ESTRO 2024 - Abstract Book

S1446

Clinical - Head & neck

ESTRO 2024

The e-Delphi technique was used to gain consensus from a multidisciplinary team including specialist dentists, dental hygienists, radiation oncologists, and radiation therapists involved in the care of patients with HNC. The Delphi study consisted of three rounds. Each round had an online questionnaire distributed via Qualtrics. The sample consisted of a team of 43 international healthcare professionals. A patient and carer survey was developed together with former patients with HNC and piloted for understanding prior to distribution. The link for the survey was made available via social media posts of the Irish Cancer Society, with relevant survivorship groups tagged. For the Delphi component, a ten-point Likert scale was used to gain consensus using median, mode, and interquartile range (IQR) calculations. For yes/no answers and ranking questions, consensus was defined as >/=70% agreement between respondents. Stability, or the degree of permanence of participants’ vote distribution and responses over successive rounds, with less than 15% change in two consecutive rounds reflected consensus for yes/no answers and ranking questions. For ten-point Likert Scale questions stability was reported for gaining consensus in two or more consecutive rounds. There was consensus on the need for multidisciplinary oral health management of patients with HNC pre- and post RT with the use of standardised oral health assessment tools, extractions of teeth with poor prognosis, use of fluorides, and provision of oral health care advice. Furthermore, consensus on these questions had stability between the three rounds of the study. However, the timing of extractions pre- RT, the number of teeth extracted, prophylactic antibiotic use, use of antifungals, replacement of metallic fillings with non-metallic in the field of RT, and optimal timing for implant placement did not reach consensus. In the patient survey, most of the patients with HNC were referred for oral health assessment and management before RT. Patients reported that their pre-RT oral health treatment included extractions, followed by scaling, polishing, and filling. However, only half of the patients who had extractions pre-RT were given prophylactic antibiotics. Results:

Conclusion:

This research has highlighted that gaining international consensus on the prevention and management of ORN is challenging. It has highlighted that future attention needs to focus on optimising timing of dental extractions prior to RT, timing of subsequent implants, prophylactic use of antibiotics and antifungals, and replacement of metallic fillings with those that do not cause artefact on imaging.

Keywords: osteoradionecrosis, prevention, oral health

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