Main Session
Sep
29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care
3605 - Rates of Osteoradionecrosis in Sinonasal Malignancies with Current Radiation Modalities: A Systematic Review and Meta-Analysis
Presenter(s)
Sarah Rosmarin, DO, MS - Temple University Hospital, Philadelphia, PA
S. Rosmarin1,2, W. Nyaaba3, J. Rajasekaran4, A. Jain2, and H. Abou-Al-Shaar1,5; 1University of Pittsburgh Medical Center, Pittsburgh, PA, 2Lake Erie College of Osteopathic Medicine, Greensburg, PA, 3University of Illinois Chicago, Chicago, IL, 4Drexel University College of Medicine, Philadelphia, PA, 5University of Texas Health Science Center, Houston, TX
Purpose/Objective(s):
Osteoradionecrosis (ORN) is a late complication of radiation therapy for sinonasal malignancies. Prior studies have focused on outcomes for head and neck malignancies, but there is a scarcity of studies that have been dedicated to sinonasal malignancies. Our review analyzes sinonasal ORN rates with modern radiation techniques to further understand risk when recommending therapy.Materials/Methods:
We followed PRISMA 2020 guidelines and searched PubMed and Cochrane databases for studies reporting human sinonasal ORN rates. We included studies utilizing intensity-modulated radiation therapy (IMRT), proton therapy, and/or carbon-ion radiation therapy (CIRT) with n >25, and patients eighteen years or older. We excluded outdated modes, such as two-dimensional conformal radiation therapy (2D-CRT) and 3D-CRT. We excluded case reports, case studies, posters, abstracts, and non-English language articles. Studies that combined sinonasal with other head and neck malignancies, included re-irradiated patients, or palliative radiation were excluded. R version 4.5.2 was used to study random-effects meta-analysis of proportions to estimate the pooled incidence of ORN. The between-study variance (t²) was estimated using Restricted Maximum Likelihood (REML). Confidence intervals for pooled estimates were calculated using the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. Bias was assessed using Begg’s rank correlation test.Results:
A total of 18 studies met our criteria. One study included two different modality groups, so the data was reported individually for a total of 19 different studies. The overall rate of ORN was 4.2% (95% CI: [2.1%-8.3%]; p <0.001) for a total of 1944 patients. Between-study heterogeneity was I² = 0.7%; t² = 1.38. Sub-group analysis showed a significant difference between modalities (p <0.001) with IMRT having the lowest incidence rate of 2.4% (95% CI: [0.8 % - 6.8%]), proton therapy: 4.5% (95% CI: [0.5 - 29.2)], CIRT: 11.9% (95% CI: [9.2 - 15.2]), mixed: 5.7% (95% CI: [0.9 - 27.6]). Mixed-effects meta-regression with median dose as a continuous moderator indicated no statistically significant impact of radiation dose on ORN rates (OR 1.08; CI: [0.92-1.26]; p = 0.343). Begg’s rank correlation test showed no significant evidence of bias (p = 0.132).Conclusion:
ORN rates for sinonasal malignancies are low with modern radiation modalities. Radiation dose amongst these newer modalities does not significantly alter ORN rates. Further multi-center prospective trials should classify risk of clinically significant ORN between the various modern radiation modalities.