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Utilising radiotherapy dose to guide 3D surgical reconstructions for mandibular osteoradionecrosis

Published online by Cambridge University Press:  22 April 2022

Nick West Open the ORCID record for Nick West [Opens in a new window] ,
Nick Willis ,
James Adams ,
Matthew Kennedy ,
Glyndwr Jenkins  and
Shahid Iqbal
Nick West*
Affiliation:
Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK
Nick Willis
Affiliation:
Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK
James Adams
Affiliation:
Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK
Matthew Kennedy
Affiliation:
Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK
Glyndwr Jenkins
Affiliation:
Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK
Shahid Iqbal
Affiliation:
Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK
*
Author for correspondence: Nick West, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne NE7 7DN, UK. Tel: +44 0191 2448743. E-mail: nick.west@nhs.net
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Abstract

Introduction:

Following radiotherapy for head and neck cancer, a proportion of patients present with mandibular osteoradionecrosis (ORN). Reported incidence and presentation of ORN vary widely, although often initiated by trauma with radiotherapy being the biggest risk factor. Evolved disease requires surgery, mandibular resection and reconstruction. As ORN is a progressive disease, it can manifest beyond resected volumes, compromising surgery. To minimise surgical failures, we present incorporating radiotherapy dose into the surgical design and decision processes—dose guided surgery (DGS).

Method:

Five mandibular ORN patients, referred for resection and reconstruction, underwent DGS—mandible visualised on diagnostic CT, propagated to radiotherapy planning CT, radiotherapy dose displayed on the mandible, high-risk mandible converted to stl files and incorporated in the surgical design.

Results:

DGS ensures high-dose, high-risk ORN mandible is resected, and fixation devices are located in low-dose, low-risk areas.

Conclusions:

DGS represents a potential new standard of care for patients presenting with mandibular ORN post-radiotherapy. Formal follow-up of this small cohort is ongoing although DSG is anticipated to increase the success rate of this high cost, high burden procedure compared to surgery designed on clinical and radiological assessments alone.

Keywords

mandibular osteoradionecrosismandibular resection and reconstruction headneck radiotherapy dose guided surgery
Type
Case Study
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e42
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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