Prevention and Management of Osteoradionecrosis in Patients with Head and Neck Cancer Treated with Radiation Therapy

Published online before print May 1, 2024. DOI: 10.1200/JCO.23. 02750

Douglas E. Peterson, Shlomo A. Koyfman, Noam Yarom, Charlotte Duch Lynggaard,  Nofisat Ismaila, Lone E. Forner, Clifton David Fuller, Yvonne M. Mowery, Barbara A. Murphy, Erin Watson,  David H. Yang, Ivan Alajbeg, Paolo Bossi, Michael Fritz, Neal D. Futran, Daphna Y. Gelblum, Edward King, Salvatore Ruggiero, Derek K. Smith, Alessandro Villa, Jonn S. Wu, and Deborah Saunders

Purpose

To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer.

Methods

The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008.

Results

A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation.

Recommendations

Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.

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