Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Osteoradionecrosis (ORN) of the jaw is a severe and debilitating complication associated with radiotherapy during the treatment of recurrent nasopharyngeal carcinoma (RNPC). With technological advancements in radiotherapy techniques, there has been a significant improvement in the control of RNPC; however, the risk of ORN remains a critical concern due to its impact on quality of life and its resistance to conventional treatments. This study aims to investigate the prevalence of ORN among patients undergoing radiotherapy for RNPC, analyzing risk factors associated with its development to provide insights into better preventive and management strategies.
Methods: A systematic review and meta-analysis was conducted according to 2020 PRISMA guidelines. Three databases (PubMed, Scopus, and Web of Science) were screened to determine the number of ORN complications. The authors screened the available studies for inclusion and exclusion criteria. Inclusion criteria included randomized controlled trials, prospective and retrospective cohort trials, and patients with RNPC undergoing radiotherapy with a reported incidence of ORN. Case series were excluded in addition to any studies with no RNPC or lack of delineation of RNPC groups, patients undergoing treatments other than radiotherapy for RNPC, and patients whose full texts were not attainable. ORN was analyzed using single proportions meta-analysis on R studio. Meta-regression analysis was performed on age, the total dose of reirradiation radiotherapy, and the recurrent tumor stage. Egger’s regression test and funnel plot were generated to assess publication bias.
Results: The literature search yielded 782 studies for systematic review. After deleting 314 duplicates, 468 studies were screened by two authors. After a two-pass system screening by abstract and title, 42 studies were reviewed for Full-text screening. After full-text screening, eight final studies were used in the analysis. The incidence of ORN following treatment for RNPC was 8%, with a pooled follow-up period of 35.4 months (95% CI [5%, 10%], I2=0.73, p<0.01). Funnel plot and Egger’s test indicated a lack of publication bias p=0.25. Meta-regression analysis of age, rT staging, and total radiotherapy dosage showed no significant correlation toward the incidence of ORN.
Conclusion: Our findings highlight the incidence rate of ORN following various aggressive radiotherapy treatments, such as fractionated or intensity-modulated radiotherapy. No correlation was found between recurrent tumor staging, age, or total radiotherapy dosage administered. More studies are needed to examine other possible risk factors for osteoradionecrosis.