Osteoradionecrosis in patients with head and neck cancer after reirradiation - a systematic review and meta-analysis.
5 affiliations
- 1Department of Oral and Maxillofacial Surgery, University of Leipzig Medical Center, Leipzig, Germany.
- 2Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany.
- 3Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany.
- 4Department of Engineering & IT, Carinthia University of Applied Sciences, Villach, Austria.
- 5Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
Abstract
To determine the observed incidence and risk factors of osteoradionecrosis (ORN) following reirradiation for recurrent or second primary head and neck cancer. A systematic review with meta-analysis was conducted according to the PRISMA guidelines, with the study protocol prospectively registered with PROSPERO (CRD42025635226). A literature search was performed in PubMed/MEDLINE and Web of Science. Randomized and observational studies investigating reirradiation for recurrent or second primary head and neck tumors were included. The primary endpoint was occurrence of ORN of the maxilla and/or mandible. Of 580 identified records, 62 studies involving 3278 patients (median age, 61 years; 2087 [63.7%] male) were included, among them 14 prospective and 48 retrospective studies. Teletherapy was administered in 2546 patients (77.7%), and brachytherapy in 684 patients (20.9%). At a median follow-up of 26 months, the pooled observed incidence of ORN of the mandible and/or maxilla was 3.6% (95% CI, 2.8%-4.6%). When restricted to patients evaluable for late adverse events, pooled observed ORN incidence was 4.0% (95% CI, 3.0%-5.3%). A higher study-level proportion of patients receiving adjuvant reirradiation was associated with increased observed ORN incidence (β = 1.091; 95% CI, 0.256-1.926; P = .01), whereas radiation dose, modality, and interval between primary radiotherapy and reirradiation were not predictive. This meta-analysis demonstrates that the observed incidence of ORN after reirradiation for recurrent or second primary head and neck cancer is approximately 4%. These findings provide a benchmark for patient counseling, while highlighting the need for standardized ORN assessment in future studies.
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BibTeX
@article{fritz2026osteoradionecrosis,
title = {{Osteoradionecrosis in patients with head and neck cancer after reirradiation - a systematic review and meta-analysis.}},
author = {Annemarie Fritz and Nils Gleim and Anita Kloss-Brandstätter and Thomas Kuhnt and Nils H Nicolay and Andreas Maximilian Fichter and Sebastian Gaus and Alexander Rühle},
journal = {Clinical and translational radiation oncology},
year = {2026},
month = oct,
doi = {10.1016/j.ctro.2026.101342},
url = {https://europepmc.org/article/MED/42999878},
note = {CC BY},
}
RIS
TY - JOUR
TI - Osteoradionecrosis in patients with head and neck cancer after reirradiation - a systematic review and meta-analysis.
AU - Annemarie Fritz
AU - Nils Gleim
AU - Anita Kloss-Brandstätter
AU - Thomas Kuhnt
AU - Nils H Nicolay
AU - Andreas Maximilian Fichter
AU - Sebastian Gaus
AU - Alexander Rühle
PY - 2026
DA - 2026/10/28
JO - Clinical and translational radiation oncology
DO - 10.1016/j.ctro.2026.101342
UR - https://europepmc.org/article/MED/42999878
AB - To determine the observed incidence and risk factors of osteoradionecrosis (ORN) following reirradiation for recurrent or second primary head and neck cancer. A systematic review with meta-analysis was conducted according to the PRISMA guidelines, with the study protocol prospectively registered with PROSPERO (CRD42025635226). A literature search was performed in PubMed/MEDLINE and Web of Science. Randomized and observational studies investigating reirradiation for recurrent or second primary head and neck tumors were included. The primary endpoint was occurrence of ORN of the maxilla and/or mandible. Of 580 identified records, 62 studies involving 3278 patients (median age, 61 years; 2087 [63.7%] male) were included, among them 14 prospective and 48 retrospective studies. Teletherapy was administered in 2546 patients (77.7%), and brachytherapy in 684 patients (20.9%). At a median follow-up of 26 months, the pooled observed incidence of ORN of the mandible and/or maxilla was 3.6% (95% CI, 2.8%-4.6%). When restricted to patients evaluable for late adverse events, pooled observed ORN incidence was 4.0% (95% CI, 3.0%-5.3%). A higher study-level proportion of patients receiving adjuvant reirradiation was associated with increased observed ORN incidence (β = 1.091; 95% CI, 0.256-1.926; P = .01), whereas radiation dose, modality, and interval between primary radiotherapy and reirradiation were not predictive. This meta-analysis demonstrates that the observed incidence of ORN after reirradiation for recurrent or second primary head and neck cancer is approximately 4%. These findings provide a benchmark for patient counseling, while highlighting the need for standardized ORN assessment in future studies.
SN - 2405-6308
ER -