{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:49:50Z","timestamp":1791982190727,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Osteoradionecrosis (ORN) of the jaw remains a serious late complication of head and neck cancer (HNC) radiotherapy. Although intensity\u2010modulated radiotherapy (IMRT) and volumetric\u2010modulated arc radiotherapy (VMAT) are expected to reduce ORN risk, large real\u2010world data in the modern era are limited. This study evaluated the incidence, latency, and risk factors of ORN across radiotherapy modalities in a large hospital\u2010based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 6199 patients with HNC treated with curative radiotherapy between 2006 and 2020. ORN was defined as exposed necrotic jaw bone persisting for &gt;\u20093\u2009months without tumor recurrence. ORN incidence was compared between conventional 2D\/3D radiotherapy and IMRT\/VMAT. Latency to ORN onset was assessed using Kaplan\u2013Meier analysis, and independent predictors were identified using multivariate Cox regression for demographic, tumor\u2010related, treatment\u2010related, and patient\u2010related variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 278 patients (4.5%) developed ORN. The incidence was 5.5% after 2D\/3D radiotherapy and 4.4% after IMRT\/VMAT, without a significant overall difference. However, IMRT\/VMAT significantly reduced ORN risk in nasopharyngeal carcinoma (NPC) (1.6% vs. 5.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). ORN incidence was highest in oral cavity cancers (7.9%), particularly gingival and floor\u2010of\u2010mouth subsites. Median latency to ORN onset was 24\u2009months (interquartile range 12\u201344) and was longer after IMRT\/VMAT than after 2D\/3D radiotherapy (26 vs. 18\u2009months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021). Multivariate analysis identified non\u2010NPC diagnosis (adjusted hazard ratio [aHR] 2.71), advanced clinical stage (aHR 1.66), dental extraction (aHR 3.21), adverse oral habits (aHR 1.45), and abnormal body mass index (aHR 1.45) as independent predictors of ORN (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large contemporary cohort, ORN occurred in 4.5% of HNC patients after radiotherapy. IMRT\/VMAT reduced ORN risk and delayed onset, particularly in NPC. Tumor site, disease stage, dental extraction, oral habits, and nutritional status remain key determinants, underscoring the importance of individualized risk stratification and preventive dental care in the IMRT\/VMAT era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70314","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T03:23:58Z","timestamp":1778469838000},"page":"2883-2892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and Site\u2010Specific Risk Factors of Jaw Osteoradionecrosis for Head and Neck Patients in the\n                    <scp>IMRT<\/scp>\n                    \/\n                    <scp>VMAT<\/scp>\n                    Era: Evidence From a Large, Hospital\u2010Based Cohort"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5213-9023","authenticated-orcid":false,"given":"Fang\u2010Yu","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Dentistry National Taiwan University Hospital, College of Medicine  Taipei Taiwan"},{"name":"Department of Dentistry National Taiwan University Hospital, Jinshan Branch  New Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Hsin","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Dentistry National Taiwan University Hospital, College of Medicine  Taipei Taiwan"},{"name":"Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University  Taipei Taiwan"},{"name":"School of Dentistry, National Taiwan University  Taipei Taiwan"},{"name":"National Taiwan University Hospital Hsin\u2010Chu Branch  Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiang\u2010Fong","family":"Kao","sequence":"additional","affiliation":[{"name":"Institute of Oncology, National Taiwan University  Taipei Taiwan"},{"name":"Department of Medical Oncology National Taiwan University Cancer Center  Taipei Taiwan"},{"name":"Department of Oncology National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4674-4892","authenticated-orcid":false,"given":"Shih\u2010Jung","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Dentistry National Taiwan University Hospital, College of Medicine  Taipei Taiwan"},{"name":"Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University  Taipei Taiwan"},{"name":"School of Dentistry, National Taiwan University  Taipei Taiwan"},{"name":"Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(83)80005-6"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(87)90136-8"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.moo.0000170527.59017.ff"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2008.04.006"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/idj.12318"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12663-015-0762-9"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2021.02.011"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jrr\/rrw047"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(80)90380-6"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19810415)47:8<1980::AID-CNCR2820470813>3.0.CO;2-Y"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2019.1643037"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-016-0679-6"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-017-2048-8"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-020-01701-5"},{"key":"e_1_2_7_16_1","unstructured":"Cancer Registry Annual Report 2020 \u201cHealth Promotion Administration Ministry of Health and Welfare Taiwan \u201d2022."},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2019.04.018"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.06.021"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2021.12.024"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2023.03.020"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01951"}],"container-title":["Head &amp; 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