Osteoradionecrosis in patients with head and neck cancer after reirradiation - a systematic review and meta-analysis
In brief
About 4% develop jawbone necrosis after head and neck cancer reirradiation
A review of 62 studies covering 3,278 patients found that about 4% developed bone necrosis of the jaw after reirradiation, at a median follow-up of 26 months. Studies with more patients receiving adjuvant reirradiation reported higher rates, but radiation dose, treatment type, and time between radiation courses were not predictive; inconsistent assessment limits comparisons.
- Journal
- Clinical and translational radiation oncology (Q1)
- Published
- 28 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Annemarie Fritz, Nils Gleim, Anita Kloss-Brandstätter, Thomas Kuhnt, Nils H Nicolay, Andreas Maximilian Fichter, et al.
- PMID
- 42999878
- DOI
- 10.1016/j.ctro.2026.101342
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 9 November 2026): Meta-analysis quantifies osteoradionecrosis after head-neck reirradiation
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.