Imaging-based maxillomandibular changes after head and neck radiotherapy: A systematic review and meta-analysis

Area of Science:

• Oral and Maxillofacial Radiology
• Oncology
• Radiotherapy

Background:

• Head and neck cancer (HNC) patients undergoing radiotherapy often experience adverse effects on jawbone integrity.
• Understanding these maxillomandibular bone changes is critical for patient management and treatment planning.

Purpose of the Study:

• To systematically review and evaluate maxillomandibular bone changes after radiotherapy in HNC patients.
• To synthesize findings from qualitative and quantitative imaging analyses.

Main Methods:

• Systematic review following PRISMA guidelines, using the PEOS framework.
• Comprehensive literature search across major databases (PubMed, Embase, Cochrane, Web of Science) and gray literature.
• Inclusion of observational studies and experimental clinical trials; exclusion of high-risk bias studies.

Main Results:

• 30 studies with 2441 patients were included, reporting bone integrity alterations like osteoradionecrosis (ORN, 7%), bone sclerosis, and density reduction.
• Panoramic radiography was common; quantitative analyses (radiomics, fractal dimension) detected subtle bone deterioration.
• Periodontal changes and impaired bone healing (delayed ossification, nonunion) were also noted.

Conclusions:

• Radiotherapy significantly impacts head and neck cancer patients' bone integrity and healing capacity.
• Advanced imaging techniques are vital for early detection of radiation-induced bone complications.
• Personalized interventions are needed to mitigate these adverse effects.