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DRUG INFORMATION ROUNDS

Role of Pentoxifylline and Vitamin E in Attenuation of Radiation-Induced Fibrosis

Drug Information Clinical Specialist, Veterans Affairs (VA) Medical Center, San Francisco, CA; Adjunct Faculty, Thomas J Long School of Pharmacy, University of the Pacific, Stockton, CA; Assistant Professor, School of Pharmacy, University of California, San Francisco

Audrey J Lee, PharmD BCPS

Associate Professor of Pharmacy Practice, Thomas J Long School of Pharmacy, University of the Pacific, Stockton; Clinical Specialist, Internal Medicine, VA Medical Center, San Francisco

Reprints: Dr. Chiao, Pharmacy Department (119), VA Medical Center, San Francisco, CA 94121-1545, fax 415/750-2055, teresa.chiao{at}med.va.gov

OBJECTIVE: To evaluate the use of pentoxifylline and vitamin E as monotherapy and in combination for the treatment of radiation-induced fibrosis (RIF).

DATA SOURCES: Literature retrieval was performed through MEDLINE (1966-March 2004) using the terms vitamin E, -tocopherol, pentoxifylline, radiation-induced fibrosis, and radiation injury.

DATA SYNTHESIS: Few treatments exist for managing RIF of soft tissues. Due to its antioxidant properties, vitamin E may reduce the oxidative damage induced by radiation. The precise mechanism of action for pentoxifylline in management of RIF remains unclear. Uncontrolled studies evaluating vitamin E or pentoxifylline as monotherapy in RIF have shown modest improvement in clinical regression of fibrosis. However, controlled data are needed to verify these benefits. Studies involving pentoxifylline plus vitamin E demonstrated regression in RIF. The combination was more effective than placebo and may be superior to monotherapy with either agent. Adverse effects were rarely reported in the studies and consisted mainly of gastrointestinal and nervous system effects.

CONCLUSIONS: Overall, pentoxifylline is well tolerated and is one of the few commercially available drugs with clinical data for management of RIF. Despite a lack of large, well-designed clinical trials, pentoxifylline plus vitamin E should be considered as an option in patients with symptomatic RIF.

Key Words: -tocopherol, pentoxifylline, radiation-induced fibrosis, vitamin E

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E186

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