Identifying and Integrating Predictive Factors for Mandibular Osteoradionecrosis after Irradiation of Head and Neck Cancers.

Abstract Testing for various risk factors for mandibular osteoradionecrosis (ORN) should be performed before and after treatment in patients with head and neck cancer. The different clinical criteria for this severe radiation-induced complication are patient-dependent (intrinsic radiosensitivity, undernutrition due to weight loss, smoking, microcapillary involvement, unstable oral status, hyposalivation) and/or disease-related (oral cancer). The risk factors are also related to the disease (e.g., advanced tumor size, mandibular tumor invasion). Therapeutic risk factors are also associated with a higher risk of ORN (primary tumor surgery, chemotherapy with radiotherapy, tooth extraction after radiotherapy, stomatological follow-up and daily fluoride groove placement, non-observance of prophylaxis in case of absence, and non-observance of curative treatment). Finally, various dose studies have specified parameters targeting dose levels delivered to the mandible that increased the risk of ORN. Mean mandibular doses above 48-54 Gy and a high proportion of mandibular volumes receiving 30-60 Gy appear to discriminate against the risk of developing ORN. Key word: Head and neck cancers – Mandibular osteoradionecrosis – Predictive factors – Dosimetric parameters