Establishing a targeted plan for prophylactic dental extractions in patients with laryngeal cancer receiving adjuvant radiotherapy

Publication date: Available online 13 February 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Courtney Hentz, Aidnag Z. Diaz, Richard W. Borrowdale, Bahman Emami, Michael Kase, Mehee Choi
Objective(s)The purpose of this study was to determine dose delivered to individual mandibular tooth-bearing regions during adjuvant intensity-modulated radiotherapy (IMRT) for laryngeal cancers.Study DesignTwenty patients with laryngeal cancer treated with IMRT were included. Individual mandibular tooth-borne areas were manually contoured. Average doses were calculated for individual teeth.ResultsDoses to individual teeth increased with more posterior location. Highest dose was observed for third molar (M3) (43.1Gy, p<0.001). Doses to molars and premolars correlated with T- and N-stage (p=0.007, p<0.001, respectively). For ipsilateral nodal disease, there was no difference between dose to ipsilateral vs. contralateral teeth. Only in N2c tumors, dose was above our threshold for extraction for M3 only (51.5Gy).Conclusion(s)T- and N- stage drive dose to individual mandibular tooth-borne areas. With the exception of the posterior molars, particularly in node-positive patients, radiation exposure falls below the threshold reported for pre-RT tooth extractions (50Gy). We conclude that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of osteoradionecrosis in laryngeal cancer patients receiving adjuvant RT.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1VbnqNX
via IFTTT