Establishing a targeted plan for prophylactic dental extractions in patients with laryngeal cancer receiving adjuvant radiotherapy Journal Article


Authors: Hentz, C; Diaz, A. Z.; Borrowdale, R. W.; Emami, B; Kase, M.; Choi, M
Article Title: Establishing a targeted plan for prophylactic dental extractions in patients with laryngeal cancer receiving adjuvant radiotherapy
Abstract: OBJECTIVE: The purpose of this study was to determine dose delivered to individual mandibular tooth-bearing regions during adjuvant intensity-modulated radiotherapy for laryngeal cancers. STUDY DESIGN: Twenty patients with laryngeal cancer treated with intensity-modulated radiotherapy were included. Individual mandibular tooth-borne areas were manually contoured. Average doses were calculated for individual teeth. RESULTS: Doses to individual teeth increased with more posterior location. Highest dose was observed for third molar (M3) (43.1 Gy; P .001). Doses to molars and premolars correlated with T- and N-stage (P = .007; P .001, respectively). For ipsilateral nodal disease, there was no difference between the doses to ipsilateral teeth and contralateral teeth. Only in N2 c tumors, dose was above our threshold for extraction for M3 only (51.5 Gy). CONCLUSIONS: T- and N-stage drive dose to individual mandibular tooth-borne areas. With the exception of the posterior molars, particularly in node-positive patients, radiation exposure falls below the threshold reported for pre-RT tooth extractions (50 Gy). We concluded that a more conservative approach to prophylactic tooth extraction with a greater emphasis on dental management may be warranted for the prevention of osteoradionecrosis in patients with laryngeal cancer receiving adjuvant RT.
Journal Title: Oral surgery, oral medicine, oral pathology and oral radiology
Volume: 122
Issue: 1
ISSN: 2212-4411
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2016
Start Page: 43
End Page: 49
Language: eng
DOI/URL:
Notes: CI: Copyright (c) 2016; JID: 101576782; 2015/11/16 [received]; 2016/01/18 [revised]; 2016/01/28 [accepted]; 2016/02/13 [aheadofprint]; ppublish