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

Abstract

Osteoradionecrosis (ORN) of the jaws remains one of the most debilitating complications of radiotherapy (RT) in patients with head and neck cancer (HNC). Liquid pentoxifylline and vitamin E (PVe) presents an alternative formulation to tablets for patients with dysphagia or enteric feeding. This study aimed to assess the clinical outcomes of using a liquid formulation of PVe for both established ORN and as a prophylaxis to avoid its occurrence after dental extractions. A secondary objective was to determine patient-reported side effects in relation to the liquid formulation of PVe. The clinical records of 111 patients with HNC who were prescribed liquid PVe were reviewed retrospectively (66 with established ORN and 45 as prophylaxis before an invasive dental procedure). In established ORN, 44% healed, and 41% were stable. In the prophylaxis group, 96% of surgical sites healed completely, with 4% (n=2) developing ORN. Most patients (89%) were able to tolerate liquid PVe. Of the 11% (n=12) who could not tolerate this regime, the most commonly reported side effect was gastric irritation (n=5/12), whereas no more than 1 patient reported dizziness, malaise, and bleeding. This retrospective review suggests that liquid PVe is efficacious for both established ORN and as a prophylaxis. Side effects reported were similar to those recognized for the tablet formulation.