The association between head and neck radiotherapy, and osteoradionecrosis: A retrospective analysis of risk factors

Head and neck cancer is the fastest accelerating cancer. Radiotherapy is commonly used to treat head and neck cancer. Whilst radiotherapy is an effective treatment modality for head and neck cancer, it is associated with significant early and late side effects which impact on the quality of life of patients. The late side effects of radiotherapy (depending on the volume and dose) may cause irreversible problems such as dysphagia, xerostomia, dental decay, and osteoradionecrosis.

We performed a retrospective analysis of head and neck cancer cases treated with radiotherapy at Leeds Teaching Hospitals Trust, UK. The aim of this process was to perform an exploratory analysis into the potential risk factors for osteoradionecrosis, focussing on risk factors that would be identifiable at a pre-radiotherapy dental screening appointments. This methodology was not utilised to determine statistically significant correlations, but to inform future studies which may involve regression analysis, and subsequent risk prediction.

Our study confirms findings from previous studies suggesting that variables such as the timing of pre-radiotherapy extractions, the number of pre-radiotherapy extractions, and the smoking status of the patient may increase the risk of osteoradionecrosis. We found new potential risk factors which require further investigation, including the presence of dental pathology on the pre-treatment PET-CT. This novel finding may provide further indication of the patient specific risk for osteoradionecrosis.