Is pentoxifylline plus vitamin E effective for treatment of radiation-induced fibrosis (RIF)?

Late or chronic fibrosis of soft tissues represents a serious and common complication of radiation therapy in the treatment of malignancy.1,2 Few treatment modalities exist for managing RIF.2 Pentoxifylline, a methylxanthine derivative approved by the Food and Drug Administration for the treatment of patients with intermittent claudication, is one of the first medications available in the US that may be used to treat RIF, particularly when given in combination with vitamin E.2-4 The literature evaluating the use of pentoxifylline and vitamin E for RIF is reviewed here. Late radiation injuries usually do not become clinically apparent until several months or years following the completion of radiation therapy and are characterized by a loss of elasticity and mild induration.1,2 Fibrosis can occur with more severe injury and is commonly seen in breast, head, neck, and connective tissues.2,4-6 Complications of fibrosis include chronic pain, neuropathy, loss of joint range of motion, and lymphedema.1 In addition to fibrosis, other late manifestations of radiation-induced injury include ulceration and necrosis associated with diminished vascular supply.1,2,5 The underlying mechanisms behind the development of RIF remain unknown.2 Early theories proposed that RIF was caused by direct microvascular destruction, resulting in tissue hypoxia and nutritional deficits related to vascular insufficiency. More recent theories have implicated the role of cytokines and growth factors in the development of Role of Pentoxifylline and Vitamin E in Attenuation of Radiation-Induced Fibrosis