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

Patel, Vinod; Young, Helen; Mellor, Amy; Sproat, Chris; Kwok, Jerry; Cape, Angela; Mahendran, Krishantini

doi:10.1016/j.oooo.2023.02.012

Cited by 4 publications

(7 citation statements)

References 30 publications

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“…Hence, multiple medical conditions coupled with polypharmacy have a heightened risk of adverse events. Beyond a single patient reporting gastric irritation which is a well‐recognised side effect 2,3,8–10,12–14 of pentoxifylline, no further issues were identified.…”

Section: Discussionmentioning

confidence: 99%

The use of pentoxifylline within the medical regime for the management and prevention of osteoradionecrosis in patients with cardiac‐, cerebrovascular and thromboembolic conditions

Jawad,

AlHakim,

Sproat

et al. 2024

Oral Surgery

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ObjectiveOsteoradionecrosis (ORN) is a serious and late complication following radiotherapy for head and neck cancer (HNC). Current medical management involves the use of pentoxifylline, which is advised to be used with caution in certain patients with cardiac‐ or cerebrovascular conditions. This retrospective review aims to assess the clinical outcomes of patients medically managed on the background of pre‐existing cardiac‐ and cerebrovascular conditions or treatment with anticoagulant/antiplatelet therapy for thromboembolic disease.Materials and MethodsClinical records of 36 patients were identified and reviewed retrospectively. Patients were split into two subgroups—patients having treatment for established ORN (n = 21) and patients ‘at risk’ of ORN following dentoalveolar surgery (n = 15).ResultsIn the established ORN group, 38% healed, and 57% were considered stable. In the prophylaxis group, 100% of cases healed with no ORN. Overall, across both groups, most patients reported no major side effects from pentoxifylline, with the most common being gastric irritation (n = 3, 8%).ConclusionThis retrospective review provides early valuable insight on pentoxifylline for patients with existing cardiac‐, cerebrovascular and thrombo‐embolic conditions who have been treated with radiotherapy for HNC, both prophylactically to help prevent ORN and as treatment for established ORN.

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Section: Discussionmentioning

confidence: 99%

The use of pentoxifylline within the medical regime for the management and prevention of osteoradionecrosis in patients with cardiac‐, cerebrovascular and thromboembolic conditions

Jawad,

AlHakim,

Sproat

et al. 2024

Oral Surgery

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“…However, medical management is not without its own challenges. PENTO/CLO is ideally an oral tablet regime, 12 though considering several HNC patients who have dysphagia, it has been adapted to a liquid formulation 13,14 . The latter is recognised to have a higher side effect profile such as gastric irritation, nausea, headaches and vomiting 13 .…”

Section: Discussionmentioning

confidence: 99%

“…PENTO/CLO is ideally an oral tablet regime, 12 though considering several HNC patients who have dysphagia, it has been adapted to a liquid formulation. 13,14 The latter is recognised to have a higher side effect profile such as gastric irritation, nausea, headaches and vomiting. 13 Though many patients can tolerate these while they habituate to the medication, this may be more challenging if they are undergoing further palliative treatment such as chemotherapy or immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

The management of osteoradionecrosis in palliative head and neck cancer patients

AlHakim,

Jawad,

Sproat

et al. 2024

Oral Surgery

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ObjectiveOsteoradionecrosis (ORN) is a well‐recognised complication of radiotherapy in the cured head and neck cancer (HNC) patients. More recently with improved survivorship in the palliative HNC group, there is an increasing population that is also burdened by radiation late effects such as ORN. Currently, there is no proven approach to manage ORN in this cohort of patients. This study reports the management and outcome of a case series of palliative care HNC patients with established ORN.Materials and MethodsThe clinical records of 20 palliative care HNC patients with an established ORN diagnosis were identified and reviewed retrospectively.ResultsAll 20 patients were managed via a conservative approach. Medical management via PENTO (n = 4, 20%) or PENTOCLO (n = 8, 40%) was the most popular approach. All but two patients had ORN that healed (4/20, 20%), or was stabilised (14/20, 70%). The two patients with progressive ORN had a tumour diagnosis adjacent to the necrotic site.ConclusionMedical management via PENTO/CLO provided promising results in this small cohort of palliative patients with ORN. The overall combined healing and stability of ORN status are comparable to those in the literature, though most cases are stabilised as opposed to cured.

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“…There are only five retrospective case studies published on the prophylactic use of PENTO to prevent ORN: four studies conducted in Europe, one study in India and none reported in the U.S. Across four retrospective case studies that utilized PENTO in a tablet form, the ORN rate in patients was 3.1% (12/387), and at the individual tooth level, it was 0.9% (11/1269) [31]. The fifth study used a liquid formulation of pentoxifylline and tocopherol and the majority of the patients (38/45) had only dental extractions carried out; the ORN rate in patients was 4.4% (2/45) [32]. The two ORN patients eventually healed after continual use of PENTO for 19 and 44 months [32].…”

Section: Introductionmentioning

confidence: 99%

“…The fifth study used a liquid formulation of pentoxifylline and tocopherol and the majority of the patients (38/45) had only dental extractions carried out; the ORN rate in patients was 4.4% (2/45) [32]. The two ORN patients eventually healed after continual use of PENTO for 19 and 44 months [32].…”

Section: Introductionmentioning

confidence: 99%

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

Owosho,

DeColibus,

Okhuaihesuyi

et al. 2024

Dentistry Journal

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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.

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

Cited by 4 publications

References 30 publications

The use of pentoxifylline within the medical regime for the management and prevention of osteoradionecrosis in patients with cardiac‐, cerebrovascular and thromboembolic conditions

The use of pentoxifylline within the medical regime for the management and prevention of osteoradionecrosis in patients with cardiac‐, cerebrovascular and thromboembolic conditions

The management of osteoradionecrosis in palliative head and neck cancer patients

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

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