Striking regression of radiation-induced fibrosis by a combination of pentoxifylline and tocopherol.
Radiation-induced fibrosis (RIF) is a terminal sequela to irradiation that does not regress spontaneously. A preliminary study of a combination of pentoxifylline (PTX) and tocopherol (vit-E) has shown clinical activity with 50% superficial RIF regression at 6 months in half of the patients studied. The present report is of a 67-year-old woman presenting with bulky cervicothoracic RIF who, 10 years previously, had received radiochemotherapy for a small cell thyroid carcinoma to a dose of 50 Gy, with severe acute side-effects. She had palpable cervicosternal fibrosis measuring 10 x 8 cm, with local inflammatory signs and functional consequences (cough, restricted cervical movement, dyspnoea and bronchitis) with a SOMA scale for grading the long-term side effects of radiation therapy of 19/14. CT showed deep RIF extending from the vocal cords to the carina, with laryngotracheal compression but without cancer recurrence. PTX (800 mg d-1) and vit-E (1000 U d-1), orally administered daily for 18 months, were well tolerated. The patient exhibited clinical regression and functional improvement. The linear dimensions and SOMA scale were, respectively, 8 x 6 cm and 11 at 6 months; 4 x 4 cm and 7 at 12 months; and complete response with no measurable RIF and 1 at 18 months. This is the first time that the combination of PTX and vit-E has had a significant antifibrotic effect by completely reversing deep RIF as shown by CT scan normalization.
Delanian
S
S
Service d'Oncologie-Radiothérapie, Hôpital Saint-Louis, Paris, France.
D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis; D006801:Humans; D010431:Pentoxifylline / Q000627:therapeutic use*; D011832:Radiation Injuries / Q000188:drug therapy*; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D013964:Thyroid Neoplasms / Q000532:radiotherapy*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014810:Vitamin E / Q000627:therapeutic use*
D014665:Vasodilator Agents; D014810:Vitamin E; D010431:Pentoxifylline