The use of liquid formulation pentoxifylline and vitamin E in both established and as a prophylaxis for dental extractions "at risk" of osteoradionecrosis

Efficacy of PENTOCLO Therapy in Treating Head & Neck Osteoradionecrosis: A Systematic Review

IMPORTANCE

Osteoradionecrosis (ORN) has been shown to affect up to 20% of all head and neck cancer patients receiving radiation therapy. Despite its prevalence, a standard definitive therapy to treat this condition has yet to be available. A novel treatment modality with pentoxifylline, tocopherol, and clodronate (PENTOCLO) was first reported in the literature in 2005. There has since been a steady rise in the number of studies exploring the efficacy of PENTOCLO in treating ORN in head and neck patients.

OBJECTIVE

This article investigates the efficacy of PENTOCLO in treating ORN in head and neck cancer patients.

EVIDENCE REVIEW

PubMed, Scopus, Cochrane Library, and Medline were used to review articles on PENTOCLO use for head and neck ORN from 2005 to the present. Two reviewers independently screened titles and abstracts from 114 articles, and inclusion was based on pair consensus. The main inclusion criteria were human clinical studies using PENTOCLO for at least 6 months in treating ORN in head and neck cancer patients. The selected main outcomes to determine the efficacy of PENTOCLO therapy were wound healing status after treatment, reduction in the percentage of exposed bone, and symptom surveys post-PENTOCLO therapy. Eight studies were selected for final statistical analysis.

FINDINGS

The primary site of ORN in most studies was mandible (77%). Of the 141 patients encompassed in this review, 66 (46.8%) patients had complete resolution, and 61 (43.3%) patients had significant wound healing. Total wound healing was achieved on an average of 10 months. The mean area of exposed bone decreased by 96% and the symptom survey scores decreased by 93% after treatment.

CONCLUSION AND RELEVANCE

These results suggest PENTOCLO may be an effective treatment option in patients with head and neck ORN.

Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series

Osteoradionecrosis of the jaw is a morbid complication of radiotherapy in patients with oral and oropharyngeal cancers that may be precipitated by dental extractions. Pentoxifylline and tocopherol (PENTO) has been utilized in the management of osteoradionecrosis and as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. This observational study aims to report the outcome of the prophylactic use of PENTO in the prevention of osteoradionecrosis of the jaw after dental extractions in post-radiated oral and oropharyngeal cancer patients and to review the current literature on this topic. Four post-radiated oral and oropharyngeal oncology patients were referred to the dental oncology clinic of the University Dental Practice, University of Tennessee Health Sciences Center for dental extractions. All four patients were prescribed pentoxifylline 400 mg BID (twice a day) and tocopherol 400 IU BID (oral tablets) for 2 weeks before extraction(s) and for 6 weeks after extraction(s). All patients were followed up every week after the second week post-extraction if feasible until the extraction site(s) healed (covered by mucosa). The assessment endpoint was defined as 6 weeks post-extraction with the outcomes assessed as using four categories determined by the area of exposed bone: complete healing (complete mucosal coverage of extraction site); partial healing (reduction in size of extraction site); no change; and progression (increase in size of the extraction site). At the assessment endpoint, all patients had complete healing of all extraction sites. The ORN rate at the patient level (0/4) and individual tooth level (0/8) was 0%. All patients tolerated the PENTO medications and no adverse effects from the use of these medications were reported. This limited study in addition to the other reviewed studies estimates the rate of ORN at the patient level as 3.2% (14/436) for post-radiated head and neck oncology patients after dental extractions/invasive oral procedures. In conclusion, this PENTO regimen can reduce/prevent the incidence of ORN in post-radiated head and neck oncology patients. This safe and cost-effective protocol (PENTO regimen) should be further evaluated as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. We recommend large prospective studies to be carried out to further validate these findings.