ArticlePentoxifylline in the Treatment of Radiation-Related Soft Tissue Injury: Preliminary ObservationsNeal D. Futran, MD,DMD 1 *, Andrea Trotti, MD 2, Clement Gwede, RN,MPH 2

1Division of Otolaryngology-Head and Neck Surgery, University of South Florida, Moffit Cancer Center, Tampa, FL.2Division of Radiation Oncology, University of South Florida, Moffit Cancer Center, Tampa, FL.

*Correspondence to Neal D. Futran, Neal D. Futran, MD, DMD, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Box 356515, Seattle, WA 98195-6515, U.S.A.

AbstractSoft tissue or mucosal injuries following radiotherapy of head and neck cancer include ulceration (necrosis), fibrosis, pain, and atrophy. Current management includes analgesics, wound debridement, antibiotics, and physical therapy depending on the type of injury. Pentoxifylline is a methylxanthine derivative that produces dose-related hemorrheologic effects, lower blood viscosity, improved erythrocyte flexibility, and increased tissue oxygen levels. Twenty-six patients with late radiation complications (occurring more than two months after x-ray therapy) were given treatment with oral pentoxifylline: 15 for soft tissue necrosis (STN), six for fibrosis, and five for mucosal pain. Nine of 12 patients with STN completely healed. In all three failures osteoradionecrosis developed. Mucosal pain resolved in all five patients. Fibrosis improved in 67% of those patients. Pentoxifylline appears to accelerate healing of STN and reverse some late radiation injuries. This is the first series to our knowledge that documents activity of this agent in moderate radiotherapy complications such as fibrosis, pain, or mucosal fragility.

Sucralfate in the prevention of radiation-induced oral mucositis.Cengiz M, Ozyar E, Oztürk D, Akyol F, Atahan IL, Hayran M.

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Abstract

Radiotherapy-induced mucositis decreases the quality of life by impairing eating, swallowing, and talking and by disturbing sleep. Mucositis may also predispose to local and systemic infections and may cause interruption of radiotherapy course. We studied the efficacy of sucralfate suspension in the prevention and management of oral mucositis and pain during radiotherapy in a double-blind, placebo-controlled, randomized,

prospective trial. Twenty-eight patients with head and neck cancer were included in the study. The patients were randomized to use either sucralfate mouth washing (n = 18) or placebo washing (n = 10) during irradiation. Oral mucositis and symptoms were assessed by the same physician using Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring criteria. All patients developed varying degrees of radiation-induced mucositis. Grade 4 mucositis was not encountered in any patient. One patient had grade 1, seven patients grade 2, and two patients grade 3 mucositis in placebo group. In sucralfate group, nine patients each had grade 1 and grade 2 with no grade 3 mucositis. Patients in the sucralfate group experienced significantly lower degree of mucositis than placebo group (p < 0.05). Sucralfate mouth washing is beneficial in decreasing the intensity of radiation-induced mucositis and oral discomfort. It is cheap, easy to administer with no serious side effect, and may be routinely used in patients receiving head and neck radiotherapy.