Pentoxifylline and tocopherol (vitamin E) with/without clodronate for the management of osteoradionecrosis: A scoping review

Abstract

Background: Treatment of osteoradionecrosis (ORN) is not a straightforward task, and it is unpredictable. However, a combination of pentoxifylline; an antioxidant drug, and tocopherol (vitamin E) works as a potent antifibrotic agent and have shown recently both significant and impressive results.Aims: This scoping review aims to investigate the most prescribed regimen of pentoxifylline and tocopherol with/without clodronate for the management of ORN.Methods: Ovid MEDLINE and EMBASE databases were used to retrieve eligible studies using planned search keywords. PROSPERO and Cohcarne library were also searched for ongoing or published systematic reviews, respectively. Included articles were grouped thematically according to the type of studies and accordingly they were summarized.Results: A total of 27 articles met the inclusion criteria and included in the data analyses. All the included articles were published between 1997 and 2020. Of these 27 included studies, two were randomized control trials, two were systematic reviews, six were retrospective studies, five were observational studies, seven were narrative reviews, four were case reports, and lastly one was an in-vitro study. Conclusions:Treatment by PENTO (800 mg of pentoxifylline + 1000 IU of tocopherol) once daily for an early established ORN or PENTOCLO (PENTO regimen + 1600 mg of clodronate) once daily for the refractory/severe cases of ORN appears to be the most prescribed regimen used for the treatment of ORN using these drugs. These drugs appear safe, effective and inexpensive for the treatment of ORN.

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

“…PENTO protocol is low-cost, clinically feasible, safe and well tolerated by patients. 33 More comprehensive studies, controlling confounding factors such as concomitant antibiotic therapy, are necessary to establish the effectiveness of PENTO in ORN prevention. Moreover, a standardized and widely accepted protocol is still necessary in order to obtain comparable results.…”

The Progress in Reconstruction of Mandibular Defect Caused by Osteoradionecrosis

“…Te main mechanism is to inhibit fbrosis induced by radiation. And in 2023, Assim Banjar reviewed the articles published between 1997 and 2020 on the treatment of ORN with Pentoxifyline and vitamin E and found that the early use of Pentoxifyline and vitamin E could signifcantly reduce the severity of ORN and reduce the degree of injury [65][66][67]. It is mainly because Pentoxifyline and vitamin E could efectively inhibit the production of free oxygen, thus reducing the damage caused by radiation to bones.…”

Histopathological insight into a healed case of osteoradionecrosis treated with triple therapy medical management

“…4 Previous published data reported on medical management of ORN reported an overall healing rate of 54.4% 5 in the largest case cohort reported to date with smaller cases series providing a much wider spectrum of successful outcomes. 6 Though clinical and radiographic resolution using PEN-TO(CLO) have been repeatedly reported in the literature, understandably histopathological analysis of the healed area remains largely unknown. The suggestion is the healed site is a complex mix of bone, mucosa, scar and fibrous tissue.…”

“…The synergistic impact of these drugs to provide an antifibrotic effect aims to stabilise and prevent progression of the disease process and encourage healing 4 . Previous published data reported on medical management of ORN reported an overall healing rate of 54.4% 5 in the largest case cohort reported to date with smaller cases series providing a much wider spectrum of successful outcomes 6 …”