Supportive Care in Cancer

, Volume 18, Issue 8, pp 1089–1098 | Cite as

Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies

  • Douglas E. PetersonEmail author
  • Wolfgang Doerr
  • Allan Hovan
  • Andres Pinto
  • Debbie Saunders
  • Linda S. Elting
  • Fred K. L. Spijkervet
  • Michael T. Brennan
Review Article



The purpose of this study is to review the evidence base from 1990 to 2008 to (1) clarify the impact of cancer therapies on prevalence of osteoradionecrosis (ORN) in head and neck cancer patients, and to (2) evaluate management strategies and their consequences on quality of life and cost of care.


Articles were selected for the time period beginning after 1989, excluding the 1990 NCI monograph articles from the 1989 NIH-sponsored Oral Complications in Cancer Therapy Symposium that was published in 1990. The search included both Medline/PubMed and Embase and was limited to humans. The search was limited to publications in the English language. No abstracts were utilized in the current review. Each article was evaluated by two reviewers. A weighted prevalence was calculated for the prevalence of ORN while incorporating predetermined quality measures. The level of evidence, recommendation grade, and guideline (if possible) were provided for published preventive and management strategies for ORN.


A total of 43 articles between 1990 and 2008 were reviewed. The weighted prevalence for ORN included conventional radiotherapy (RT) = 7.4%, intensity modulated RT (IMRT) = 5.1%, chemoradiotherapy (CRT) = 6.8%, and brachytherapy = 5.3%. Hyperbaric oxygen may contribute a role in management of ORN. However, no clear guideline recommendations could be established for the prevention or treatment of ORN based on the literature reviewed.


New cancer treatment modalities such as IMRT and concomitant CRT have had minimal effect on prevalence of ORN. No studies to date have systematically addressed impact of ORN on either quality of life or cost of care.


Osteoradionecrosis Head and neck radiation Cancer 



The authors thank Ms. Tainika Williams, Department of Oral Medicine, Carolinas Medical Center, North Carolina, USA, for her excellent administrative assistance.

Conflicts of interest

The authors declared that they have no potential conflicts of interests.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Douglas E. Peterson
    • 1
    • 2
    Email author
  • Wolfgang Doerr
    • 3
    • 4
  • Allan Hovan
    • 5
  • Andres Pinto
    • 6
    • 7
  • Debbie Saunders
    • 8
  • Linda S. Elting
    • 9
  • Fred K. L. Spijkervet
    • 10
  • Michael T. Brennan
    • 11
  1. 1.Department of Oral Health and Diagnostic Sciences, School of Dental MedicineUniversity of Connecticut Health CenterFarmingtonUSA
  2. 2.Program in Head & Neck Cancer and Oral Oncology, Neag Comprehensive Cancer CenterUniversity of Connecticut Health CenterFarmingtonUSA
  3. 3.Department of Radiotherapy and Radiation Oncology and OncoRay, Medical Faculty Carl Gustav CarusDresden University of TechnologyDresdenGermany
  4. 4.Radiobiology Laboratory, Department of Radiation Oncology, Oral Care ProgramDresden University of TechnologyDresdenGermany
  5. 5.Program of Oral Oncology/DentistryBritish Columbia Cancer AgencyVancouverCanada
  6. 6.Department of Oral Medicine, School of Dental MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Oral Medicine Center, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  8. 8.Dental OncologySudbury Regional Hospital Regional Cancer ProgramSudburyCanada
  9. 9.Section of Health Services Research, Department of Biostatistics and Applied MathematicsThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  10. 10.Department of Oral & Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  11. 11.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA

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