title: Pentoxifylline and tocopherol in the management of cancer patients with medication-related osteonecrosis of the jaw: an observational retrospective study of initial case series.
abstract: OBJECTIVE
  Very few studies have evaluated the efficacy of pentoxifylline and tocopherol (PENT-E) in the management of medication-related osteonecrosis of the jaw (MRONJ), although some studies have shown the therapeutic and prophylactic benefit of PENT-E in the management of osteoradionecrosis. We report the outcomes of MRONJ managed with PENT-E in patients with metastatic bone disease or multiple myeloma.
  
  
  METHODS
  Seven patients diagnosed with established cases of refractory MRONJ caused by antiresorptive medications for the management of metastatic bone tumors or multiple myeloma were administered PENT-E for a mean period of 16.8 months (range 3-48 months).
  
  
  RESULTS
  At the latest follow-up visit, all patients demonstrated relief of symptoms. There was radiographic evidence of new bone fill of prior radiolucent defect in all patients. Two patients had resolution of exposed bone, two patients had partial resolution, one patient had no change in exposed bone, and one patient with three sites of exposed bone before starting PENT-E had resolution in one site, partial resolution in another site, and no change in the third site. PENT-E was well tolerated in all patients.
  
  
  CONCLUSIONS
  Our case series demonstrated that PENT-E was well tolerated and may be an effective adjunct in the management of MRONJ.
authors.affiliation: Oral/Dental Oncology Research Fellow, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Adepitan A
authors.initials: AA
authors.lastname: Owosho
authors.affiliation: Attending, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Cherry L
authors.initials: CL
authors.lastname: Estilo
authors.affiliation: Chief Attending, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Huryn
authors.affiliation: Assistant Attending, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA. Electronic address: Kims2@mskcc.org.
authors.forename: SaeHee K
authors.initials: SK
authors.lastname: Yom
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010431:Pentoxifylline / Q000627:therapeutic use*; D012189:Retrospective Studies; D024505:Tocopherols / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D050071:Bone Density Conservation Agents; D016166:Free Radical Scavengers; D024505:Tocopherols; D010431:Pentoxifylline