Dental extractions within 2 weeks of RT do not develop into osteoradionecrosis in head and neck cancer patients

Despite this, osteoradionecrosis after pre-RT extractions is relatively rare. The findings, published in JAMA Otolaryngology-Head & Neck Surgery, indicate that patients with head and neck cancer who are to undergo RT should not delay treatment for extractions when it might compromise oncologic control.

The researchers found those who healed had extractions an average of 4.8 days earlier than patients who developed ORN; however, only 1.8% (16 patients) developed ORN associated with pre-RT extractions.

Patients with head and neck cancer undergo teeth extraction with poor prognoses to minimize post-RT extractions, which are known to cause osteoradionecrosis. However, many patients are required to start RT before the complete healing of the extraction sites. The role of pre-RT extractions in ORN development has been disputed in the literature.

Against the above background, Junhyung Lee, Princess Margaret Cancer Centre, Toronto, Ontario, Canada, and colleagues aimed to investigate whether the timing of pre-RT dental extractions is associated with ORN development in patients with head and neck cancer.

For this purpose, the researchers conducted a retrospective cohort study at a single institution in Canada between 2011 and 2018. It included 879 patients with head and neck cancer who underwent pre-RT dental extractions before curative RT of 45 Gy or greater.

The investigators considered patient clinical characteristics and demographic information (eg, nodal involvement, primary cancer site, smoking status, chemotherapy, dental pathology).

The main outcomes of the study were timing (number of days) from dental extractions to RT start date and pre-RT extractions categorized as minor bone spicules (MBS), ORN, or healed.

The study led to the following findings:

• Of 879 patients with a median age of 62 years, 96.3% healed from pre-RT dental extractions, 1.8% developed MBS, and 1.8% developed ORN.
• The median time in number of days from pre-RT extraction(s) to the start of RT was 9 days in the healed cohort, 6 days in the MBS cohort, and 6 days in the ORN cohort.
• There was a large difference in the timing of pre-RT extractions between the healed and the MBS cohorts (mean 11.9 vs 7.4 days to radiation; difference 4.4), and the healed and the ORN cohorts (mean 11.9 vs 7.1 days; difference 4.8 days).

"These findings indicate that the timing of dental extractions affects ORN development, but most extractions performed within 14 days of the radiation therapy start date do not develop into ORN," the researchers concluded.

Reference:

Lee J, Hueniken K, Cuddy K, et al. Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online October 19, 2023. doi:10.1001/jamaoto.2023.3429