Management of osteoradionecrosis of the jaws with pentoxifylline–tocopherol: a systematic review of the literature and meta-analysis

Kolokythas, Antonia; Rasmussen, J.T.; J, Reardon; Chen, Feng

doi:10.1016/j.ijom.2018.08.007

Cited by 67 publications

(82 citation statements)

References 31 publications

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“…Basically by infection control with antibiotics and antiseptic agents as well as by the removal of the devitalized bone when possible. 19 In our case, the infection was controlled with association of Amoxicillin -Clavulanic acid and Metronidazol as well as Antiseptic agent; Chlorohexidine mouth wash. We also prescribed Pentoxifylline and Tocopherol (Vit E) following the protocol proposed by Delanian. 11 Pentoxifylline (PTX), is an antioxidant agent generally used to treat vascular diseases such as intermittent claudication.…”

Section: Volume 2 Issue 3 (Pagementioning

confidence: 59%

Conservative Approach of a Severe Case of Osteoradionecrosis of the Mandible- Case Report

Dorsaf

Ons

Yosri

et al. 2020

Int. J. Drug Res. Dental Sci

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Osteoradionecrosis (ORN) of the jaw is a severe, complex, and multifactorial complication of radiotherapy (RT) for head and neck cancers. Most cases of ORN develop during the first 3 years with a peak between 6 months and 2 years after completion of RT however the patient is considered at risk of developing this condition many years later. The management of ORN is usually based on conventional medical care by focusing on comorbidity factors, However, in some refractory ORN cases, the condition requires extensive surgical resection. Based on the "the radiation-induced fibro-atrophic theory" introduced by Delanian, a new conservative approach of ORN seems to be promising by combining antioxidant agents: pentoxifylline and Tocopherol (PtxE) in the treatment of severe cases of ORN. The aim of this paper was to report the case of a severe case of ORN of the mandible stabilized by a conservative approach combining antibiotics, antiseptic agent as well as antioxidant therapy (PtxE), and to discuss the efficacy of this approach.

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Section: Volume 2 Issue 3 (Pagementioning

confidence: 59%

Conservative Approach of a Severe Case of Osteoradionecrosis of the Mandible- Case Report

Dorsaf

Ons

Yosri

et al. 2020

Int. J. Drug Res. Dental Sci

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“…19 However, given the risk of bisphosphonate-induced osteonecrosis and the unavailability of clodronate in the United States, PENTO alone has been evaluated, with a recent meta-analysis supporting its use in mandibular ORN. 20 The largest report of PENTO in TBORN evaluated five cases and concluded that it may be beneficial for symptom control and coverage of exposed bone. 21 In the present study, PENTO controlled symptoms better than conservative management alone, but given our low number of cases, definitive conclusions cannot be made.…”

Section: Discussionmentioning

confidence: 99%

Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience

et al. 2021

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Objectives/Hypothesis: To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes.Study Design: Retrospective chart review. Methods: Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease.Results: TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful.Conclusions: TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management.

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“…Conservative measures include systemic antibiotics, local antimicrobial irrigation, hyperbaric oxygen therapy, and medicinal products derived from methylxanthines as well as antioxidants [11,12]. In addition, the combination of systemic pentoxifylline and tocopherol (PENTO) for the treatment of ORN has been proposed as possible therapy [3,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Pentoxifylline, tocopherol, and sequestrectomy are effective for the management of advanced osteoradionecrosis of the jaws—a case series

Anjos

Walfrido

Valente

et al. 2020

Support Care Cancer

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Background The aim of the present study was to evaluate the efficacy of pentoxifylline and tocopherol for the management of osteoradionecrosis of the jaws. Methods Twenty-five patients diagnosed with osteoradionecrosis of the jaws treated with pentoxifylline 400 mg + tocopherol 400 mg three times daily (tid) were evaluated. Clinical records and image tests were reviewed. All patients were previously submitted to head and neck radiation therapy and presented with a clinical and radiographic diagnosis of osteoradionecrosis of the jaws.Results Following therapy with pentoxifylline and tocopherol, 76% (19/25) of the patients showed complete mucosal healing, in which 47.3% (9/19) did not undergo sequestrectomy. From this particular group, 77.7% (7/9) were in stage I and 33.3% (3/9) used the protocol for up to 3 months. Among those who underwent to sequestrectomy, complete mucosal healing was observed in 52.7% (10/19). Among these, 60% (6/10) were in stage I and 100% of the patients were using the protocol for more than 3 months. In all other patients, partial healing of the mucosa was observed since they presented advanced disease. These represented 24% of the sample (6/25), 66.6% (4/6) were in stage III, and 60% (4/6) used the protocol for over 6 months. Conclusion Pentoxifylline and tocopherol may provide effective management of osteoradionecrosis of the jaws, and the association with sequestrectomy may avoid major surgical procedures.

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Management of osteoradionecrosis of the jaws with pentoxifylline–tocopherol: a systematic review of the literature and meta-analysis

Cited by 67 publications

References 31 publications

Conservative Approach of a Severe Case of Osteoradionecrosis of the Mandible- Case Report

Conservative Approach of a Severe Case of Osteoradionecrosis of the Mandible- Case Report

Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience

Pentoxifylline, tocopherol, and sequestrectomy are effective for the management of advanced osteoradionecrosis of the jaws—a case series

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