Risk-adapted dental care prior to intensity-modulated radiotherapy (IMRT)

Area of Science:

• Oncology
• Radiation Oncology
• Dental Medicine

Background:

• Intensity-modulated radiotherapy (IMRT) for head-and-neck tumors (HNT) at UniversitätsSpital Zürich (USZ) since 2002 has reduced normal tissue damage.
• IMRT has led to decreased rates of osteoradionecrosis (ORN) and severe xerostomia in HNT patients.
• Risk-adapted dental care (RaDC) was implemented as standard pre-IMRT dental treatment to improve ORN prophylaxis.

Purpose of the Study:

• To evaluate the efficacy of risk-adapted dental care (RaDC) in head-and-neck tumor patients undergoing IMRT.
• To assess the impact of RaDC on the rate of osteoradionecrosis (ORN) as a measure of dental care effectiveness.

Main Methods:

• RaDC was clinically implemented in August 2006 for all HNT patients prior to IMRT.
• A comparison was made between patients receiving RaDC and those treated with conventional dental procedures before IMRT (January 2002 - July 2006).
• The study monitored ORN rates and the number of dental extractions performed.

Main Results:

• The rate of grade-2 osteoradionecrosis (ORN) was similar between conventionally treated (2%) and RaDC groups (1%).
• No grade-3 ORN occurred in either group during the analysis period.
• Fewer dental extractions were performed in the RaDC cohort (47% had no extractions) compared to the conventional care group (27% had no extractions).

Conclusions:

• Minimally invasive dental treatment through RaDC resulted in no higher-grade ORN and no ORN-related jaw resections.
• Risk-adapted dental care is a recommended, effective strategy for ORN prophylaxis in HNT patients undergoing IMRT.
• The findings support the adoption of RaDC as a standard of care for pre-IMRT dental management.