195 Tooth extractions and weight loss in OPSCC 6 Materials and Methods Study design and population Patients with OPSCC, who were treated with primary or postoperative CRT/ BRT in the Comprehensive Cancer Center of Maastricht University Medical Center (MUMC+) and Maastro Clinic between January 2013 and December 2016, were included in this retrospective cohort study. Exclusion criteria were single modality treatment with radiotherapy only, previous head and neck radiation, and TF dependency at start of the oncological treatment. Patients were part of a larger MUMC+ sample from a cohort study on alterations in body composition in locally advanced head and neck squamous cell carcinoma (LAHNSCC) [21]. Additional data extraction on dental status from the electronic health records was performed by an experienced maxillofacial prosthodontist (DB). This study was approved by the medical ethics committee of the MUMC+ (METC 2020-1589). All patients received primary CRT or BRT (cisplatin or cetuximab, respectively) or postoperative CRT (cisplatin) with curative intent. RT was administered using intensity-modulated RT (IMRT) for five days per week for six (BRT) or seven (CRT) weeks, in fractions of 2Gy. Cisplatin was administered intravenously in doses of 100 mg/m2 every 3 weeks [24, 25] concurrently with daily fractionated IMRT up to 66Gy in 33 fractions or 70Gy in 35 fractions in case of postoperative and primary RT, respectively. Cetuximab was indicated in patients not fit for cisplatin and consisted of a 400 mg/m2 loading dose, followed by 250 mg/m2 weekly, combined with accelerated fractionated IMRT up to 68Gy in 34 fractions in 38 days [26]. According to the national standard procedures, the dental status was assessed through oral and radiographic examination (e.g. orthopantomography), at least 14 days before the start of CRT/BRT [8-10]. Teeth with a poor prognosis due to extensive caries, advanced periodontal disease, and non-restorable teeth were considered as potential source of infection for ORN. Radiographic abnormalities like apical radiolucency, (partially) impacted teeth, residual root tips, root resorption, and dental cysts were also considered as potential source of infection. Poor prognosis teeth within the estimated radiation fields were treated, usually by extraction. During CRT/BRT, instructions were given to continue normal daily oral care (tooth brushing and/or interdental cleaning) as long as possible and to rinse the mouth with salt-baking soda solution 8 to 10 times a day [8, 9]. Patients received custom-made fluoride trays in combination with a neutral 1% sodium fluoride gel to be used every other day [8, 9]. To relieve the symptoms of mucositis, patients were sprayed with saline 3 times a week by the dental hygienist [27].
RkJQdWJsaXNoZXIy MTk4NDMw