Efficacy of PENTOCLO Therapy in Treating Head & Neck Osteoradionecrosis: A Systematic Review

Importance: Osteoradionecrosis (ORN) has been shown to affect up to 20% of all head and neck cancer patients receiving radiation therapy. Despite its prevalence, a standard definitive therapy to treat this condition has yet to be available. A novel treatment modality with pentoxifylline, tocopherol, and clodronate (PENTOCLO) was first reported in the literature in 2005. There has since been a steady rise in the number of studies exploring the efficacy of PENTOCLO in treating ORN in head and neck patients. Objective: This article investigates the efficacy of PENTOCLO in treating ORN in head and neck cancer patients. Evidence Review: PubMed, Scopus, Cochrane Library, and Medline were used to review articles on PENTOCLO use for head and neck ORN from 2005 to the present. Two reviewers independently screened titles and abstracts from 114 articles, and inclusion was based on pair consensus. The main inclusion criteria were human clinical studies using PENTOCLO for at least 6 months in treating ORN in head and neck cancer patients. The selected main outcomes to determine the efficacy of PENTOCLO therapy were wound healing status after treatment, reduction in the percentage of exposed bone, and symptom surveys post-PENTOCLO therapy. Eight studies were selected for final statistical analysis. Findings: The primary site of ORN in most studies was mandible (77%). Of the 141 patients encompassed in this review, 66 (46.8%) patients had complete resolution, and 61 (43.3%) patients had significant wound healing. Total wound healing was achieved on an average of 10 months. The mean area of exposed bone decreased by 96% and the symptom survey scores decreased by 93% after treatment. Conclusion and Relevance: These results suggest PENTOCLO may be an effective treatment option in patients with head and neck ORN.