Osteoradionecrosis and intensity modulated radiation therapy: An overview

•The application of IMRT is expected to improve treatment tolerability.•The real benefit on osteoradionecrosis risk reduction should not be clearly drawn.•Mandible should be contoured as whole organ, with alveolar bone, excluding teeth.•Dmax <70 Gy, V50 = 62 and V60 = 20 are dose constraints suggestions to reduce ORN.

Osteoradionecrosis (ORN) is an ongoing topic, especially about its definition, pathogenesis, staging system and management algorithm. But what about its real incidence in intensity modulated radiotherapy (IMRT) era?This paper discusses the mandible in radiation therapy planning as organ at risk and reviews the literature for evidence of radiation damage, discussing likely dose constraints and the use of IMRT to reduce radiation dose to this structure. PubMed search was performed.