Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

MD Anderson Head and Neck Cancer Symptom Working Group

doi:10.1016/j.radonc.2017.06.026

Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

MD Anderson Head and Neck Cancer Symptom Working Group

Research output: Contribution to journal › Article › peer-review

59 Scopus citations

Abstract

Purpose To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era. Material and methods Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN. Results 68 ORN cases and 131 controls were matched. Median follow-up was 41 months and median time to development of ORN was 16 months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6 Gy, p < 0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p < 0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44 ≥ 42% and V58 ≥ 25%. Conclusions Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44 < 42% and V58 < 25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.

Original language	English (US)
Pages (from-to)	232-239
Number of pages	8
Journal	Radiotherapy and Oncology
Volume	124
Issue number	2
DOIs	https://doi.org/10.1016/j.radonc.2017.06.026
State	Published - Aug 2017

Keywords

Dose-volume histogram
Head and neck cancer
Intensity-modulated radiotherapy
Mandible
Oropharynx cancer
Osteoradionecrosis

ASJC Scopus subject areas

Hematology
Oncology
Radiology Nuclear Medicine and imaging

MD Anderson CCSG core facilities

Biostatistics Resource Group

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10.1016/j.radonc.2017.06.026

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@article{d7b9aab77b0d4fddae03fad7984365ab,

title = "Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison",

abstract = "Purpose To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era. Material and methods Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN. Results 68 ORN cases and 131 controls were matched. Median follow-up was 41 months and median time to development of ORN was 16 months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6 Gy, p < 0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p < 0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44 ≥ 42% and V58 ≥ 25%. Conclusions Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44 < 42% and V58 < 25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.",

keywords = "Dose-volume histogram, Head and neck cancer, Intensity-modulated radiotherapy, Mandible, Oropharynx cancer, Osteoradionecrosis",

author = "{MD Anderson Head and Neck Cancer Symptom Working Group} and Mohamed, {Abdallah S.R.} and Hobbs, {Brian P.} and Hutcheson, {Katherine A.} and Murri, {Michael S.} and Naveen Garg and Juhee Song and {Brandon Gunn}, G. and Vlad Sandulache and Beadle, {Beth M.} and Jack Phan and Morrison, {William H.} and Frank, {Steven J.} and Pierre Blanchard and Garden, {Adam S.} and Hesham El-Halawani and Mona Kamal and Chambers, {Mark S.} and Lewin, {Jan S.} and Renata Ferrarotto and {Ronald Zhu}, X. and Xiaodong Zhang and Hofstede, {Theresa M.} and Cardoso, {Richard C.} and Gillenwater, {Ann M.} and Sturgis, {Erich M.} and Weber, {Randal S.} and Rosenthal, {David I.} and Fuller, {Clifton D.} and Lai, {Stephen Y.}",

note = "Publisher Copyright: {\textcopyright} 2017 Elsevier B.V.",

year = "2017",

month = aug,

doi = "10.1016/j.radonc.2017.06.026",

language = "English (US)",

volume = "124",

pages = "232--239",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

TY - JOUR

T1 - Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy

T2 - Results from a case-matched comparison

AU - MD Anderson Head and Neck Cancer Symptom Working Group

AU - Mohamed, Abdallah S.R.

AU - Hobbs, Brian P.

AU - Hutcheson, Katherine A.

AU - Murri, Michael S.

AU - Garg, Naveen

AU - Song, Juhee

AU - Brandon Gunn, G.

AU - Sandulache, Vlad

AU - Beadle, Beth M.

AU - Phan, Jack

AU - Morrison, William H.

AU - Frank, Steven J.

AU - Blanchard, Pierre

AU - Garden, Adam S.

AU - El-Halawani, Hesham

AU - Kamal, Mona

AU - Chambers, Mark S.

AU - Lewin, Jan S.

AU - Ferrarotto, Renata

AU - Ronald Zhu, X.

AU - Zhang, Xiaodong

AU - Hofstede, Theresa M.

AU - Cardoso, Richard C.

AU - Gillenwater, Ann M.

AU - Sturgis, Erich M.

AU - Weber, Randal S.

AU - Rosenthal, David I.

AU - Fuller, Clifton D.

AU - Lai, Stephen Y.

PY - 2017/8

Y1 - 2017/8

N2 - Purpose To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era. Material and methods Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN. Results 68 ORN cases and 131 controls were matched. Median follow-up was 41 months and median time to development of ORN was 16 months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6 Gy, p < 0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p < 0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44 ≥ 42% and V58 ≥ 25%. Conclusions Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44 < 42% and V58 < 25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.

AB - Purpose To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era. Material and methods Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN. Results 68 ORN cases and 131 controls were matched. Median follow-up was 41 months and median time to development of ORN was 16 months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6 Gy, p < 0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p < 0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44 ≥ 42% and V58 ≥ 25%. Conclusions Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44 < 42% and V58 < 25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.

KW - Dose-volume histogram

KW - Head and neck cancer

KW - Intensity-modulated radiotherapy

KW - Mandible

KW - Oropharynx cancer

KW - Osteoradionecrosis

UR - http://www.scopus.com/inward/record.url?scp=85024920292&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85024920292&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2017.06.026

DO - 10.1016/j.radonc.2017.06.026

M3 - Article

C2 - 28733053

AN - SCOPUS:85024920292

SN - 0167-8140

VL - 124

SP - 232

EP - 239

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

IS - 2

ER -

Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison

Abstract

Keywords

ASJC Scopus subject areas

MD Anderson CCSG core facilities

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