Sultan A, Hanna GJ, Margalit DN, Chau N, Goguen LA, Marty FM, Rabinowits G, Schoenfeld JD, Sonis ST, Thomas T, Tishler RB, Treister NS, Villa A, Woo SB, Haddad R, Mawardi H, et al.
The oncologist. Date of publication 2017 Mar 1;volume 22(3):343-350.
1. Oncologist. 2017 Mar;22(3):343-350. doi: 10.1634/theoncologist.2016-0298. Epub
2017 Feb 16.
The Use of Hyperbaric Oxygen for the Prevention and Management of
Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women's Cancer Center
Multidisciplinary Guideline.
Sultan A(1)(2), Hanna GJ(3), Margalit DN(4)(5), Chau N(3), Goguen LA(6), Marty
FM(7), Rabinowits G(3), Schoenfeld JD(4)(5), Sonis ST(1)(2)(8), Thomas T(6),
Tishler RB(4)(5), Treister NS(1)(2)(8), Villa A(1)(2)(8), Woo SB(1)(2)(8), Haddad
R(3)(8), Mawardi H(9)(8).
Author information:
(1)Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston,
Massachusetts, USA.
(2)Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental
Medicine, Boston, Massachusetts, USA.
(3)Department of Medical Oncology, Dana-Farber Cancer Institute, Boston,
Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org
(4)Department of Radiation Oncology, Brigham and Women's Hospital, Boston,
Massachusetts, USA.
(5)Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston,
Massachusetts, USA.
(6)Division of Otolaryngology, Brigham and Women's Hospital, Boston,
Massachusetts, USA.
(7)Division of Infectious Diseases, Brigham and Women's Hospital, Boston,
Massachusetts, USA.
(8)Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston,
Massachusetts, USA; Robert_haddad@dfci.harvard.edu hmawardi@partners.org.
(9)Department of Diagnostic Sciences, King Abdulaziz University, Faculty of
Dentistry, Jeddah, Saudi Arabia
BACKGROUND: Osteoradionecrosis of the jaw (ORN) is an infrequent yet potentially
devastating complication of radiation therapy to the head and neck region.
Treatment options include antimicrobial therapy, local sequestrectomy, resection,
and the use of hyperbaric oxygen (HBO). Published data on ORN are difficult to
compare because of the lack of a universally accepted classification and staging
system, and the literature on the use of HBO to either prevent or successfully
manage ORN is controversial and inconclusive. Therefore, we aimed to establish a
standard approach for using HBO at our institution.
MATERIALS AND METHODS: A literature search was conducted of articles published in
the English language between January 1980 and January 2016. Retrieved articles
were evaluated by two independent reviewers. Isolated case reports, abstracts,
case series, review articles, and cohort studies without a control group were
excluded; summary data were extracted from the remaining studies. A panel of
experts from Head and Neck Oncology and Oral Medicine from the Dana-Farber Cancer
Institute and Brigham and Women's Hospital reviewed the summary data and
established multidisciplinary guidelines on the use of HBO for the prevention and
management of ORN.
RESULTS: Seven studies were evaluated and reviewed by the multidisciplinary
panel. There was no consistent evidence in support of HBO for either the
prevention or management of ORN.
CONCLUSION: Based on the available evidence and expert opinion, routine use of
HBO for the prevention or management of ORN is not recommended and is rarely used
at our institution. The Oncologist 2017;22:343-350 IMPLICATIONS FOR PRACTICE: The
Division of Head and Neck Oncology of Dana-Farber/Brigham and Women's Cancer
Center does not recommend the routine use of HBO for the prevention or management
of ORN. Adjunctive HBO may be considered for use on a case-by-case basis in
patients considered to be at exceptionally high risk who have failed conservative
therapy and subsequent surgical resection.
© AlphaMed Press 2017.
DOI: 10.1634/theoncologist.2016-0298
PMCID: PMC5344641 [Available on 2018-03-01]
PMID: 28209748
