January 06, 2020

PENTOCLO Treatment of Mandibular Osteoradionecrosis

Patients with throat cancer not uncommonly undergo treatment with radiation in order to fully eradicate cancer presence. Along with the many potential side effects of radiation therapy is potential for osteoradionecrosis which basically is when the bone itself dies and becomes necrotic and/or exposed. This complication most often involves the jawbone and can occur even 5 years after radiation treatment has been completed.

Although the typical scenario is a non-healing exposed bone after tooth removal, it can also occur spontaneously. Treatment typically requires antibiotics and hyperbaric oxygen (HBO). However, HBO is time consuming, expensive, and carries its own risks including barometric damage to the lungs, sinus, and ear as well as changes in vision causing near-sightedness. Rarely, it may even cause oxygen poisoning, which can lead to lung failure, fluid in the lungs, or seizures.

Surgery can be pursued as an alternative to remove the necrotic bone, but is considered quite morbid and even disfiguring to some degree.

Other medical interventions have been researched as an alternative to HBO and surgery. Researchers in France have developed a medical regimen with just pills called PENTOCLO (PENtoxifylline – TOcopherol – CLOdronate) that cured 76.5% of patients with osteoradionecrosis over an average time duration of 9.6 months. Treatment sometimes lasted as long as 2 years. So what is the protocol?

Here goes...

Phase 1: The "disinfiltration" phase which lasts 28 days.
• Ciprofloxacin 500 mg oral suspension, morning and evening
• Clindamycin 600 mg 3 times per day
• Fluconazole 50 mg oral suspension, once daily
• Prednisone 20 mg, once daily
Omeprazole 20 mg, once daily.

Phase 2: The "therapeutic" phase or PENTOCLO phase
• Pentoxifylline 400 mg, 1 tablet, morning and evening
Tocopherol 500mg, 1 capsule, morning and evening
• Clodronate 800 mg, 1 tablet, morning and evening, Monday to Friday (5 days per week)
• Prednisone 20 mg, once daily, Saturday and Sunday (2 days per week)
Omeprazole 20 mg, once daily, Saturday and Sunday (2 days per week).

The end of treatment was determined by a complete clinical cure OR maximum of 2 years at which point PENTOCLO treatment would be considered a failure.

Just something to think about for those wishing to avoid HBO or surgery.

Reference:
Efficacy of Pentoxifylline–Tocopherol–Clodronate in Mandibular Osteoradionecrosis. Laryngoscope. 2019 Nov 20. doi: 10.1002/lary.28399. [Epub ahead of print]



Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.

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