BIOMARKERS FOR PREDICTING MANDIBULAR OSTEORADIONECROSIS IN ORAL AND OROPHARYNGEAL CANCER PATIENTS
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Keywords
Mandibular osteoradionecrosis, biomarkers, oral cancer, oropharyngeal cancer, radiotherapy complications, inflammation, matrix metalloproteinase, hypoxia-inducible factors
Abstract
Background: Mandibular osteoradionecrosis (ORN) is a severe complication following radiotherapy (RT) in patients with oral and oropharyngeal cancers. It is characterized by non-healing necrotic bone, ORN leads to significant morbidity, including pain, infection, and impaired oral function. Identifying biomarkers that can predict ORN risk is crucial for early intervention and personalized treatment, potentially reducing the severity and incidence of ORN.
Objective: This systematic review aims to evaluate the current evidence on biomarkers that predict the development of ORN in patients receiving radiotherapy for oral and oropharyngeal cancers. By identifying key molecular and genetic markers, the review seeks to highlight potential clinical applications in risk stratification and patient management.
Methodology: A systematic search was conducted in PubMed, EMBASE, and Cochrane databases, including studies published between 2000 and 2024. Studies that examined associations between biomarkers and ORN risk in head and neck cancer patients treated with radiotherapy were included. Data extraction focused on patient demographics, biomarker types, study outcomes, and incidence of ORN. The quality of studies was assessed using standardized tools such as the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool.
Results: 72 studies met the inclusion criteria, identifying several key biomarkers associated with ORN risk. These include inflammatory cytokines (e.g., TNF-α, IL-6), matrix metalloproteinases (MMP-2, MMP-9), and hypoxia-inducible factors (HIF-1α). Elevated levels of these markers were significantly correlated with increased risk of ORN, reflecting their role in inflammation, tissue hypoxia, and impaired bone healing. Genetic polymorphisms in bone remodeling and angiogenesis pathways, such as VEGF and BMP, were also linked to ORN susceptibility, though further validation is required.
Conclusion: This systematic review highlights the potential of biomarkers in predicting ORN risk in patients undergoing radiotherapy. The data underscore the need for larger studies to confirm these findings and integrate biomarkers into clinical practice.
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Zahra Zareen
Maher Dental Institute, Texas
Aisha Alyassi
Sheikh Shakhbout Medical City, Abudhabi
Mariya Farooq
Shifa College of Dentistry, Islamabad
Aymen Mian Muhammad Altaf
Marina Dental Center, UAE
Farzeen Harris
Yenepoya Medical College and Hospital, Mangalore
Mais Dahham Salama
Postgraduate Clinical Trainee, Dubai Health, Dubai, UAE
Meera Abdalla Alharmoodi
University of Sharjah, UAE
Munza Yousuf
Bahria University Medical and Dental College, Karachi
Sara Majid A Al Sani
Dubai Medical College, UAE
Rawda Ahmed Mehanna
Clinical Teaching Assistant, Clinical Sciences Department, Dubai Medical College for Girls, Dubai, UAE
Mahnoor Sohail
Khyber Medical University, Peshawar