Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based Model Article Swipe
Erin Watson
,
Katrina Hueniken
,
Junhyung Lee
,
Shao Hui Huang
,
Amr El Maghrabi
,
Wei Xu
,
Amy C. Moreno
,
C.J. Tsai
,
Ezra Hahn
,
Andrew McPartlin
,
Christopher M. K. L. Yao
,
David P. Goldstein
,
John R. de Almeida
,
John N. Waldon
,
Clifton D. Fuller
,
Andrew Hope
,
Salvatore L. Ruggiero
,
Michael Glogauer
,
Ali Hosni
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1200/jco.23.01951
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1200/jco.23.01951
PURPOSE Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. METHODS Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). RESULTS ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% ( P < .001) with an AUC of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, ClinRad, was proposed on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems. CONCLUSION We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1200/jco.23.01951
- OA Status
- green
- Cited By
- 22
- References
- 40
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4396568956
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4396568956Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1200/jco.23.01951Digital Object Identifier
- Title
-
Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based ModelWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-05-01Full publication date if available
- Authors
-
Erin Watson, Katrina Hueniken, Junhyung Lee, Shao Hui Huang, Amr El Maghrabi, Wei Xu, Amy C. Moreno, C.J. Tsai, Ezra Hahn, Andrew McPartlin, Christopher M. K. L. Yao, David P. Goldstein, John R. de Almeida, John N. Waldon, Clifton D. Fuller, Andrew Hope, Salvatore L. Ruggiero, Michael Glogauer, Ali HosniList of authors in order
- Landing page
-
https://doi.org/10.1200/jco.23.01951Publisher landing page
- Open access
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YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://www.ncbi.nlm.nih.gov/pmc/articles/11500043Direct OA link when available
- Concepts
-
Medicine, Osteoradionecrosis, Head and neck cancer, Logistic regression, Radiation therapy, Internal medicine, Stage (stratigraphy), Oncology, Biology, PaleontologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
22Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 15, 2024: 7Per-year citation counts (last 5 years)
- References (count)
-
40Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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