System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 42858853 DOI: 10.1016/j.radonc.2026.111820

Dose-effect analysis of late dental adverse effects following radiation therapy in survivors of paediatric head and neck rhabdomyosarcoma.

Radiother Oncol

Authors: Koen B Krommenhoek, Marinka L F Hol, Niels van der Aa, Michael Suttie, Mark N Gaze, Jan Wiersma, Henry C Mandeville, Callum Gillies, Olga Slater, Arjan Bel, Reinier C Hoogeveen, Johannes H M Merks, Daniel J Indelicato, Alfred G Becking

Affiliations

  • Department of Oral and Maxillofacial Surgery, Academic Centre Dentistry Amsterdam (ACTA), The Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands; Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands.
  • Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands; Department of Otolaryngology and Head and Neck Cancer, University of Utrecht, Utrecht, The Netherlands.
  • Department of Oral Public Health, Academic Centre Dentistry Amsterdam (ACTA), The Netherlands.
  • Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Big Data Institute, University of Oxford, Oxford, United Kingdom.
  • Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
  • Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
  • Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Radiotherapy, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, United Kingdom.
  • Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
  • Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
  • Department of Oral Radiology and Digital Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
  • Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands; Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
  • Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.
  • Department of Oral and Maxillofacial Surgery, Academic Centre Dentistry Amsterdam (ACTA), The Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands.

Abstract

INTRODUCTION

Paediatric head and neck rhabdomyosarcomas (HNRMS) often require radiotherapy, causing dental complications during critical development. Limited literature suggests dose-dependent risks, but clear thresholds for late dental adverse effects are lacking. This study aims to characterize dose effects on developing dentition in paediatric HNRMS patients to identify dose-response relationships informing evidence-based treatment planning.

MATERIALS AND METHODS

Orthopantomograms from survivors of HNRMS were evaluated using the validated DENTALE scoring system. Radiation doses from brachytherapy, external beam radiation with protons and photons to deciduous teeth were retrieved from treatment plans and converted to EQD2 (α/β = 3 Gy). Dose-response relationships were modelled per tooth using binary logistic regression in Mplus (COMPLEX option for within-patient dependency; model fit assessed by ROC analysis).

RESULTS

Among 34 survivors (median age at diagnosis 5.6 years), 27 (79.4 %) exhibited late dental AE. Of 919 assessable permanent teeth, 242 (26.3 %) showed abnormalities. Increasing radiation dose was consistently associated with higher AE probability. The dose corresponding to 50 % predicted probability of any dental AE was 23 Gy(EQD2). Structure-specific thresholds were higher for crowns (68 Gy) and eruption disturbances (52 Gy(EQD2)), and lower for roots (24 Gy(EQD2)) and crown-root ratio abnormalities (36 Gy(EQD2)).

CONCLUSION

This study demonstrates dose-effect relationships for radiation exposure of developing dentition, with clinically relevant structure-specific thresholds. Teeth receiving no radiation still show developmental abnormalities, likely due to chemotherapy. These findings support incorporating dentition as organ at risk and dose constraints into paediatric head-and-neck radiotherapy planning to reduce dental morbidity.

MeSH

Radiotherapy, Tooth, Rhabdomyosarcoma, Probability, Crowns, Therapeutics, Dentition