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

Lookup NU author(s): Nick West, Dr Shahid Iqbal


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© The Author(s), 2022. Published by Cambridge University Press. 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.

Publication metadata

Author(s): West N, Willis N, Adams J, Kennedy M, Jenkins G, Iqbal S

Publication type: Article

Publication status: Published

Journal: Journal of Radiotherapy in Practice

Year: 2023

Volume: 22

Online publication date: 22/04/2022

Acceptance date: 15/03/2022

ISSN (print): 1460-3969

ISSN (electronic): 1467-1131

Publisher: Cambridge University Press


DOI: 10.1017/S1460396922000115


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