Table 1.
Clinical characteristics of patients.
| Case | Sex | Age | Pathological diagnosis | Primary site | Types of RT/dose (Gy) | Chemotherapy | Surgery for primary tumor |
Time interval (months)∗ |
Pathological fracture |
Lesion location∗∗ | Extent of SM∗∗∗ |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | M | 71 | SCC | Oral cavity | Conventional/61.5 | — | Tumor resection biND/RF |
120 | + | Ipsilateral | Body |
| 2 | M | 58 | SCC | Oropharynx | Conventional/70 | CDDP | uniND | 104 | − | Contralateral | Body |
| 3 | M | 70 | SCC | Neck (unknown primary) | Conventional/66 | CDDP | uniND | 75 | − | Contralateral | Body |
| 4 | M | 62 | SCC | Oropharynx | Conventional/70 | CDDP/5-FU | — | 78 | + | Contralateral | A |
| 5 | F | 80 | SCC | Oral cavity | IMRT/60 | — | Tumor resection uniND/RF |
6 | + | Ipsilateral | AT |
| 6 | M | 66 | AC | Neck (unknown primary) | Conventional/60 | — | uniND | 121 | + | Contralateral | A |
| 7 | M | 65 | SCC | Oropharynx | Conventional/60 | CDDP/NDP | Tumor resection uniND/RF |
137 | − | Ipsilateral | A |
| 8 | M | 64 | SCC | Neck (unknown primary) | Conventional/81 | CDDP/5-FU | — | 152 | + | Ipsilateral | AT |
| 9 | M | 63 | SCC | Nasopharynx | Conventional/70 | CDDP/5-FU | — | 56 | − | Contralateral | Body |
| 10 | M | 63 | SCC | Oropharynx | Conventional/70 | CDDP | — | 84 | + | Contralateral | Body |
| 11 | M | 74 | SCC | Oropharynx | Conventional/66 | CDDP/5-FU | Tumor resection biND/RAMC |
71 | − | Contralateral | Body |
RT, radiotherapy; ORN, osteoradionecrosis; SCC, squamous cell carcinoma; AC, adenocarcinoma; IMRT, intensity-modulated radiotherapy; CDDP, cisplatin; 5-FU, fluorouracil; NDP, nedaplatin; biND, bilateral neck dissection; uniND, unilateral neck dissection; RF, radial forearm free flap; RAMC, rectus abdominis myocutaneous free flap; SM, segmental mandibulectomy. ∗Time interval between the end of RT and the day of surgical debridement and fibula flap reconstruction. ∗∗Ipsilateral: ORN occurred at the same side of primary tumor exposed to radiation. Contralateral: ORN occurred at contralateral side of primary tumor exposed to radiation. ∗∗∗Extent of segmental mandibulectomy was classified according to the CAT classification, described in detail in the text.