Document Detail


Multimodality surgical and hyperbaric management of mandibular osteoradionecrosis.
MedLine Citation:
PMID:  19328634     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To elucidate long-term outcomes in 65 consecutive patients meeting a uniform definition of mandibular osteoradionecrosis (ORN) treated with multimodality therapy including hyperbaric oxygen (HBO). METHODS AND MATERIALS: Pretreatment, post-treatment and long-term follow-up of mandibular lesions with exposed bone were ranked by a systematic review of medical records and patient telephone calls. The ranking system was based on lesion diameter and number plus disease progression. Changes from pretreatment to post-treatment and follow-up were analyzed by Wilcoxon signed-rank tests. Improved wound survival, measured by time to relapse, defined as any less favorable rank after HBO treatment, was assessed by Kaplan-Meier analysis. RESULTS: In all, 57 cases (88%) resolved or improved by lesion grade or progression and evolution criteria after HBO (p < 0.001). Four patients healed before surgery after HBO alone. Of 57 patients who experienced improvement, 41 had failed previous nonmultimodality therapy for 3 months and 26 for 6 months or more. A total of 43 patients were eligible for time-to-relapse survival analysis. Healing or improvement lasted a mean duration of 86.1 months (95% confidence interval [95% CI], 64.0-108.2) in nonsmokers (n = 20) vs. 15.8 months (95% CI, 8.4-23.2) in smokers (n = 14) versus 24.2 months (95% CI, 15.2-33.2) in patients with recurrent cancer (n = 9) (p = 0.002 by the log-rank method). CONCLUSIONS: Multimodality therapy using HBO is effective for ORN when less intensive therapies have failed. Although the healing rate in similarly affected patients not treated with HBO is unknown, the improvements seen with peri-operative HBO were durable provided that the patients remained cancer free and abstained from smoking.
Authors:
John J Freiberger; David S Yoo; Guy de Lisle Dear; Thomas A McGraw; George H Blakey; Rebecca Padilla Burgos; Kevin Kraft; John W Nelson; Richard E Moon; Claude A Piantadosi
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-03-26
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  75     ISSN:  1879-355X     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-05     Completed Date:  2009-10-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  717-24     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC, USA. freib002@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Carcinoma, Adenoid Cystic / radiotherapy
Carcinoma, Squamous Cell / radiotherapy
Combined Modality Therapy / methods
Confidence Intervals
Female
Follow-Up Studies
Head and Neck Neoplasms / radiotherapy*
Hodgkin Disease / radiotherapy
Humans
Hyperbaric Oxygenation*
Male
Mandibular Diseases / surgery,  therapy*
Middle Aged
Osteoradionecrosis / surgery,  therapy*
Smoking / adverse effects
Statistics, Nonparametric
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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