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Head and Neck Surgery

PENTO and PENTOCLO Efficacy in Treating Osteoradionecrosis: Systematic Review and Meta-analysis

Sunday, October 1, 2023
1:24 PM - 1:30 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Arianna V. Ramirez, MD

    Resident
    University of Texas Medical Branch School of Medicine
    Galveston, TX, United States

    • Co-Author(s)

  • Janisah Amirah Isip Saripada, BS

    Medical Student
    University of Texas Medical Branch
    GALVESTON, Texas, United States

  • Amy Wang

    Student
    University of Texas Medical Branch
    Katy, TX, United States

    • Senior Author(s)

  • Orly M. Coblens, MD

    Associate Professor & Residency Program Director
    University of Texas Medical Branch at Galveston
    Galveston, Texas, United States

    • Co-Author(s)

  • SS

    Sepehr Shabani, MD

    Assistant Professor
    UTMB Department of Otolaryngology
    Galveston, TX, United States

    • Senior Author(s)

  • SS

    Sepehr Shabani, MD

    Assistant Professor
    UTMB Department of Otolaryngology
    Galveston, TX, United States

Disclosure(s):
Arianna V. Ramirez, MD: No relevant relationships to disclose.
Janisah Amirah Isip Saripada, BS: No relevant relationships to disclose.
Orly M. Coblens, MD: No relevant relationships to disclose.
Introduction: Osteoradionecrosis (ORN) remains a dreaded sequela of head and neck radiotherapy. Treatment of osteoradionecrosis with tocopherol, pentoxifylline, and clodronate (PENTOCLO) has become a novel treatment modality for osteoradionecrosis.

Methods: We investigate the efficacy of both PENTO and PENTOCLO in treating osteoradionecrosis in head and neck cancer patients by way of systematic review and meta-analysis. Pubmed, Scopus, Cochrane Library, and Medline databases were utilized. Keywords searched included “PENTOCLO” “Pentoxyfylline+Tocopherol + Clodronate”, “PENTO”, and “Pentoxifylline + Tocopherol”. Two reviewers independently screened titles and abstracts from 271 articles. Inclusion criteria included human clinical studies utilizing PENTOCLO or PENTO for a minimum of 6 months in treating ORN in head and neck patients from the year 2000 and onwards. The selected primary outcomes were wound healing status after treatment, reduction in the percentage of exposed bone, and reduction in patient symptoms. After duplicates and unrelated studies were removed, 9 PENTOCLO and 11 PENTO studies were selected for further review and statistical analysis. This resulted in the inclusion of 261 patients treated with PENTO and 223 patients treated with PENTOCLO.

Results: The majority of studies focus on the mandible/jaw as the primary site for osteoradionecrosis (77%), with other investigations treating ORN of the sphenoid, temporal bone, and piriform sinus. Preliminary analysis of selected outcome measures shows an average healing rate of 75% of ORN with PENTOCLO therapy. Likewise, 72% of patients within PENTO studies showed resolution of ORN disease along with a 78.5% reduction in exposed mandible surface area after treatment. Minimal adverse effects of either treatment were noted.

Conclusions: Our initial investigation into these treatment modalities shows promising results to suggest PENTOCLO and PENTO may be effective and low-risk treatment options in patients with ORN following head and neck radiation therapy.