I wrote a previous blog post in which I hypothesized that by using a combination of vitamin E (alpha-tocopherol) and pentoxifylline (PTX), patients undergoing breast or chest wall radiation therapy for breast cancer might be able to reduce their risk of developing tissue fibrosis and breast implant contracture. This hypothesis was based on studies showing that using these two agents together could reduce tissue fibrosis in patients treated for head and neck cancers.
We now have a randomized study showing that vitamin E and PTX indeed reduces the degree of radiation-induced breast tissue fibrosis!
Fifty three patients were randomized after radiation therapy to the breast to either:
- (n=26 patients) a regimen of vitamin E (400 IU, alpha-tocopherol, one tab per day) and PTX (400 mg, one tab taken three-times per day) starting immediately after completing their breast radiation therapy, and then continued for 6-months, or
- (n=27 patients) a control group of patients who also completed radiation therapy but did not get the vitamin E/PTX regimen
They studied the softness of the tissue using a scientific instrument called a ’tissue compliance meter’ (TCM), which gives a quantitative, non-objective measurement of tissue firmness by pressing on areas of the breast. The amount of tissue indentation is able to be measured and compared using a mirror location on the opposite, un-irradiated breast. Studies show that method is much more accurate and sensitive in measuring tissue compliance (similar to density, softness or suppleness) than manual palpation.
Eighteen months after completing radiation therapy, TCM measurements were done on all patients.
The investigators found that the patients who received the 6-month regimen of vitamin E/PTX had 50% less fibrosis than those who didn’t get the vitamin E/PTX regimen! Aside from a mild skin rash in one patient, this regimen was well tolerated.
How Does Vitamin E and PTX Work?
We don’t know for sure, but this is one hypothesis:
- In addition to reducing tissue fibrosis, PTX is also used for improving the blood supply to small vessels from conditions of impaired microcirculation (i.e. claudication, vascular dementia, sickle cell disease.) One of the mechanisms by which PTX may work in preventing and reducing radiation-induced tissue fibrosis is by making red blood cells more deformable, so they can bring oxygen to the tissues more easily and reduce inflammation.
- Vitamin E is an antioxidant, and may work by reducing inflammatory-derived free radicals in the radiated tissues. If this chronic, low level inflammation is able to be lessened, tissue fibrosis should be reduced.
Side Effects, Interactions & Contraindications:
The Dosing Is:
- Vitamin E (I recommend you buy “mixed tocopherols”, as you want to include more than just the standard “alpha tocopherol” form): 400 I.U. twice a day and
- Pentoxifylline (ask your doctor for a prescription): 400 mg, three times each day
A preventive regimen of vitamin E and PTX after breast radiation therapy should be considered in patients who want to minimize their risk of radiation-induced fibrosis.
You will want to start this treatment shortly after completion of radiation therapy, so discuss this with your radiation oncologist during your treatment course to find out if they think you might be a good candidate.
It doesn’t work for everyone and results will vary, but even if you completed radiation a while ago, this regimen may still be able to reduce the amount of fibrosis in your breast. Again, discuss this with your radiation oncologist.