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Management of postirradiation bone necrosis of mandible
Radiation Oncology ??Biology ??Physics
86 ARS 63rd Annual Meeting
Smal1 lesions can be treated adequately by either surgery or radiotherapy, but a large number of cases are big on presentation and are best treated with radiation. Some cases illustrating the pitfalls of inadequate selection wil1 be presented. It is perhaps important to remind not only radiation oncologists, but al1 our colleagues dealing with lip cancer, that radiation plays an important role in the management of lip cancer. Great care should be taken in selecting the best modality for every patient and prevent unnecessary death and horrible
disfigurement.
(113)
SALIVARY GLAND TUMORS IN PATIENTS WITH A HISTORY OF CHILDHOOD HEAD AND NECK IRRADIATION: REPORT OF FORY-ONE
Alfred
D. Katz,M.
D. ,* Stephen E. Lee,
M.D.,
and Susan Preston-Martin,
CASES
Ph. D.
Cedars Sinai Medical Center, Division of General Surgery and the University of Southem Califomia School of Medicine, Department of Family and Preventive Medicine Childhood
head and neck irradiation
was administered
for benign disease to millions
of Americans in the second to sixth decade of the twentieth century. The increased incidence of thyroid cancer in this irradiated group has been wel1 documented. More recently, the polyglandular aspect of this iatrogenic disease hos been presented with the association of parathyroid
disease and saiivary gland neoplasms.
In the further evaluation
of irmdiation sources as a possible etiological agent of salivary gland neoplasms, excesrive dental x-rays must be considered. Salivary gland irradiatiai from I 131 thempy to the thyroid is also being studied. All patients seen for salivary gland surgery in the past 3 years or in follow-up from such surgery were questioned 41 patients,
for a “childhood”
heod and neck irradiation
history.
(30 females and II males),
ranging in age from 18 to 85 years old, had a total of 46 salivary gland neoplasms, I branchial cyst, and 2 chronic inflammatory glands. The time interval from irradiation to tumor mass was 6 to 66 years. 23 patients received irradiation for acne, 5 for hypertrophied tonsils and adenoids, 3 patients had “extensive” mastoid x-mys, and 6 had “excessive” dental x-rays. and one each, received irradiation for hirsuitism, sinuritis, a parotid tumor, and 1131 thempy for hyperthyroidism. 7 patients had multiple salivary gland neoplasms, 5 being synchronous. It is the purpose of this paper to review
the entity of “childhood”
head and neck
irradiation and salivary gland tumors; report on 41 cases; and stress the need for lifetime surveilance in all patients with this history.
(114)
MANAGEMENTOF POSTIRRADIATION
*Homayoon Shidnia,
2
M.D.‘;
Varoujan
BONE NECROSIS OF MANDIBLE
Chalian,
M.D.’
and Ned Hornback, M.D.'
1 Department of Radiation Oncology Department of Maxillofacial Prosthetics Indiana University School of Medicine 1100 West Michigan Street Indianapolis, Indiana 46223
With an increasing awareness of the risk of bone necrosis and the close cooperation of dentists and maxillofacial specialists with radiation oncologists, the incidence of bone necrosis of the mandible after irradiation therapy has significantly decreased. The management of
Radiation Oncology??Biology ??Physics
ARS63rdAnnualMeeting87
mandibular bone necrosis remains a formidable problem for radiation oncologists and dentists. In this paper, the authors discuss methods of treatment including use of a specially designed paste carrier and topical medication. The time relationship between the tooth extraction, radiation treatments and necrosis also wil1 be discussed. Experience gained in the treatment of post-irradiation necrosis in 18 patients wil1 be discussed. Meticulous evaluation of the dental condition played a great role in the prevention of complications, and post-irradiation care of the oral cavity was an important factor in preventing the development of radiation necrosis. A specially designed topical paste was used and found to control a high percentage of these lesions. Both large and smal1 lesions can often be treated successfully by conservative management. It was shown in this study that the risk of radiation necrosis increased with the use of radioisotope implants as the complications were found to be dose dependent.
(115) PROSPECTIVE, IWJDOMIZED COMPARISON OF CHEMOTHF.RAPYOF RECURRENT OR METASTATIC SQUAMOUS CANCER OF TBE HEAD AND NECK (SCHhN) WIT'HMETHOTREXATE (M) VERSUS METBOTREXATB, BLEOMYCIN (B) AND CIS-DIAMMINEDICHLOROPLATINUM 11 (D) AN EASTERN COOPERATIVE ONCOLOGY GROUP STUDY Steven E. Vogl, David Schoenfeld, Barry R. Kaplan and Harvey Lerner Albert Einstein College of Medicine, Bronx, N.Y., Sidney Farber Cancer Institute, Boston, Mass. and Pennsylvania Hospital, Philadelphia, Pa. Patients with distant metastases or regional recurrence after irradiation of their SCHLN were randomized between M 4Omg/M2 i.v. weekly (escalating to 60mg/M2 after 1 week in the absente of toxicity) or 21 day c cles of M 40mg/M2 i.m. days 1 and 1 B 1OU i.m. days 1,8 and 15, and D SOmg/Ms i.v. bolus day 4. 9s Furosemide 4Omg/M was given at the start of a 2 hour infusion of DSaNS with 1OmEq KCl/liter. Thirty minutes later, mannitol, 12.5gm, was given as iv bolus just prior to D. Planned accrual is 150, with 137 now entered and 110 now evaluable for response. 85% of patients were male, 60% ambulatory, 98% had prior irradiation, 83% had prior surgical resection and 31% had distant metastases. MBD produced 15% complete remission (CR) and 30% partial remissions (PR), significantly better than the 7% CRs and 21% PRs produced by M alone. Median projected duration of remission for MBD is 6 months (m) VS 4 m for M. Survival was not improved with MBD, however: median 5% m VS 5 m for M. There were 3 treatment related deaths from M, and 1 from MBD. MBD produced severe or worse hematologie toxicity in 29X, VS 11% for M. 49% had mucositis with MBD (17% severe), VS 45% with M (22% severe). On MBD, 75% had vomiting, 2% had interstitial penumonitis, and 4% peak serum creatinines>l.Smg/dl. MBD is thus the first combination chemotherapy regimen shown to be superior in response rate to methotrexate alone in a prospective randomized trial. MBD is associated with a higher CR rate, longer remissions, and is suitable for outpatient administration.
86 ARS 63rd Annual Meeting
Smal1 lesions can be treated adequately by either surgery or radiotherapy, but a large number of cases are big on presentation and are best treated with radiation. Some cases illustrating the pitfalls of inadequate selection wil1 be presented. It is perhaps important to remind not only radiation oncologists, but al1 our colleagues dealing with lip cancer, that radiation plays an important role in the management of lip cancer. Great care should be taken in selecting the best modality for every patient and prevent unnecessary death and horrible
disfigurement.
(113)
SALIVARY GLAND TUMORS IN PATIENTS WITH A HISTORY OF CHILDHOOD HEAD AND NECK IRRADIATION: REPORT OF FORY-ONE
Alfred
D. Katz,M.
D. ,* Stephen E. Lee,
M.D.,
and Susan Preston-Martin,
CASES
Ph. D.
Cedars Sinai Medical Center, Division of General Surgery and the University of Southem Califomia School of Medicine, Department of Family and Preventive Medicine Childhood
head and neck irradiation
was administered
for benign disease to millions
of Americans in the second to sixth decade of the twentieth century. The increased incidence of thyroid cancer in this irradiated group has been wel1 documented. More recently, the polyglandular aspect of this iatrogenic disease hos been presented with the association of parathyroid
disease and saiivary gland neoplasms.
In the further evaluation
of irmdiation sources as a possible etiological agent of salivary gland neoplasms, excesrive dental x-rays must be considered. Salivary gland irradiatiai from I 131 thempy to the thyroid is also being studied. All patients seen for salivary gland surgery in the past 3 years or in follow-up from such surgery were questioned 41 patients,
for a “childhood”
heod and neck irradiation
history.
(30 females and II males),
ranging in age from 18 to 85 years old, had a total of 46 salivary gland neoplasms, I branchial cyst, and 2 chronic inflammatory glands. The time interval from irradiation to tumor mass was 6 to 66 years. 23 patients received irradiation for acne, 5 for hypertrophied tonsils and adenoids, 3 patients had “extensive” mastoid x-mys, and 6 had “excessive” dental x-rays. and one each, received irradiation for hirsuitism, sinuritis, a parotid tumor, and 1131 thempy for hyperthyroidism. 7 patients had multiple salivary gland neoplasms, 5 being synchronous. It is the purpose of this paper to review
the entity of “childhood”
head and neck
irradiation and salivary gland tumors; report on 41 cases; and stress the need for lifetime surveilance in all patients with this history.
(114)
MANAGEMENTOF POSTIRRADIATION
*Homayoon Shidnia,
2
M.D.‘;
Varoujan
BONE NECROSIS OF MANDIBLE
Chalian,
M.D.’
and Ned Hornback, M.D.'
1 Department of Radiation Oncology Department of Maxillofacial Prosthetics Indiana University School of Medicine 1100 West Michigan Street Indianapolis, Indiana 46223
With an increasing awareness of the risk of bone necrosis and the close cooperation of dentists and maxillofacial specialists with radiation oncologists, the incidence of bone necrosis of the mandible after irradiation therapy has significantly decreased. The management of
Radiation Oncology??Biology ??Physics
ARS63rdAnnualMeeting87
mandibular bone necrosis remains a formidable problem for radiation oncologists and dentists. In this paper, the authors discuss methods of treatment including use of a specially designed paste carrier and topical medication. The time relationship between the tooth extraction, radiation treatments and necrosis also wil1 be discussed. Experience gained in the treatment of post-irradiation necrosis in 18 patients wil1 be discussed. Meticulous evaluation of the dental condition played a great role in the prevention of complications, and post-irradiation care of the oral cavity was an important factor in preventing the development of radiation necrosis. A specially designed topical paste was used and found to control a high percentage of these lesions. Both large and smal1 lesions can often be treated successfully by conservative management. It was shown in this study that the risk of radiation necrosis increased with the use of radioisotope implants as the complications were found to be dose dependent.
(115) PROSPECTIVE, IWJDOMIZED COMPARISON OF CHEMOTHF.RAPYOF RECURRENT OR METASTATIC SQUAMOUS CANCER OF TBE HEAD AND NECK (SCHhN) WIT'HMETHOTREXATE (M) VERSUS METBOTREXATB, BLEOMYCIN (B) AND CIS-DIAMMINEDICHLOROPLATINUM 11 (D) AN EASTERN COOPERATIVE ONCOLOGY GROUP STUDY Steven E. Vogl, David Schoenfeld, Barry R. Kaplan and Harvey Lerner Albert Einstein College of Medicine, Bronx, N.Y., Sidney Farber Cancer Institute, Boston, Mass. and Pennsylvania Hospital, Philadelphia, Pa. Patients with distant metastases or regional recurrence after irradiation of their SCHLN were randomized between M 4Omg/M2 i.v. weekly (escalating to 60mg/M2 after 1 week in the absente of toxicity) or 21 day c cles of M 40mg/M2 i.m. days 1 and 1 B 1OU i.m. days 1,8 and 15, and D SOmg/Ms i.v. bolus day 4. 9s Furosemide 4Omg/M was given at the start of a 2 hour infusion of DSaNS with 1OmEq KCl/liter. Thirty minutes later, mannitol, 12.5gm, was given as iv bolus just prior to D. Planned accrual is 150, with 137 now entered and 110 now evaluable for response. 85% of patients were male, 60% ambulatory, 98% had prior irradiation, 83% had prior surgical resection and 31% had distant metastases. MBD produced 15% complete remission (CR) and 30% partial remissions (PR), significantly better than the 7% CRs and 21% PRs produced by M alone. Median projected duration of remission for MBD is 6 months (m) VS 4 m for M. Survival was not improved with MBD, however: median 5% m VS 5 m for M. There were 3 treatment related deaths from M, and 1 from MBD. MBD produced severe or worse hematologie toxicity in 29X, VS 11% for M. 49% had mucositis with MBD (17% severe), VS 45% with M (22% severe). On MBD, 75% had vomiting, 2% had interstitial penumonitis, and 4% peak serum creatinines>l.Smg/dl. MBD is thus the first combination chemotherapy regimen shown to be superior in response rate to methotrexate alone in a prospective randomized trial. MBD is associated with a higher CR rate, longer remissions, and is suitable for outpatient administration.