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• W2599869034 abstract "Purpose/Objective(s)Osteoradionecrosis (ORN) is a well-known but uncommon side effect of radiation therapy (RT) for head and neck cancer, related to mandibular dose and risk of future dental extractions. This concern often leads to pre-RT extractions of teeth deemed at risk. Typically, risk of ORN is associated with mean dose of ≥50 Gray (Gy). Our study aims to identify dose to each mandibular tooth during adjuvant RT for larynx cancer, in an attempt to identify specific locations at high risk for ORN and help avoid unnecessary extractions for low-risk areas.Materials/MethodsTwenty-six patients who received adjuvant RT (median prescribed dose 60 Gy, range 59.4-66 Gy) for larynx cancer from 2006 to 2014 were selected. Patients were evenly distributed by T and N stage (average 3 patients/group). Individual mandibular tooth borne areas (central and lateral incisors, canines, premolars 1-2, and molars 1-3) were contoured on institutional planning software. Mean and maximum doses were calculated for each tooth. Values were averaged for all patients and for subsets by tooth location: incisors + canines versus premolars versus molars; T stage: T1-2 (n=8) versus T3 (n=9) versus T4 (n=9); N stage: N0 (n=9) versus N1-2b (n=11) versus N2c (n=6); and ipsilateral (IL) versus contralateral (CL) nodal involvement where applicable, in order to identify high-risk areas, defined as mean ≥50 Gy to an individual tooth. ANOVA testing was used to identify statistical significance between subsets.ResultsMean and maximum doses to individual teeth increased with more posterior location in the mouth, with highest average dose to third molars (M3), 46.53 Gy (P<.001). Dose to molars and premolars correlated with T stage (highest dose in M3 for T4 patients, 44.96 Gy) (P=.007). Dose to molars and premolars increased with higher N stage (P<.001); there was a significant difference for N+ versus N0 but not for N1-2b versus N2c. For N0, there was no clear association between dose and T stage, but all doses were well below 50 Gy (highest dose in M3: 36.2 6Gy in T4N0 group). For N1-2b, there was no difference between dose to IL molars compared to their CL counterparts, and the mean for each tooth remained <50 Gy (highest mean for IL M3 and CL M3: 40.89 Gy and 37.56 Gy, respectively). For N2c, average dose was above our threshold for extraction for M3 only (51.45 Gy).ConclusionWith the exception of the posterior molars, particularly in N+ patients, radiation exposure to teeth during adjuvant RT for larynx cancer falls below the dose threshold reported for pre-RT tooth extraction (50 Gy). We conclude that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of ORN in larynx cancer patients receiving adjuvant RT, and that M3 for advanced N stage patients is the subset at highest risk for ORN. Purpose/Objective(s)Osteoradionecrosis (ORN) is a well-known but uncommon side effect of radiation therapy (RT) for head and neck cancer, related to mandibular dose and risk of future dental extractions. This concern often leads to pre-RT extractions of teeth deemed at risk. Typically, risk of ORN is associated with mean dose of ≥50 Gray (Gy). Our study aims to identify dose to each mandibular tooth during adjuvant RT for larynx cancer, in an attempt to identify specific locations at high risk for ORN and help avoid unnecessary extractions for low-risk areas. Osteoradionecrosis (ORN) is a well-known but uncommon side effect of radiation therapy (RT) for head and neck cancer, related to mandibular dose and risk of future dental extractions. This concern often leads to pre-RT extractions of teeth deemed at risk. Typically, risk of ORN is associated with mean dose of ≥50 Gray (Gy). Our study aims to identify dose to each mandibular tooth during adjuvant RT for larynx cancer, in an attempt to identify specific locations at high risk for ORN and help avoid unnecessary extractions for low-risk areas. Materials/MethodsTwenty-six patients who received adjuvant RT (median prescribed dose 60 Gy, range 59.4-66 Gy) for larynx cancer from 2006 to 2014 were selected. Patients were evenly distributed by T and N stage (average 3 patients/group). Individual mandibular tooth borne areas (central and lateral incisors, canines, premolars 1-2, and molars 1-3) were contoured on institutional planning software. Mean and maximum doses were calculated for each tooth. Values were averaged for all patients and for subsets by tooth location: incisors + canines versus premolars versus molars; T stage: T1-2 (n=8) versus T3 (n=9) versus T4 (n=9); N stage: N0 (n=9) versus N1-2b (n=11) versus N2c (n=6); and ipsilateral (IL) versus contralateral (CL) nodal involvement where applicable, in order to identify high-risk areas, defined as mean ≥50 Gy to an individual tooth. ANOVA testing was used to identify statistical significance between subsets. Twenty-six patients who received adjuvant RT (median prescribed dose 60 Gy, range 59.4-66 Gy) for larynx cancer from 2006 to 2014 were selected. Patients were evenly distributed by T and N stage (average 3 patients/group). Individual mandibular tooth borne areas (central and lateral incisors, canines, premolars 1-2, and molars 1-3) were contoured on institutional planning software. Mean and maximum doses were calculated for each tooth. Values were averaged for all patients and for subsets by tooth location: incisors + canines versus premolars versus molars; T stage: T1-2 (n=8) versus T3 (n=9) versus T4 (n=9); N stage: N0 (n=9) versus N1-2b (n=11) versus N2c (n=6); and ipsilateral (IL) versus contralateral (CL) nodal involvement where applicable, in order to identify high-risk areas, defined as mean ≥50 Gy to an individual tooth. ANOVA testing was used to identify statistical significance between subsets. ResultsMean and maximum doses to individual teeth increased with more posterior location in the mouth, with highest average dose to third molars (M3), 46.53 Gy (P<.001). Dose to molars and premolars correlated with T stage (highest dose in M3 for T4 patients, 44.96 Gy) (P=.007). Dose to molars and premolars increased with higher N stage (P<.001); there was a significant difference for N+ versus N0 but not for N1-2b versus N2c. For N0, there was no clear association between dose and T stage, but all doses were well below 50 Gy (highest dose in M3: 36.2 6Gy in T4N0 group). For N1-2b, there was no difference between dose to IL molars compared to their CL counterparts, and the mean for each tooth remained <50 Gy (highest mean for IL M3 and CL M3: 40.89 Gy and 37.56 Gy, respectively). For N2c, average dose was above our threshold for extraction for M3 only (51.45 Gy). Mean and maximum doses to individual teeth increased with more posterior location in the mouth, with highest average dose to third molars (M3), 46.53 Gy (P<.001). Dose to molars and premolars correlated with T stage (highest dose in M3 for T4 patients, 44.96 Gy) (P=.007). Dose to molars and premolars increased with higher N stage (P<.001); there was a significant difference for N+ versus N0 but not for N1-2b versus N2c. For N0, there was no clear association between dose and T stage, but all doses were well below 50 Gy (highest dose in M3: 36.2 6Gy in T4N0 group). For N1-2b, there was no difference between dose to IL molars compared to their CL counterparts, and the mean for each tooth remained <50 Gy (highest mean for IL M3 and CL M3: 40.89 Gy and 37.56 Gy, respectively). For N2c, average dose was above our threshold for extraction for M3 only (51.45 Gy). ConclusionWith the exception of the posterior molars, particularly in N+ patients, radiation exposure to teeth during adjuvant RT for larynx cancer falls below the dose threshold reported for pre-RT tooth extraction (50 Gy). We conclude that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of ORN in larynx cancer patients receiving adjuvant RT, and that M3 for advanced N stage patients is the subset at highest risk for ORN. With the exception of the posterior molars, particularly in N+ patients, radiation exposure to teeth during adjuvant RT for larynx cancer falls below the dose threshold reported for pre-RT tooth extraction (50 Gy). We conclude that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of ORN in larynx cancer patients receiving adjuvant RT, and that M3 for advanced N stage patients is the subset at highest risk for ORN." @default.
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• W2599869034 date "2015-11-01" @default.
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• W2599869034 title "Establishing a Targeted Plan for Prophylactic Dental Extractions in Laryngeal Cancer Patients Receiving Adjuvant Radiation Therapy" @default.
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