Osteoradionecrosis After Intensity-Modulated Radiation Therapy or Proton Therapy in Oropharyngeal Carcinoma

What is the incidence and severity of osteoradionecrosis (ORN) after radiotherapy for oropharyngeal squamous cell carcinoma, and does risk differ between proton therapy and intensity-modulated radiation therapy (IMRT)?In this retrospective cohort of 1564 patients, the 3-year incidence of ORN was 3.0%. Proton therapy was associated with higher ORN rates compared with IMRT (6.4% vs 2.7% at 3 years), while high-grade ORN remained rare (approximately 1%) and did not differ by modality.Proton therapy for oropharyngeal cancer was associated with increased ORN risk, underscoring the need for refined dose constraints and treatment planning to mitigate late effects.

Corresponding Author: Nancy Y. Lee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (leen1@mskcc.org).

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