Author: Serageldin Attia, Zayne Belal, Cem Dede, Clifton David Fuller, Andrew Hope, Laia Humbert Vidan, Kate Hutcheson, Zaphanlene Kaffey, Stephen Y. Lai, Abdallah Mohamed, Amy Moreno, Jillian Rigert, Erin Watson 👨🔬
Affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., The University of Texas MD Anderson Cancer Center, UT MD Anderson, Princess Margaret Cancer Centre, UT MD Anderson Cancer Center, Hospital of the University of Pennsylvania, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Department of Head and Neck Surgery, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology 🌍
Purpose: Osteoradionecrosis (ORN) of the jaw is a debilitating radiation-induced toxicity lacking standardized classification criteria or treatment guidelines. Early identification of tissue injury could improve prediction, prevention, and management of ORN. This study aimed to identify the initial signs of ORN and assess the utility of the ClinRad classification system recently endorsed by the International Society of Oral Oncology and the American Society of Clinical Oncology as the gold standard for staging ORN.
Methods: We retrospectively reviewed 91 head and neck cancer patients treated at The University of Texas MD Anderson Cancer Center with suspected ORN. Patients who received reirradiation or lacked sufficient evidence of ORN were excluded. An oral medicine specialist reviewed imaging and clinical records to identify early signs of ORN. Cases were classified using the ClinRad system, and analyses included patient demographics, treatments, initial ORN presentations, and disease progression rates.
Results: Of 51 patients, 37% had imaging-only findings without bone exposure, while 53% exhibited both imaging findings and exposed bone. Disease progression occurred in 26% of imaging-only cases, with 63% classified as Stage 0/Grade 1. Time to ORN onset ranged from 4–62 months (mean 21 months). The ClinRad system successfully staged all cases. Imaging identified subclinical bony changes before clinical symptoms.
Conclusion: Imaging findings are critical early indicators of ORN, often preceding clinical symptoms. While imaging is not yet standardized for ORN diagnosis, this research validates its use in detecting and staging ORN, particularly at subclinical stages. Early imaging enables timely intervention, improving patient outcomes. ClinRad effectively staged ORN across its progression, demonstrating its utility in capturing early and advanced disease. These findings support integrating imaging protocols and ClinRad for early diagnosis and staging. Future studies should further validate ClinRad’s role in clinical practice and establish standardized guidelines for ORN prevention and management.