Estudo de fatores de risco para a osteorradionecrose de mandíbula e maxila em pacientes com câncer de cabeça e pescoço : caso-controle.

Abstract

Introduction: Osteoradionecrosis of the mandible and maxilla is one of the possible late complications of radiotherapy treatment in the head and neck. It consists of decreasing the lumen of the blood vessels, reducing the flow and the consequent fibroatrophic and necrotic process of the bone. Several risk factors have already been raised in the literature, with some conflicting results. Objectives: To evaluate risk factors related to osteoradionecrosis in patients seen at a referral hospital for cancer treatment by SUS. Methodology: Retrospective case-control study of unpaired samples. A total of 66 patients, 19 cases and 47 controls, with head and neck cancer, who underwent radiotherapy at the COI in HAN, with a minimum dose of 60 Gy, with an incidence on mandibular and maxillary bones and a minimum follow-up time of 60 months were investigated. Results: The average age of patients was 58.3 years, with males being the most affected (83.3%). The most affected bone was the mandible (89.5%), with an average time for the development of the pathology of 40.1 months. Most patients in the sample were treated with RT-2D (n = 49, 74.2%), with a mean total radiation dose of 60 Gy. 63.1% of the 19 patients who had ORN were treated with mandibulectomy, with the rest being treated with debridement associated with antibiotic therapy and the PENTOCLO protocol. After the average post-RT follow-up period of 80.5 months, 51 (77.3%) were alive during the survey and 15 (22.7%) died. The prevalence of oral and oropharyngeal cancer was significantly higher in the case group, compared to the control group (p = 0.0045). Furthermore, we did not obtain statistically significant differences between the groups regarding gender, age, color, histology, radiotherapy modality, smoking during follow-up, alcohol consumption, tooth extractions, overall mortality, and total radiotherapy dose (p> 0.05). Conclusion: Dental extractions are not fundamental to the osteorradionecrosis process. Primary cancer of the mouth and oropharynx were the only risk factors identified for ORN in our sample.