Prophylactic use of pentoxifylline and tocopherol in patients undergoing dental extractions following radiotherapy for head and neck cancer

Abstract

Background:In head and neck cancer patients undergoing radiotherapy, osteoradionecrosis (ORN) of the jaw is one of the major but uncommon complications. Satisfactorily results have been observed while treating ORN patients with upcoming treatment modalities such as combination therapy of pentoxifylline and Vitamin E (PVe). It is believed that in patients undergoing dental extractions, these treatment modalities can be used prophylactically for lowering the risk of development of ORN. Hence, keeping all these things in mind, we planned the present study to assess the prophylactic role of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of head and neck.Materials and Methods:A total of 110 patients were included in this retrospective study, which had radiotherapy for cancer of the head and neck. After radiotherapy, a total of 450 dental extractions were done in these 110 patients.Results:External beam therapy was given in 92.72% of the patients. 7.27% and 40% of the patients received intensity modulated radiotherapy combination of chemotherapy and intensity modulated radiotherapy, respectively. ORN developed only in 2 patients. Patients had taken PVe for a mean of 12 (24) weeks preoperatively and 14 (18) weeks postoperatively. The incidence was lower than that normally associated with dental extractions in irradiated patients.Conclusion:In patients undergoing dental extractions, after receiving radiotherapy of head and neck region, combination therapy of pentoxifylline and tocopherol are sufficiently effective.

Osteorradionecrose em mandíbula tratada com fibrina rica em plaquetas e bola de Bichat: relato de caso clínico

“…4 Quando as exodontias são realizadas após a radioterapia, diversas medidas são propostas para diminuir a ocorrência da ORN, entre elas o uso da pentoxifilina associada ao tocoferol, oxigênio hiperbárico e antibioticoterapia. 2,6,10 A pentoxifilina induz a dilatação vascular e o aumento da flexibilidade dos eritrócitos, resultando em aumento do fluxo sanguíneo. 6,7 O tocoferol é uma vitamina solúvel em gordura e fraco agente antioxidante, sendo portanto capaz de eliminar as espécies que reagem ao oxigênio, envolvidas no desenvolvimento da ORN.…”

“…Apesar da radioterapia ser um tratamento comumente utilizado para o cancro de cabeça e pescoço e aumentar suas taxas de cura, ela apresenta potenciais complicações. 1,2 Destas, a mais temida é a osteorradionecrose (ORN), a qual pode ocorrer durante ou após o tratamento. 1 A ORN manifesta -se como uma área de tecido ósseo exposto, em uma área previamente irradiada, que não cicatriza em um período de três meses, sem tumor residual ou recorrente e quando outras causas de osteonecrose foram excluídas.…”

“…O tratamento conservador inclui melhora da higiene oral, debridamento, irrigação e antibioticoterapia para prevenir infeção secundária, pentoxifilina e tocoferol, terapia com oxigênio hiperbárico. 1,2,7 Nos casos avançados, com grandes defeitos de tecido mole e ósseo, a ressecção cirúrgica geralmente é a terapia de escolha; nestes a reconstrução funcional e estética representa um desafio para os cirurgiões, devido ao alto risco de complicações cicatriciais pós--operatórias. 1,9 O presente trabalho teve como objetivo um relato de caso de uma paciente do sexo feminino, 63 anos com ORN em mandíbula, tratada de maneira conservadora, com cirurgia óssea ultrassónica, enxerto de fibrina rica em plaquetas (PRF) e bola de Bichat.…”

Pentoxifylline and tocopherol for prevention of osteoradionecrosis in patients who underwent oral surgery: A clinical audit

“…PENTO is the therapy currently in use in clinical practice for the prevention of ORN, as supported by previous literature and considering the clinical feasibility. 4,14,15 Since ORN is a not rare complication in the absence of preventive measures, it is not ethically acceptable to plan an intervention study that included, in the comparison group, non-therapy or placebo. Exclusion criteria were patient's therapy with bone-antiresorptive and/or antiangiogenic drugs associated to MRONJ.…”

“…12,13 PENTO has also been proposed as prophylactic therapy for ORN in patients who underwent head and neck RT and need oral surgery procedures, 4 although no standard of care is currently available. 6 Since data regarding the clinical efficacy of PENTO for ORN prevention are still poor and heterogeneous, 4,14 the aim of this paper is to evaluate the prophylactic effectiveness of PENTO in preventing ORN after minor oral surgery and to propose a prognostic score useful for the ORN risk analysis of the single patient.…”