7) | 12 (4.5) | |
Undiff. carcinoma | 4 (0.8) | 1 (0.4) | 3 (1.1) | |
Adenocarcinoma | 3 (0.6) | 1 (0.4) | 2 (0.7) | |
Neuroendocrine tumor | 3 (0.6) | 0 (0) | 3 (1.1) | |
Adenoid cystic carcinoma | 5 (1.0) | 2 (0.9) | 3 (1.1) | |
Sarcoma | 1 (0.2) | 0 | 1 (0.4) | |
Tumor location | 0.654 (N/A) | |||
Pharynx (tonsil, naso-, oro-, or hypopharynx) | 195 (39.2) | 96 (42.1) | 99 (36.8) | |
Oral cavity including salivary gland | 203 (40.8) | 93 (40.8) | 110 (40.9) | |
Larynx | 76 (15.3) | 35 (15.4) | 41 (15.2) | |
Nose and paranasal sinuses | 23 (4.6) | 4 (1.8) | 19 (7.1) | |
Tumor staging | 0.085 (1.575; 0.937–2.646) | |||
I-II | 71 (14.3) | 26 (11.4) | 45 (16.7) | |
III-IV | 425 (85.5) | 202 (88.6) | 223 (82.9) | |
No data | 1 (0.2) | 1 (0.4) | ||
HNR modality | ||||
3D-CRT | 141 (28.4) | 54 (23.7) | 87 (32.3) | |
IMRT | 324 (65.2) | 160 (70.2) | 164 (61.0) | 0.032 (N/A) |
Particle therapy | 32 (6.4) | 14 (6.1) | 18 (6.7) | |
Primary HNR (adjusted as binary versus adjuvant) | 270 (54.2) | 143 (62.7) | 127 (47.2) | 0.0004 (1.909; 1.332–2.736) |
HNR dosage (Gy) | 68 ± 9.3 | 68 ± 8.7 | 67 ± 9.8 | 0.139 (N/A) |
(30–122.4) | (30–122.4) | (30–120) | ||
Median: 68 | Median: 70 | Median:67 | ||
Chemotherapy | 405 (81.5) | 192 (85.1) | 213 (79.2) | 0.15 (1.402; 0.884–2.736) |
ORN | ||||
Number of cases (total) | 74 (14.9) | 39 (17.1) | 35 (13.0) | 0.209 (1.380; 0.841–2.263) ‡ |
Within year 1 | 32 (43.2) | 20 (51.3) | 12 (34.3) | |
Within year 5 | 71 (95.9) | 36(92.3) | 35(100) | |
Later than year 5 | 3 (4) | 3 (7.7) | 0 (0) | |
Location | ||||
Mandible | 67 (9.5) | 36 (92.3) | 31 (88.6) | |
Maxilla | 5 (6.8) | 1 (2.6) | 4 (11.4) | |
Both maxilla and mandible | 2 (2.7) | 2 (1.3) | 0 (0) | |
Interval between TE and ORN (days) | 753 ± 742 | 724 ± 727 | 786 ± 769 | 0.721 (N/A) |
(37–3861; 74) | (37–3100; 39) | (70–3861; 35) | ||
Median: 465 | Median: 359 | Median: 557 | ||
Follow-up (days; number of cases) | 1531 ± 1290 | 1359 ± 1310 | 1677 ± 1258 | 0.006 (N/A) |
(91–6287; 497) | (91–5347; 228) | (92–6287; 269) | ||
Median: 1161 | Median:859 | Median: 1451 |
Appendix B
Abbreviation | Explanation |
---|---|
3D-RT | 3D Conformal Radiotherapy |
HNC | Head and Neck Cancer |
HNR | Head and Neck Radiotherapy |
HR | Hazard Ratio (Statistical term) |
IMRT | Intensity-Modulated Radiotherapy |
JORN | Jaw Osteoradionecrosis |
MSK | US Memorial Sloan Kettering Cancer Center |
NNH | Number Needed to Harm (statistical term) |
OR | Odds Ratio (statistical term) |
PHR | Proportional Hazard Ratio (statistical term) |
POR | Prevalence Odds Ratio (statistical term) |
PTE | Prophylactic Tooth Extraction |
SRMA | Systematic Reviews with Meta-Analysis |
TE | Tooth Extraction |
TNM Stage | Tumor-Node-Metastasis Stage (tumor classification) |
UKGM | University Hospital Gießen and Marburg |
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Krause, I.; Hirsch, J.; Vorwerk, H.; Stuck, B.A.; Neff, A. Occurrence of Jaw Osteonecrosis and Frequency of Prophylactic Tooth Extractions Prior to Head and Neck Radiotherapy: A Retrospective Study of 497 Irradiated Patients. J. Clin. Med. 2025, 14, 1661. https://doi.org/10.3390/jcm14051661
Krause I, Hirsch J, Vorwerk H, Stuck BA, Neff A. Occurrence of Jaw Osteonecrosis and Frequency of Prophylactic Tooth Extractions Prior to Head and Neck Radiotherapy: A Retrospective Study of 497 Irradiated Patients. Journal of Clinical Medicine. 2025; 14(5):1661. https://doi.org/10.3390/jcm14051661
Chicago/Turabian StyleKrause, Inga, Julius Hirsch, Hilke Vorwerk, Boris A. Stuck, and Andreas Neff. 2025. "Occurrence of Jaw Osteonecrosis and Frequency of Prophylactic Tooth Extractions Prior to Head and Neck Radiotherapy: A Retrospective Study of 497 Irradiated Patients" Journal of Clinical Medicine 14, no. 5: 1661. https://doi.org/10.3390/jcm14051661
APA StyleKrause, I., Hirsch, J., Vorwerk, H., Stuck, B. A., & Neff, A. (2025). Occurrence of Jaw Osteonecrosis and Frequency of Prophylactic Tooth Extractions Prior to Head and Neck Radiotherapy: A Retrospective Study of 497 Irradiated Patients. Journal of Clinical Medicine, 14(5), 1661. https://doi.org/10.3390/jcm14051661