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June 19, 2017. Do we really have to counsel patients on this risk? We talk about it a lot, but show me the data. This huge population study from Taiwan published last month found risk of osteonecrosis of the jaw for patients undergoing surgery for oral cavity cancer to be 15% at 5 years and 20% at 10 years. On MVA, adjuvant RT (HR 1.39, 1.26-1.54) did, indeed, increase this risk. But hold on...platinum-based chemotherapy (HR 1.94, 1.56-2.41) surprisingly had the highest relative risk, regardless of concurrent RT. But maybe we shouldn't be surprised given this prospective toxicity data. Most osteonecrosis happened around 1 year, and 90% within 5 years. Well, there you go. Let the counseling continue.