Planned Dental Extractions After Radiation Therapy.

Autor:	Ward MC; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.; Southeast Radiation Oncology Group, PA, Charlotte, North Carolina., Petersen CM; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina., Noll J; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina., Bernard MS; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina., Kuremsky JG; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.; Southeast Radiation Oncology Group, PA, Charlotte, North Carolina., Patel A; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina., Baldwin C; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina.; Department of Otolaryngology/Head & Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Morgan J; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina.; Department of Otolaryngology/Head & Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Thakkar VV; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.; Southeast Radiation Oncology Group, PA, Charlotte, North Carolina., Atlas JL; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Carrizosa DR; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Prabhu R; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.; Southeast Radiation Oncology Group, PA, Charlotte, North Carolina., Moeller BJ; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.; Southeast Radiation Oncology Group, PA, Charlotte, North Carolina., Milas ZL; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Brickman DS; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Frenkel CH; Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Brennan MT; Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health, Charlotte, North Carolina.; Department of Otolaryngology/Head & Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2024 Oct 01; Vol. 150 (10), pp. 851-858.
DOI:	10.1001/jamaoto.2024.2353
Abstrakt:	Importance: Nonrestorable teeth are recommended to be extracted prior to radiation therapy (RT). Occasionally, preradiation extractions introduce unacceptable delays in treatment initiation. Planned dental extractions immediately postradiation presents an alternative strategy, though outcomes are uncertain. Objective: To evaluate the feasibility and safety of dental extractions immediately postradiation. Design, Setting, and Participants: A prospective cohort study including patients planned for curative-intent RT but unable or unwilling to proceed with 1 or more extractions recommended pretreatment was carried out. From January 2020 to September 2022, 58 patients were screened and 50 enrolled. The dental care was performed at a single academic department and the cancer care at regional centers. Analysis took place between September 22, 2023, and June 10, 2024. Exposure: On completion of RT, patients were recommended to complete extractions as soon as feasible, and ideally within 4 months. Main Outcomes and Measures: The primary end point was the actuarial cumulative incidence of exposed alveolar bone noted by any practitioner at any time after extraction, calculated using Gray method with death as a competing risk. As a pilot study, no formal power calculation was performed; resources allowed for 50 evaluable patients. Results: Among the 50 participants enrolled, RT was nonoperative for 32 patients (64%) and postoperative for 18 patients (36%). Intensity-modulated RT (IMRT) was delivered in all patients. Of the 50 patients, 20 (40%) declined dental extractions immediately postradiation and the remaining 30 (60%) underwent a median (range) of 8.5 (1-28) extractions at a median (range) of 64.5 (13-152) days after RT. The median (IQR) follow-up for survivors without exposed bone was 26 (17-35) months from the end of RT. The 2-year cumulative incidence of any exposed bone was 27% (95% CI, 14%-40%). The 2-year incidence of exposed bone for those who underwent dental extractions immediately postradiation was 40% (95% CI, 22%-58%) and 7% (95% CI, 0%-22%) for those who did not. Of the 13 who developed exposed bone: 4 resolved, 1 was lost to follow-up, and 8 were confirmed as osteoradionecrosis. Conclusions and Relevance: This cohort study found that postradiation dental extractions incur considerable risk, even if performed within a 4-month window.
Databáze:	MEDLINE
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