240 Chapter 8 wounds sufficient time, at least 10 to 14 days, to heal before starting RT, decisions are made based on the expected radiation dose. However, for some extracted teeth, it may be found after completion of RT that extraction was not indicated because the RT dose applied was lower than expected. In Chapter 5 we examined the number and patient and tumor characteristics associated with this number of redundantly extracted teeth. For this purpose, 358 patients with HNC, treated with RT between 2015 and 2019, were included in this cross-sectional study. Radiation dose was calculated retrospectively for each extracted tooth. The cut-off point for valid extraction was set at ≥40Gy in accordance with the national protocol. Because this guideline does not specify whether this is the mean or maximum dose, we evaluated both values separately. A total of 1759 teeth were removed from 358 patients. Of these 1759 teeth, 1274 (74%) appeared to have been removed redundantly, based on the mean dose (Dmean) of <40Gy. At the maximum dose (Dmax) of <40Gy, 1080 teeth (61%) appeared to have been removed redundantly. Tumor location and the spread of cancer to nearby lymph nodes were found to be the most important associative variables in multivariable regression analysis. The impact of tooth loss on body weight loss and tube feeding (TF) dependence during RT combined with chemotherapy (CRT) or biotherapy (BRT) was previously unknown. In Chapter 6, we retrospectively examined the effect of incomplete dentition, tooth extractions prior to CRT/BRT, and subsequent loss of functional units on (1) weight loss during therapy and (2) the need for TF during CRT/BRT for oropharyngeal squamous cell carcinomas (OPSCC). Weight loss during CRT/ BRT was assessed dichotomously, comparing weight loss >5% with stable or increased weight. Potential factors associated with weight loss were identified, including patient, tumor, and treatment characteristics. Of the 77 OPSCC patients included, 40 patients (52%) experienced weight loss >5% during CRT/ BRT. Tooth extractions prior to CRT/BRT were associated with >5% weight loss during treatment. None of the dental-related parameters showed a significant associative value for TF. In conclusion, dental extractions pre-RT to reduce the risk of ORN, are a risk factor for weight loss during CRT/BRT in OPSCC. Unintended weight loss, one of the clinical features of cachexia, negatively impact treatment-related toxicity and oncologic outcome. Therefore, it is of utmost importance to avoid weight loss during cancer treatment.
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