TY - JOUR
T1 - International Expert-Based Consensus Definition, Classification Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw
T2 - An Inter-Disciplinary Modified Delphi Study
AU - International ORAL Consortium
AU - Moreno, Amy C
AU - Watson, Erin E
AU - Humbert-Vidan, Laia
AU - Peterson, Douglas E
AU - van Dijk, Lisanne V
AU - Urbano, Teresa Guerrero
AU - Van den Bosch, Lisa
AU - Hope, Andrew J
AU - Katz, Matthew S
AU - Hoebers, Frank J P
AU - Wesson, Ruth A Aponte
AU - Bates, James E
AU - Bossi, Paolo
AU - Dayo, Adeyinka F
AU - Doré, Mélanie
AU - Fregnani, Eduardo Rodrigues
AU - Galloway, Thomas J
AU - Gelblum, Daphna Y
AU - Hanna, Issa A
AU - Henson, Christina E
AU - Kiat-Amnuay, Sudarat
AU - Korfage, Anke
AU - Lee, Nancy Y
AU - Lewis, Carol M
AU - Lynggaard, Charlotte Duch
AU - Mäkitie, Antti A
AU - Magalhaes, Marco
AU - Mowery, Yvonne M
AU - Muñoz-Montplet, Carles
AU - Myers, Jeffrey N
AU - Orlandi, Ester
AU - Patel, Jaymit
AU - Rigert, Jillian M
AU - Saunders, Deborah
AU - Schoenfeld, Jonathan D
AU - Selek, Ugur
AU - Somay, Efsun
AU - Takiar, Vinita
AU - Thariat, Juliette
AU - Verduijn, Gerda M
AU - Villa, Alessandro
AU - West, Nick
AU - Witjes, Max J H
AU - Won, Alex
AU - Wong, Mark E
AU - Yao, Christopher M K L
AU - Young, Simon W
AU - Al-Eryani, Kamal
AU - Barbon, Carly E A
AU - Khan, Abdul Ahad
AU - Lai, Stephen Y.
AU - Fuller, Clifton David
N1 - Copyright © 2025. Published by Elsevier Inc.
PY - 2025/6
Y1 - 2025/6
N2 - PURPOSE: Osteoradionecrosis of the jaw (ORNJ) is a severe iatrogenic disease characterized by bone death after radiation therapy (RT) to the head and neck. With over 9 published definitions and at least 16 classification systems, the true incidence and severity of ORNJ are obscured by lack of a standard for disease definition and severity assessment, leading to inaccurate estimation of incidence, reporting ambiguity, and likely under-diagnosis worldwide. This study aimed to achieve consensus on an explicit definition and phenotype of ORNJ and related precursor states through data standardization to facilitate effective diagnosis, monitoring, and multidisciplinary management of ORNJ.METHODS: The ORAL Consortium comprised 69 international experts, including representatives from medical, surgical, radiation oncology, and oral/dental disciplines. Using a web-based modified Delphi technique, panelists classified descriptive cases using existing classification systems, reviewed systems for feature extraction and specification, and iteratively classified cases based on clinical/imaging feature combinations.RESULTS: The Consortium ORNJ definition was developed in alignment with SNOMED-CT terminology and recent ISOO-MASCC-ASCO guideline recommendations. Case review using existing ORNJ classification systems showed high rates of inability to classify (up to 76%). Ten consensus statements and nine minimum data elements (MDEs) were outlined for prospective collection and classification of precursor/ORNJ disease states.CONCLUSION: This study provides an international, consensus-based definition and MDE foundation for standardized ORNJ reporting in cancer survivors treated with RT. Head and neck surgeons, radiation, surgical, medical oncologists, and dental specialists should adopt MDEs to enable scalable health information exchange and analytics. Work is underway to develop both a human- and machine-readable knowledge representation for ORNJ (i.e., ontology) and multidisciplinary resources for dissemination to improve ORNJ reporting in academic and community practice settings.
AB - PURPOSE: Osteoradionecrosis of the jaw (ORNJ) is a severe iatrogenic disease characterized by bone death after radiation therapy (RT) to the head and neck. With over 9 published definitions and at least 16 classification systems, the true incidence and severity of ORNJ are obscured by lack of a standard for disease definition and severity assessment, leading to inaccurate estimation of incidence, reporting ambiguity, and likely under-diagnosis worldwide. This study aimed to achieve consensus on an explicit definition and phenotype of ORNJ and related precursor states through data standardization to facilitate effective diagnosis, monitoring, and multidisciplinary management of ORNJ.METHODS: The ORAL Consortium comprised 69 international experts, including representatives from medical, surgical, radiation oncology, and oral/dental disciplines. Using a web-based modified Delphi technique, panelists classified descriptive cases using existing classification systems, reviewed systems for feature extraction and specification, and iteratively classified cases based on clinical/imaging feature combinations.RESULTS: The Consortium ORNJ definition was developed in alignment with SNOMED-CT terminology and recent ISOO-MASCC-ASCO guideline recommendations. Case review using existing ORNJ classification systems showed high rates of inability to classify (up to 76%). Ten consensus statements and nine minimum data elements (MDEs) were outlined for prospective collection and classification of precursor/ORNJ disease states.CONCLUSION: This study provides an international, consensus-based definition and MDE foundation for standardized ORNJ reporting in cancer survivors treated with RT. Head and neck surgeons, radiation, surgical, medical oncologists, and dental specialists should adopt MDEs to enable scalable health information exchange and analytics. Work is underway to develop both a human- and machine-readable knowledge representation for ORNJ (i.e., ontology) and multidisciplinary resources for dissemination to improve ORNJ reporting in academic and community practice settings.
U2 - 10.1016/j.ijrobp.2024.12.017
DO - 10.1016/j.ijrobp.2024.12.017
M3 - Article
C2 - 39826846
SN - 0360-3016
VL - 122
SP - 341
EP - 354
JO - International Journal of Radiation Oncology, Biology, Physics
JF - International Journal of Radiation Oncology, Biology, Physics
IS - 2
ER -