M. Niewald et al., RISK-FACTORS AND DOSE-EFFECT RELATIONSHIP FOR OSTEORADIONECROSIS AFTER HYPERFRACTIONATED AND CONVENTIONALLY FRACTIONATED RADIOTHERAPY FOR ORAL-CANCER, British journal of radiology, 69(825), 1996, pp. 847-851
A high frequency of osteoradionecrosis after hyperfractionated radioth
erapy (RT) of head and neck tumours led to a detailed analysis of risk
factors in the dental, surgical, and radiotherapeutic areas. 168 pati
ents with oral cancer were analysed retrospectively. 19% of them had b
een irradiated primarily and 81% postoperatively. 116 patients receive
d a total dose mostly ranging from 60 Gy to 70 Gy to the ICRU 29 refer
ence point (daily single dose 2 Gy). 52 patients were treated hyperfra
ctionally with two daily fractions of 1.2 Gy per day, 4 h minimum apar
t and a total dose 82.8 Gy. Dental findings could be evaluated in 126
patients. Factors were checked for prognostic significance for osteora
dionecrosis (ORN). Dose dependency was computed using a PROBIT analysi
s. Dental status before radiotherapy was generally poor (mean 11/32 te
eth present, of these 1 was dead, 2.4 carious, 2.4 loose, 0.3 destroye
d). On average, six teeth (range 0-27 teeth) had to be extracted. In o
ne-third of the patients bone surgery was necessary. ORN occurred in 8
.6% of the patients treated conventionally but in 22.9% of those treat
ed hyperfractionally (p=0.029). Biologically effective dose (p=0.032)
and deep paradontitis (p=0.034) proved to be significant risk factors
for ORN. PROBIT analysis showed a steadily rising dose dependency of t
he ORN frequency after conventional radiotherapy. Using total doses up
to 70 Gy the frequency of ORN was 8.6%. Dose escalation using hyperfr
actionation led to an intolerable ORN frequency (22.9%) where a short
interfraction interval was a significant factor. The use of this dose
fractionation was therefore discontinued in 1992.