Comments on: Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes

Dear Sir, We found the article ‘Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes’ by Babu et al.[1] intriguing and informative.[1] The study shows that hypofractionated accelerated radiotherapy (HART) is effective in buccal mucosa carcinoma (BMC) patients. We wish to highlight two concerns, which we hope the authors can address and in so doing, contribute to future studies. First, although osteoradionecrosis of the jaw (ORNJ) is typically defined as exposed irradiated bone that fails to heal within 3–6 months without local tumour recurrence or proven metastasis,[2] the study by Babu et al.[1] had a follow-up period ranging from 1 to 134 months, emphasising that some patients require additional follow-up time to meet ORNJ definition since the lower margin was only 1 month. Hence, the presented data may have underrated ORNJ rates, which may be higher than 10.3%. Consequently, given the universally accepted definition of ORNJ,[2,3] it could be posited that implementing a time cut-off of no less than 6 months would likely result in the identification of substantially higher ORNJ rates. Second, despite radiation-induced trismus (RIT) being a more common complication of radiotherapy than ORNJ, no data is provided on its incidence in this high-risk patient population.[4,5] However, it is impossible to spare all the components of the masticatory apparatus when designing a two-dimensional radiotherapy for BMCs. Hence, most patients likely received high doses of radiation for the masticatory apparatus components. Concerning the potential of HART for severe complication risks, providing RIT-related outcomes may be valuable in determining the exact value of HART in such patients, which may aid in improving patient outcomes and future study designs in this field. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.