Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, α-tocopherol, and clodronate

A significant complication of radiotherapy to the head and neck for cancer treatment is osteoradionecrosis (ORN) of the jaws. The management of ORN can be complex and often requires a multimodality approach. Nonsurgical treatments with or without adjunct measures and surgical interventions have all been employed on the basis of staging of the disease process. New theories on the pathophysiology of ORN have led to the identification of novel treatment modalities, including pharmacologic management using pentoxifylline, tocopherol, and clodronate (together referred to as “Pentoclo”). In this review article, we discuss the definition and staging of ORN, its etiology and pathophysiology, and traditional treatment options and present the available information on pentoxifylline, tocopherol, and clodronate and their use in combined therapy for ORN. Limited studies to date have demonstrated the effective pharmacologic use of Pentoclo in treating ORN and radiation-induced injury at other body sites. Further research is necessary to elucidate any potential role for the use of Pentoclo in the management of this debilitating disease process.