Work

Osteoradionecrosis in patients with head and neck cancer after reirradiation – a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Objective To determine the observed incidence and risk factors of osteoradionecrosis (ORN) following reirradiation for recurrent or second primary head and neck cancer. Methods A systematic review with meta-analysis was conducted according to the PRISMA guidelines, with the study protocol prospectively registered with PROSPERO (CRD42025635226). A literature search was performed in PubMed/MEDLINE and Web of Science. Randomized and observational studies investigating reirradiation for recurrent or second primary head and neck tumors were included. The primary endpoint was occurrence of ORN of the maxilla and/or mandible. Results Of 580 identified records, 62 studies involving 3278 patients (median age, 61 years; 2087 [63.7%] male) were included, among them 14 prospective and 48 retrospective studies. Teletherapy was administered in 2546 patients (77.7%), and brachytherapy in 684 patients (20.9%). At a median follow-up of 26 months, the pooled observed incidence of ORN of the mandible and/or maxilla was 3.6% (95% CI, 2.8%–4.6%). When restricted to patients evaluable for late adverse events, pooled observed ORN incidence was 4.0% (95% CI, 3.0%–5.3%). A higher study-level proportion of patients receiving adjuvant reirradiation was associated with increased observed ORN incidence (β = 1.091; 95% CI, 0.256–1.926; P = .01), whereas radiation dose, modality, and interval between primary radiotherapy and reirradiation were not predictive. Conclusion This meta-analysis demonstrates that the observed incidence of ORN after reirradiation for recurrent or second primary head and neck cancer is approximately 4%. These findings provide a benchmark for patient counseling, while highlighting the need for standardized ORN assessment in future studies.

Source: Clinical and Translational Radiation Oncology

DOI: 10.1016/j.ctro.2026.101342