Retrospective Analysis Of The Combined Effects Of Vitamin E And Pentoxifylline In Post- Radiation Recovery Of Head And Neck Cancer Patients At Tertiary Care Center, Anand

Retrospective Analysis Of The Combined Effects Of Vitamin E And Pentoxifylline In Post- Radiation Recovery Of Head And Neck Cancer Patients At Tertiary Care Center, Anand | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective Analysis Of The Combined Effects Of Vitamin E And Pentoxifylline In Post- Radiation Recovery Of Head And Neck Cancer Patients At Tertiary Care Center, Anand Vishal A. Patel, Sohilkhan R. Pathan, Nirav Asarawala, Kruti B. Sharma, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9391601/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Radiation therapy is a cornerstone of cancer treatment, but its side effects, including pain, delayed wound healing, and radiation-induced complications, significantly impact patients' quality of life. Pentoxifylline and Vitamin E have been suggested as adjunct therapies to mitigate these adverse effects. This study evaluates the efficacy of these agents in improving pain scores, wound healing, and radiation-related complications in cancer patients. Aim This study aims to assess the effectiveness of Pentoxifylline and Vitamin E in reducing pain, enhancing wound healing, and minimizing radiation-induced side effects in patients undergoing radiation therapy. Materials and Methods This retrospective study analyzed clinical data from cancer patients receiving radiation therapy, divided into a treatment group (Pentoxifylline and Vitamin E) and a control group. Patients were categorized based on cancer stage and treatment regimens. Data on radiation dosage, pain scores, wound healing rates, and radiation-related side effects were collected and statistically analyzed. Results Patients in the treatment group, particularly those in advanced cancer stages, experienced significantly lower pain scores compared to controls (p-values < 0.0001 for Stage 2 and 0.0004 for Stage 4). Wound healing was notably faster in Stages 2, 3, and 4, with statistically significant improvements (p = 0.01, 0.03, and 0.05, respectively). However, the treatment group did not show a reduction in radiation-induced side effects, with an unexpected increase in xerostomia cases (p = 0.0026). Radiation dose analysis revealed that patients in the treatment group were more likely to receive higher radiation doses (66Gy/33# and 70Gy/33#), suggesting a potentially more aggressive treatment approach. Conclusion The combination of Pentoxifylline and Vitamin E appears to provide significant pain relief and improved wound healing, particularly in advanced cancer stages. However, its impact on radiation-induced side effects remains unclear, with a potential association with increased xerostomia. Further research is required to optimize treatment protocols, refine dosage strategies, and explore the mechanisms underlying these effects to improve supportive care in cancer patients undergoing radiation therapy. Introduction The oral cavity is made up of the floor of the mouth, oral tongue, alveolar ridge, retromolar trigone, hard palate, buccal mucosa, and lip mucosa. The oropharynx includes the tonsils, base of the tongue, posterior and lateral walls of the pharynx, and soft palate. The hypopharynx includes the pyriform fossa, lateral and posterior walls of the hypopharynx, and postcricoid area, and the larynx includes the supraglottic, glottic, and subglottic areas. 1 , 2 Betel quid chewing with areca nut and lime markedly raises the risk of oral cancer in the Indian subcontinent, certain areas of Southeast Asia, and Taiwan. Alcohol ingestion is also a dose-dependent independent risk of cancer development. 2 Oral cancer, which is nearly always squamous cell carcinoma (OSCC), constitutes 90% of malignancies in the oral cavity, and has a propensity for lymphatic spread. 3 Men are 2 to 3 times more likely to develop oral cancer accompanied by oral cavity (including pharyngeal) neoplasms ranked the sixth most common malignancy in the world. 4 One of the frequent consequences of OSCC is lymph node metastases, where differentiation has an important role in the development of metastases. Lymphatic spread to the neck is directly associated with the tumoral thickness, depth of invasion, and T stage. 5 Worldwide, about 400,000 new oral cancers are diagnosed and reported each year, with two-thirds being from Asian countries, including Bangladesh, Pakistan, India, Indonesia, and Sri Lanka. 6 In high-risk countries, oral cancer accounts for almost 25% of all newly diagnosed cancers. There is a rising incidence among individuals under 40, however, the peak age is more than 60. It has a poor prognosis of less than 40% overall five-year survival rate, while early-stage detection of stages I and II increases survival to > 80%. 4 On average, nearly 50% of oral cancers are diagnosed at later stages (stages III and IV) primarily because most early symptoms are absent and patients typically do not seek medical treatment for their symptoms. After more than one month of a diagnostic delay, the risk of advanced disease only increases, often due to patient inaction or misdiagnosis by healthcare professionals. 7 , 8 The prognosis of survival declines with tumor location, with lip cancer having a better prognosis than oropharyngeal cancer. Clinically and pathologically staged at diagnosis appear to be the most important factors affecting survival. 9 Early diagnosis is linked to improved prognosis, a reduction in morbidity caused by treatment, and a better survival rate associated with treatment. 10 Fearure, although there is better awareness, it takes substantial time for the proportion of patients presenting with advanced disease to shift. Overall, there has been no significant shift in patients presenting with advanced disease over the past 40 years. 11 Radiation therapies have an essential role in the management of cancer as a curative treatment in about 40% of cases and as a palliative treatment in others. 12 Radiation therapies produce both early and late toxicities that affect normal tissues. DNA damage from radiation results in early and late effects, with severe esophagitis being one of the later negative effects that can stop treatment or lead to the necessity for treatment modifications. 13 Patients treated with head and neck radiation therapies often suffer a variety of acute and late effects. 14 Acute toxicity causes significant patient distress and outcomes in terms of treatment efficacy and exacerbated comorbidities, leading to increases in late complications. 14 Despite modern radiotherapy conformal techniques, and improved oral hygiene techniques, oral toxicity could still create a substantial problem for many patients. 15 Science has examined the inhibition of transforming growth factor-beta (TGF-β1) as a radioprotectant which can affect inflammatory responses and improve patient outcomes. 16 Vitamin E acts as an antioxidant through inhibition of TGF-β1 synthesis, and pentoxifylline, a non-specific phosphodiesterase (PDE) inhibitor, inhibits transcriptional expression of TGF-β1. 17 The combination of pentoxifylline and vitamin E has been shown to reverse osteoradionecrosis demonstrating significant ability to reduce radiation damage. 18 In addition, the effect of this combination has been shown to significantly reduce acute and subacute radiation lung injury in lung cancer patients receiving concurrent chemoradiotherapy. 19 Based on these studies, we conducted this study to examine the impact of pentoxifylline and vitamin E on acute radiation induced toxicity for head and neck cancer patients. 20 Vitamin E has been identified as an antioxidant with potential benefits for managing oral lesions. It works by interfering with the activation and detoxification of tobacco-specific nitrosamines, which are carcinogenic. Several antioxidants have been studied for oral cancer prevention, including β-carotene, provitamin A, vitamin C, vitamin E, zinc, selenium, and spirulina. 21 The tocopherol family includes alpha, beta, gamma and delta forms of vitamin E, with alpha-tocopherol as the most biologically active form. It serves as a strong antioxidant, eliminates free radicals, and inhibits the formation of nitrosamines, which contribute to carcinogenesis. Vitamin E has been proven in studies to downregulate mutant p53, activate wild-type p53, and produce antiangiogenic effects by opposing transforming growth factor-alpha (TGF-α). Other research has reported no toxicity from vitamin E, and patients with oral leukoplakia taking vitamin E had clinical and histological improvement. 22 Research indicates that oral cancer patients have weakened antioxidant defenses (vitamins E and C) and increased oxidative stress, leading to a higher susceptibility to DNA damage. Supplementation with these antioxidants may aid in disease management. 23 Additionally, vitamin E has been shown to benefit patients with radiotherapy-treated oral squamous cell carcinoma by reducing glycoconjugate levels, which may serve as a marker for treatment response. 24 Wound healing comprises four phases: hemostasis, inflammation, proliferation, and remodeling of the tissues, where controlling inflammation represents a key part of the process. If inflammatory processes are inappropriately activated, healing will be impaired. 25 , 26 Pentoxifylline (PTX), which has anti-inflammatory and antioxidant properties, inhibits synthesis of inflammatory mediators, reduces leukocyte function, and reduces oxidative stress as a result of decreased production of oxygen-free radical species. 27 , 28 Thus, PTX may also contribute to accelerated wound healing and may limit tissue damage from radiation. As such, PTX may offer adjunctive therapy with vitamin E in the management of oral cancer. Due to the rising rates of oral cancer and the poor prognosis of the disease, it is important to establish effective treatment and prevention strategies. Antioxidants such as vitamin E work to reduce oxidative stress and inhibit carcinogenesis while pentoxifylline (PTX) is anti-inflammatory and helps with healing. PTX and vitamin E have both shown a reduction in toxicity from radiation therapy and improvements in overall health and treatment tolerance in individuals with cancer. Although there is a growing body of literature supporting the use of PTX and vitamin E as treatment options, more studies are needed in order to develop clinical standards for each. The goal of this study is to assess the effects of PTX and vitamin E in reducing acute radiation-induced effects in head and neck patients, potentially leading to additional option to improve prognosis and quality of life. Material and Methods Aim This study aims to determine if pentoxifylline and Vitamin E impact recovery outcomes following surgery and/or radiotherapy in patients with Head and Neck cancers. We are particularly interested in determining the effect of pentoxifylline and Vitamin E on recovery after radiotherapy (e.g., wound healing, pain, incidence of radiotherapy side effects) for patients with oropharyngeal cancers who have undergone surgery and radiotherapy. Primary Objective The main aim for this retrospective analysis is to examine the effect of Vitamin E and pentoxifylline on the healing rate of chronic wounds in Head and Neck cancer patients who have had surgical care and radiation treatment. We are primarily interested in determining if the use of Vitamin E and pentoxifylline compared to patients receiving standard of care has better wound healing outcomes. Secondary Objectives To assess the effect of Vitamin E and pentoxifylline on pain management in post-operative and post-radiation phases among Head and Neck cancer patients, including the reduction in pain intensity. To assess whether the use of Vitamin E and pentoxifylline is associated with a decreased incidence and severity of radiation-related side effects, such as mucositis, xerostomia, and dysphagia in Head and Neck cancer patients. To conduct subgroup analyses based on variables such as cancer stage, and radiation dosage to identify specific patient groups that may benefit the most from the administration of Vitamin E and pentoxifylline. The primary objective focuses on the specific outcome of wound healing, while the secondary objectives encompass a broader range of post-treatment recovery outcomes, including pain management, and the incidence of radiation-related side effects, to provide a comprehensive assessment of the combined effects of these interventions in Head and Neck cancer patients. Study Design and Source Data This study was a retrospective case-control analysis. The data was collected from M.S. Patel Cancer Centre and the Medical Records Department of Shree Krishna Hospital and Medical Research Centre, Gokal Nagar, Karamsad, Anand, Gujarat, India. Methods A retrospective analysis was conducted on medical records of oral cancer patients who received both Vitamin E and Pentoxifylline postoperatively. Data collection included information on dosage, duration, complications, and treatment outcomes. Statistical analysis was performed to assess wound healing, pain management, and radiation-related side effects. Inclusion Criteria Age ≥ 18 years. Confirmed diagnosis of oral cancer. Underwent surgical treatment for oral cancer. Availability of complete medical records, including postoperative management details. Received a combination of Vitamin E and Pentoxifylline postoperatively. Exclusion Criteria Incomplete medical records. History of allergies or adverse reactions to Vitamin E or Pentoxifylline. Presence of significant comorbidities that could affect the analysis (any of the three: Stroke, Ischemic Heart Disease (IHD), or Chronic Kidney Disease (CKD). Statistical Analysis In the study, a total of 206 patients participated, divided into two groups of 103 patients each. Group 1 (the treatment group) received Pentoxifylline and Vitamin E tablets and Group 2 (the control group) did not receive either of the two medications. In order to determine the appropriate statistical tests into comparison analyses a normality test was conducted for the continuous/numeric outcome variables such as pain score and wound healing. Normality was assessed using the Shapiro-Wilk, Kolmogorov-Smirnov, Cramer-von Mises and Anderson-Darling tests, where all tests were rated with a p-value < 0.05, rejected the null hypothesis and concluded the data was not normality distributed. Based on the finding of non-normality of the data non-parametric statistical tests were used: For continuous variables (i.e. pain score), the Wilcoxon rank sum (Mann-Whitney U-test) test was used in place of the two-sample t-test, as non-parametric approaches are mean focused (i.e. medians are compared rather than means), which is appropriate in non-normal situation. For categorical variables that had greater than two categories (e.g. cancer stage, histology), the Kruskal-Wallis test was used in place of ANOVA as a non-parametric test. Subgroup analyses were noted to explore differences in treatment outcomes based on either cancer stage. The aim was to determine whether postoperative wound healing, pain control, and radiation-related side effects differed between treatment and control groups under the different cancer stages (i.e. did the results differ in stage I as compared to stage II). The subgroup analyses were specified in accordance to guidance provided in the Cochrane Handbook. 29 Results In this study, 206 patients diagnosed with oral cancer recruited in this study, they were divided into two groups consisting of 103 patients: a treatment group and a control group. Variable Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) Male 80 (77.7%) 71 (68.9%) 151 (73.3%) Female 23 (22.3%) 32 (31.1%) 55 (26.7%) Age Group Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) 25-34 years 5 (4.85%) 6 (5.82%) 11 (5.33%) 35-44 years 31 (30.09%) 28 (27.18%) 59 (28.64%) 45-54 years 28 (27.18%) 32 (31.06%) 60 (29.12%) 55-64 years 21 (20.38%) 27 (26.81%) 48 (23.30%) 65+ years 18 (17.47%) 10 (9.70%) 28 (13.59%) Table 1 (A): Gender Distribution across Treatment and Control Groups Table 1 (B): Age Distribution across Treatment and Control Groups In the study there were 23 women (22.3%) and 80 men (77.7%) in the treatment group. In comparison, there were 32 women (31.1%) and 71 men (68.9%) in the control group. In total, there were 55 women (26.7%) and 151 men (73.3%) in both groups (Table 1A). A sum total of 206 patients were randomly split into two groups, treatment and control, to study whether Vitamin E and Pentoxifylline decreased postoperative recurrence of oral cancer. Patients were surveyed into diferent group stratifications by age with equal distributions. The use of stratifications by age minimizes confounding related to age to better evaluate the benefit of treatment for the different age strata in each age group. (Table 1B). Smoking Status Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) Non-smokers 75 (72.8%) 84 (81.6%) 159 (77.2%) Current Smokers 25 (24.3%) 11 (10.7%) 36 (17.5%) Former Smokers 3 (2.9%) 8 (7.7%) 11 (5.3%) Chewing Tobacco Use Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) No 52 (50.5%) 59 (57.3%) 111 (53.9%) Yes 46 (44.7%) 34 (33.0%) 80 (38.8%) Former 5 (4.9%) 10 (9.7%) 15 (7.3%) Table 2 (A) : Smoking Status across Treatment and Control Groups Table 2 (B): Chewing Tobacco Use Status across Treatment and Control Groups Analysis of the smoking status of 206 patients was done to determine if smoking status had an effect on postoperative outcome. Of note, 77.2% of patients were non-smokers, whereas 17.5% were current smokers and 5.3% were previous smokers. This demographic analysis of patients provided the opportunity for a more complete examination of smoking status as a factor in treatment outcomes (Table 2A). The study evaluated tobacco status in a cohort of 206 oral cancer patients who were randomized into treatment or control groups. Of the 206 participants, 53.9% were non-tobacco users, 38.8% were current tobacco users, and 7.3% were former tobacco users. It is important to be aware of the distribution of non-users, current users, and former users, as tobacco use is a risk factor for oral cancer and may be of consideration in the postoperative period (Table 2B). Alcohol Use Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) No 97 (94.2%) 98 (95.1%) 195 (94.7%) Yes 5 (4.9%) 3 (2.9%) 8 (3.9%) Occasionally (beer) 1 (1%) 2 (1.9%) 3 (1.45%) Table 3: Alcohol Use Status across Treatment and Control Groups Alcohol consumption among the 206 study participants was low, with 94.7% being non-users, 3.9% regular users, and 1.45% occasional beer drinkers. The minimal variation between treatment and control groups ensures comparability in evaluating the effects of vitamin E and pentoxifylline on postoperative outcomes ( Table 3) . Comorbidities Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) Yes 21 (20.4%) 18 (17.5%) 39 (18.9%) No 82 (79.6%) 85 (82.5%) 167 (81.1%) Comorbidities Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) Diabetes 6 (5.8%) 6 (5.8%) 12 (5.8%) Hypertension 17 (16.5%) 15 (14.6%) 32 (15.5%) IHD 1 (1.0%) 0 (0%) 1 (0.5%) Stroke 1 (1.0%) 0 (0%) 1 (0.5%) Table 4 (A): Presence of Comorbidities Across Treatment and Control Groups Table 4 (B): Types of Comorbidities Across Treatment and Control Groups The study recorded comorbidities to evaluate their impact on postoperative outcomes in oral cancer patients. Among the 206 participants, 18.9% had comorbidities, with minimal variation between the treatment and control groups, ensuring reliable comparisons of intervention effectiveness (Table 4A). The categorization of comorbidities provides valuable insights into their potential impact on postoperative recovery in oral cancer patients. Hypertension, being the most prevalent condition (15.5%), may influence healing outcomes, while diabetes (5.8%) and less frequent conditions like ischemic heart disease and stroke (0.5% each) highlight individual health variations. Understanding these factors helps in assessing prognostic differences and guiding targeted postoperative care strategies.(Table 4B) Description Group 1: Treatment (Mean ± SD) Group 2: Control (Mean ± SD) Total (Mean ± SD) Weight (kg) 51.6 ± 11.9 51.5 ± 12.5 51.6 ± 12.2 Table 5: Average Weight across Treatment and Control Groups The mean weight of patients in both treatment (51.6 kg, SD = 11.9 kg) and control groups (51.5 kg, SD = 12.5 kg) remained consistent, minimizing potential bias due to body mass differences. This uniformity helps isolate the effects of the treatment regimen, as variations in body weight can influence medication metabolism and overall recovery (Table 5). Cancer Stage Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) Stage-1 6 (5.8%) 3 (2.9%) 9 (4.4%) Stage-2 22 (21.4%) 19 (18.4%) 41 (19.9%) Stage-3 49 (47.6%) 33 (32.0%) 82 (39.8%) Stage-4 26 (25.2%) 48 (46.6%) 74 (35.9%) Table 6: Distribution of Cancer Stages across Treatment and Control Groups The distribution of cancer stages in the study participants, shows that considerably more control patients had Stage 4 (advanced CA), in comparison to the treatment group; this is of importance, as advanced stages have been shown to relate to poorer recovery and treatment outcomes. For the 206 participants, the balance of Stage 1 and Stage 2 cases were fairly similar between groups, however, within the treatment group, Stage 3 was the most common. However Stage 4 had a vastly higher percentage in the control group (46.6% vs. 25.2% treatment group). The determinants for this higher stage of advanced disease is of importance when assessing the effectiveness of vitamin E and pentoxifylline in postoperative recovery. Thus, the findings suggest that the stage of disease may potentially affect treatment response and the overall prognosis and interpretation of the findings needs to be within the context of disease severity. (Table 6) Histology Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) MDSCC 62 (60.2%) 69 (67.0%) 131 (63.6%) WDSCC 19 (18.4%) 13 (12.6%) 32 (15.5%) SCC 12 (11.7%) 7 (6.8%) 19 (9.2%) PDSCC 7 (6.7%) 8 (7.8%) 15 (7.2%) Undifferentiated SCC 3 (2.9%) 6 (5.8%) 9 (4.3%) Table 7: Distribution of Histological Types across Treatment and Control Groups When determining the behavior of the tumor and the response to therapy, the histological distribution of these types among participants in each group is important. The majority of patients, about two-thirds, had a diagnosis of moderately differentiated squamous cell carcinoma (MDSCC) that accounted for 63.6% of the entire patient sample in both treatment and placebo groups. Well-differentiated squamous cell carcinoma (WDSCC) was next among the histological types followed by SCC, poorly differentiated squamous cell carcinoma (PDSCC), and undifferentiated squamous cell carcinoma. As we have presented data on the histological subtypes of our sample, this is an additional reason to evaluate the efficacy of treatment as it relates the level of tumor differentiation since it is possible that tumors from different histological subtypes may respond differently to vitamin E and pentoxifylline. These histological subtypes may also be supportive for future treatment decisions and prognostication post-operatively (table 7). Primary Site (Anatomical Location) Group 1: Treatment (N=103) Group 2: Control (N=103) Total (N=206) Primary Site (Anatomical Location) Buccal Mucosa 40 (38.8%) 51 (49.5%) 91 (44.2%) Buccal Mucosa Tongue 39 (37.9%) 35 (34.0%) 74 (35.9%) Tongue Pharynx (includes oro-, hypo-, nasopharynx) 7 (6.8%) 4 (3.9%) 11 (5.3%) Pharynx (includes oro-, hypo-, nasopharynx) Palate and Tonsil(s) 5 (4.9%) 5 (4.9%) 10 (4.9%) Palate and Tonsil(s) Larynx 6 (5.8%) 3 (2.9%) 9 (4.4%) Larynx Lip 1 (1.0%) 4 (3.9%) 5 (2.4%) Lip Alveolus 2 (1.9%) 1 (1.0%) 3 (1.5%) Alveolus Ca cervix 2 (1.9%) 0 2 (1.0%) Ca cervix Nasal Wall 1 (1.0%) 0 1 (0.5%) Nasal Wall Table 8: Distribution of Primary Anatomical Sites across Treatment and Control Groups The site of the oral cancer lesion is important to treatment response and prognosis. The most prevalent sites of lesions in the study population were the buccal mucosa (44.2%), tongue (35.9%), pharynx (5.3%), palate or tonsils (4.9%) and larynx (4.4%). Other sites that were less common included the lip (2.4%), alveolus (1.5%), cervix (1.0%) and nasal wall (0.5%).This distribution illustrates the concept of anatomical site directing potential therapeutic route, e.g., anatomical sites may influence treatment effects after surgery with vitamin E or pentoxifylline, type of surgery or toxicity may also play a role. Identifying these patterns also helps with the same possible treatment options based on treatability of the lesion or tumor location (Table 8). Side Effect Patients (n=103) Controls (n=103) Total (n=206) p-value Yes 74 (71.8%) 75 (72.8%) 149 (72.3%) 1.0* No 29 (28.2%) 28 (27.2%) 57 (27.7%) Table 9: Radiation-Related Side Effects The occurrence of side effects was similar within the treatment group (71.8%) and control group (72.8%), with a total of 149 events in treatment groups (72.3%). By applying the Fisher's exact test (p = 1.0), no observed differences were noted between the groups. Therefore, we interpreted that the adverse effects of radiation were comparable across treatment groups (Table 9). Type of Side Effect Patients (n=103) Controls (n=103) Total (n=206) p-value Dysphagia 0.30* Yes 31 (30.1) 39 (37.9) 70 (34.0) No 72 (69.9) 64 (62.1) 136 (66.0) Mucositis 0.26* Yes 46 (44.7) 55 (53.4) 101 (49.0) No 57 (55.3) 48 (46.6) 105 (51.0) Xerostomia 0.0026* Yes 9 (8.7) 6 (5.8) 15 (7.2) No 94 (91.3) 97 (94.2) 191 (92.7) Table 10: Specific Types of Radiation-Related Side Effects A p-value of 0.30 signifies that 70 cases (34.0%) of the study had dysphagia, with 31 cases (30.1%) being patients and 39 cases (37.9%) being controls. For mucositis, a total of 101 cases (49.0%) were reported, for a p-value of 0.26, consisting of 46 patients (44.7%) and 55 controls (53.4%). Xerostomia was reported in 6 controls (5.8%) and 9 patients (8.7%), for a total of 15 cases (7.2%) of xerostomia with a p-value of 0.0026* demonstrating there was a significant difference in the incidence of xerostomia between the groups.(Table 10) Wound Healing Status Patients Controls Total No Wound Present 41 (39.8%) 36 (35.0%) 77 (37.4%) Healing in Progress 48 (46.6%) 42 (40.8%) 90 (43.7%) Table 11: Wound Healing Status and Rate For the categorization of wound healing, the category 'No wound present' was seen in 41 patients (39.8%) and in 36 controls (35.0%). The category 'Healing in progress' included 48 patients (46.6%) and in 42 controls (40.8%). Furthermore, there was a significant difference in the rates of wound healing between groups. The median wound healing for the group of patients was 17 days (IQR = 8) compared to 30 days (IQR = 18) for the control group with a p-value of 0.0002. Median Wound Healing Rate (Days) were as follows: Patients = 17 (IQR = 8), Controls = 30 (IQR = 18); p-value = 0.0002.(Table 11) Group Median (IQR) Patients 1 (2) Controls 4 (5) Total 2 (4) p-value <.0001 Table 12: Pain Scores The median pain scores also indicated a significant difference, with patients reporting a median score of 1 (IQR = 2) compared to 4 (IQR = 5) in controls, with a p-value <.0001. These findings highlight significant differences in pain management and wound healing between the patient and control groups, suggesting potential impacts of treatment modalities on these outcomes.(Table 12) Cancer Stage Pain Score - Patients (Median [IQR]) Pain Score - Controls (Median [IQR]) p-value Stage 1 1 (0) 7 (8) 0.50 Stage 2 0.5 (2) 5 (4) 0.0004 Stage 3 1 (2) 3 (6) 0.05 Stage 4 0 (1) 4 (3) <0.0001 Table 1 3 . Comparison of pain scores between patient and control group by Cancer Stages Footnote: IQR= Inter Quartile Range *Non-parametric Wilcoxon Sum Sign Rank Test (Mann-Whitney U test), p-value When analyzing pain scores in patients and controls across cancer stages, there were significant differences across several stages. No difference was statistically significant at Stage 1 (p=0.50). At Stage 2, however, patients scored significantly lower pain (median=0.5, IQR=2) than controls (median=5, IQR=4) with a significant difference (p=0.0004). At Stage 3, the results showed a trend towards significance (p=0.05), suggesting pain management strategies were possibly becoming effective in utilizing benefits (Table 16). The overall largest difference was measured at Stage 4 when no pain was expressed in patients (median=0, IQR=1) compared to controls (median=4, IQR=3) that was highly significant (<0.0001). This data indicates that through specific therapy application (i.e., pentoxifylline and vitamin E), the patient population managed their pain better than observed re-engagement measures among stage designated control subjects. The difference in pain scores was lower than significant observed in Stage 1 due to a natural expression of lower pain levels or established protocols exhibiting their maximum effectiveness as disease progressed (Table 13). Cancer Stage Patient (Median, IQR) Control (Median, IQR) p-value Stage 1 16 (13.5) n/a - Stage 2 14 (4) 23 (11) 0.01 Stage 3 19.5 (9) 30 (18) 0.03 Stage 4 17 (11) 30 (18) 0.05 Table 1 4 . Comparison of wound healing rate (days) between patient and control group by Cancer Stages Footnote IQR= Inter Quartile Range *Non-parametric Wilcoxon Sum Sign Rank Test (Mann-Whitney U test), p-value The evaluation of wound healing rates among the several stages of cancer showed a significant difference between the groups of patients and controls. Controls in Stage 1 were not available for comparison. In Stage 2, the patients had significantly better wound healing than the controls with a median of 14 (IQR=4 days), compared to controls with a median of 23 (IQR=11 days), resulting in a p-value of 0.01. Wound healing was observed to be markedly faster in Stage 3 patients (median=19.5, IQR=9 days) compared to controls (median=30, IQR=18), resulting in a p-value of 0.03. Stage 4 had indications of faster healing with patients compared to controls with a reduced median of 17 days (IQR=11 days), and controls at a median of 30 (IQR=18), resulting in a p-value of 0.05. This data provides interesting evidence that pentoxifylline, vitamin E, and similar therapies could accelerate healing with Stages 2, 3, and 4 patients being encouraged that some form of intervention could be beneficial in the postoperative recovery period for oral cancer patients (Table 14). variable Cancer Stage 1 (n=9) Cancer Stage 2 (n=41) Patient (n=6) n (%) Control (n=3) n (%) p-value* Patient (n=22) n (%) Control (n=19) n (%) p-value* Radiation related efftects 1.0 0.29 Yes 5 (83.3) 2 (66.7) 15 (68.2) 16 (84.2) No 1 (16.7) 1 (33.3) 7 (31.8) 3 (15.8) Table 1 5 (a). Radiation-Related Side Effects by Cancer Stages variable Cancer Stage 3 (n=82) Cancer Stage 4 (n=74) Patient (n=49) n (%) Control (n=33) n (%) p-value* Patient (n=26) n (%) Control (n=48) n (%) p-value* Radiation related efftects 0.46 0.59 Yes 36 (73.5) 21 (63.6) 18 (69.2) 36 (75.0) No 13 (26.5) 12 (36.4) 8 (30.8) 12 (25.0) Table 1 5 (b). Radiation-Related Side Effects by Cancer Stages Footnote: *Fisher's exact test, p-value Analysis of the adverse effects of radiation for each of the cancer stages AM discussed found no significant difference between treatment and control groups. For Stage 1 (n=9), a p-value of 1.0 indicates that the treatment made no difference in the occurrence of side effects, while it should be acknowledged that the small sample size could undermine the strength of this conclusion. The small sample size could limit the strength of any conclusion, even though the p-value was strongly correlated with revealing that the treatment was not notably beneficial for moderating radiation related side effects. Similarly, Stage 2 (n=41) demonstrated a p-value of 0.29, indicating that the treatment made no difference in treatment outcome between groups, once again showing that the treatment did not significantly moderate radiation related side effects during this stage of treatment either. For Stage 3 (n=82), p-value (0.46) also found no significant difference, thereby further supporting the conclusion that the treatment may not have meaningfully impacted the adverse effects of radiation during this stage of treatment. For Stage 4 (n=74), while Stage 4 was the most advanced cancer stage with the most number of cases analyzed, and therefore the final course of treatment, a p-value of 0.59 demonstrated no significant difference between the treatment versus control group. Therefore, continuing to follow patients throughout systematically their treatment, across cancer stages, will again consistently show that the treatment did not significantly become an advantage for moderating radiation related side effects ( see Table 15 a,b). Arm Radiation Dosage(Gy) Radiation Duration Wound Healing(Days) Pain Score(0-10) control 30GY/10# 11 radiations no wound healing 5 control 30GY/10# 21 radiations no wound 0 patient 60Gy/30# 34 radiations 14 days 0 Table 16. Analysis of Specific Cases with Metastasis The analysis demonstrates differences between both the control group and the treatment group in maximum dose, healing, and pain scores. The control group was given a prescribed 30 Gy total, which was given in ten gaming sessions. Some patients received as much as twenty-one sessions of treatment, a likely confounding aspect related to individual need. The treatment group was given a higher cumulative radiation dose (60 Gy) total, prescribed for thirty gaming sessions, which demonstrates a more assertive prescription. While wound healing was uneventful in the control group, the analyst described one participant as not exhibiting any wound healing. Healing was evident with the treatment group with one report of an average of 14 days to heal, as well as one participant simply stating that she “healed.” The pain scores did vary in the control group; for example, one participant reported a pain score of 5 (moderate pain) while a second participant did not have a pain score. Although treatment in relation to these multifactorial applications warrants exploration, it is worthy of note that one treated patient did report no pain during the dose escalation radiation sessions. Although the analysis of these findings provided meaningful insight into factors affecting healing and pain, the sample size did not allow the ability to conclude any specific relationship to dose. All treatment pathways should still remain individualized, however studies with a better sample size had greater potential to observe effects dose might have on pain and the radiation or wound healing processes (Table 16). Radiation Dosage Radiation Duration (Days) Wound Healing (Days) Pain Score (0-10) Radiation Dosage 62 Gy / 31# 33 16 0 62 Gy / 31# 30 Gy / 10# 11 0 5 30 Gy / 10# 30 Gy / 10# 21 9999 0 30 Gy / 10# 70 Gy / 35# 35 0 8 70 Gy / 35# 30 Gy / 10# 31 35 6 30 Gy / 10# 30 Gy / 10# 30 9999 0 30 Gy / 10# Table 1 7 . (a) Pain Score, Control Group (6 Cases) Radiation Dosage Radiation Duration (Days) Wound Healing (Days) Pain Score (0-10) 66 Gy / 30# 18 9999 0 64 Gy / 32# 32 0 1 64 Gy / 31# 31 0 3 64 Gy / 32# 33 14 1 Table 1 7 . (b) Pain Score, Patient/Treatment Group (4 Cases) No additional analysis was performed for recurrence due to limited sample size (n=10) Footnotes: 9999 indicates no wound present and 0 indicates no wound healing The assessment examines the comparison of radiation dosage, wound healing, and pain scores between the treatment and control groups. The control group experienced radiation dosages variable from 30 to 70 Gy over 11 to 35 days, with two of those patients calling it "no wound present," and this is quite advanced with a clinical situation that is very individualized. The treatment group allowed for a more rigorous standardization, with treatment in the range of 64 to 66 Gy over 18 to 33 days. The pain scores of the control group was also significantly variable (0-8), suggesting implications with pain experience or management; whereas the treatment group indicated, generally, lower reported scores (0-3), suggesting significantly less pain control. Wound healing was also variable; one patient treated ultimately healed in 14 days, was otherwise no reported wounds for the other two treatments. On the whole, the treatment group had less variability in the radiation exposure, lower pain scores, and potentially better management. If there is some level of consistency in cancer treatment with some level of standardization, there would likely be better patient outcomes than patients treated with variability in the control group (Table 17A,B). Radiation dosage (Gy/fraction) Patient (n=103), count(%) Control (n=103), count(%) Total (n=206) 30GY/10# 0 6 (5.8) 6 (2.9) 30GY/30# 0 1 (1.0) 1 (0.5) 32GY/10# 1 (1.0) 0 1 (0.5) 45GY/15# 0 3 (2.9) 3 (0.5) 50.4GY/2 2 (1.9) 0 2 (1.0) 60GY/30# 7 (6.8) 4 (3.9) 11 (5.3) 62GY/30# 0 1 (1.0) 1(0.5) 62GY/31# 26 (25.2) 16 (15.5) 42 (20.4) 62GY/32# 2 (1.9) 2 (1.9) 4 (1.9) 63GY/32# 1 (1.0) 0 1 (0.5) 64GY/30# 1 (1.9) 1 (1.0) 1 (0.5) 64GY/31# 2 (1.9) 0 2 (1.0) 64GY/32# 26 (25.2) 31 (30.1) 57 (27.7) 65GY/32# 0 1 (1.0) 1 (0.5) 66GY/30# 1 (1.0) 1 (1.0) 2 (1.0) 66GY/33# 15 (14.6) 22 (21.4) 37 (18.0) 70GY/33# 19 (18.4) 3 (2.9) 22 (10.7) 70GY/35# 1(0.9) 11 (10.67) 12 (5.8) Table. 18 (a) Analysis of Radiation Dosage Details across Patient and Control Groups Variable Mean (±SD) Mean (±SD) Mean (±SD) Radiation duration (days) 27.2 (8.0) 29.4 (5.9) 28.3 (7.1) Table. 18 (b) Analysis of Radiation duration Both groups received the same common dosages of radiation, including 62 Gy / 32# (27.7%), 62 Gy / 31# (20.4%), 66 Gy / 33# (18.0%), and 70 Gy / 33# (10.7%); however, higher dosages (66 Gy and above) were more common for the patient group (specifically the dosages of 70 Gy / 33# while the control group was more likely to receive the dose of 70 Gy / 35#). Lower dosages (like 30 Gy) were infrequently utilized, almost exclusively in the control group.As seen with codings 106 or higher, treatment doses suggest a more organized, intensive treatment plan for the patient group (likely indicative of severity of disease, level of therapeutic intervention, etc.) while the variably used dosages within the control group are more suggestive of non standard treatment, which may influence very high or low treatable attributes unique to the clinic. Further analysis would be required to assess treatment dosages in relation to clinical outcomes, treatment acceptance, or effectiveness (Table 18 a,b). Discussion In order to assess the efficacy of the combination of Vitamin E and Pentoxifylline on outcomes such as pain scores, healing time, and radiotherapy side effects in various cancer patients stages, this study researched large samples of cancer patients who were randomized to either treatment or control group. The outcome showed that the treatment group, especially the patients of more advanced disease stage had significantly reduced levels of pain. The treatment group patients with Stage 2 cancer had a median pain score that was lower than the control group (p < 0.0001), while the Stage 4 patients also had a median pain level that was lower than controls (p = 0.0004). This is in part an indication that the treatment worked to significantly reduce pain in the treatment group patients with more advanced cancer because of the anti-inflammatory component of the different treatment regiments. The Stage 1 patients in the treatment group did not significantly differ from median pain scores which may also be the effect of early stages of cancer that usually has low baseline pain levels. The analysis of subgroups on rate of wound closure also supported treatment for wound care, especially at stages when faster wound closure is important for quality of life and healing purposes. The second, third and fourth stage patients in the treatment group also healed quicker than the control group with statistically sound differences p = .01, p = .03, p = .05 respectively. The results are consistent with previous findings of Vitamin E and Pentoxifylline potentially improving blood flow and oxygenation at the wound site, which supports more rapid tissue healing. While the treatment did demonstrate some efficacy with respect to the alleviation of pain and wound healing, there was no statistically significant reduction in the incidence of radiation side effects at any stage of cancer treatment. This indicates that, despite its ability to address certain symptoms of cancer therapy, the original study suggests that it does not appear to ameliorate the sensitivity to radiation-induced damage. This finding supports the complex biology of radiation toxicity and suggests that more targeted approaches may be necessary for future studies. In our study consideration of incidences of dry mouth as a relatively common side effect of radiation treatment, the frequency of the incidence was statistically different (higher in the treatment group) between treatment and control groups. The incidence of xerostomia (the effect) was significantly greater in the treatment group with p-values (P = 0.0026). This finding indicates the treatment, Pentoxifylline and Vitamin E, has effect in the prevention of xerostomia in patients undergoing radiation therapy for cancer. This finding is critical especially when considering overall quality of life for patients suffering from this effect since dry mouth can have significant implications on comfort and nutrition. The examination of radiation dose levels and type of partition provides an opportunity to gain further understanding of the treatment strategies. Interestingly, there were more patients in the treatment group with radiation doses above the average (66GY/33# and 70GY/33#), which indicated this group was possibly more likely to receive the more aggressive treatment. Additional consideration of the association between increased radiation exposure and patient outcomes is warranted, specifically if the increased radiation exposure of the treatment group was a contributing factor in providing improved pain and wound healing. Both Sayed's research and the current research examined the effectiveness of Pentoxifylline and Vitamin E on mitigating radiation induced complications in head and neck cancer patients, though the distinction in respective "areas of interest" did vary, yet both approaches determined efficacy. With Sayed's research involving a prospective randomized controlled trial, it specifically evaluated how the treatment combination of Pentoxifylline and Vitamin E affected the incidence, intensity, onset, and duration of oral mucositis and dysphagia. The outcomes of Sayed's work demonstrated that the treatment combination produced no change in these issues regarding incidence or onset; however, the treatment did produce significant reductions in intensity and length of time of these radiation concerns. This ultimately resulted in decreased length of stay and treatment interruptions for patients undergoing radiation. The current research went beyond looking only at the respective side effects of dyphagia and oral mucositis, and examined overall patient healing rates and pain. Overall, the research produced significant improvements in the areas of patient healing rate from radiation and pain improvement, particularly with patients with a more advanced disease state. Similar to Sayed's findings, it is important to note that our analysis did not show a significantly decreased incidence of patient's experiencing side effects related to radiation. Both studies demonstrate the variation in response based on the specific side effects in the context of patient history regarding stage of disease and the benefit the treatment therapy has on the improved patient outcome through the ongoing treatment related to radiation. 30 Both Ferreira's and our project examine the possible protective properties of Vitamin E for head and neck cancer patients receiving radiation therapy but use different methodology and endpoints. Ferreira's project evaluated the impact of Vitamin E on the number and severity of oral mucositis in patients undergoing standard radiation therapy, and found significant reductions in both symptomatic mucositis as well as pain. Our research looked at the impact of using both Pentoxifylline and Vitamin E in treating radiation related side effects more broadly, such as pain and wound healing in patients who had potentially different stages of cancer. While both research pointed toward a reduction in pain, our trial was not centered on oral mucositis, but was focused on examining overall side effects, wound healing and pain level, and showed improved outcomes particularly in patients with advanced disease. Thus, it is clear that, while both research calling attention to the efficacy of Vitamin E in promoting beneficial side effects in patients undergoing radiation, the specific and overall impacts of vitamin E may be different in patients groups depending on various factors, including study design and patient population. 31 This study indicates potential benefit to using vitamin E and pentoxifylline for the relief of pain and healing of wounds in patients with cancer, especially those with advanced disease. However, if some of the side effects of radiation treatment do not improve, alternative treatment pathways may indeed be considered to alleviate some of the side effects sustained by radiation that impact the patient's quality of life. Future research should seek to expand our knowledge of the mechanisms of these treatments to allow the desired outcomes for patients and healthcare providers. This will include determining the optimum doses, exploring combinations with other efficacious medicinal agents, as well as evaluate long term goal of outcomes such as survival and quality of life. In addition, a systematic and comprehensive assessment of the impact of radiation prescriptions of treatment outcome will raise therapeutic strategies in many stages, and in many clinical situations related to cancer. Expanding the knowledge of how treatment pathways impact care and outcomes for who remains clinically relevant in order provide the most optimal personalized clinical practice for the cancer patient. The bottom line may translate to an enhanced prognosis [outcomes] and quality of life for patients suffering from cancer.Due to the limited size and homogeneity in geography of the site of the study, generalizing the results of this study to another larger, more heterogeneous group of individuals with diverging clinical and demographic characteristics may be difficult, if not somewhat impractical. The retrospective nature of the data may also indicate potential validity threats to the data collected and impacting reliability of the results, conclusions and generalizability due to conditions of the data collected in the retrospective process. Conclusion In conclusion, this study assessed differences in outcomes between patients who received Vitamin E and Pentoxifylline and a control group regarding wound healing, pain scores, and side effects from radiation in patients with cancer undergoing treatment. The results indicate significant improvements in wound healing and decreased pain scores in the treatment group, particularly in advanced cancer stages (2, 3, and 4), suggesting that the combined therapy may have benefitted certain complications of radiation therapy. However, there were not any significant differences in incidence of radiation side effects across cancer stage and between groups. These results indicate that adjunctive therapy can improve quality of life with reliability of treatment in patients with cancer receiving radiation therapy. More studies are warranted, however, including randomized controlled trials that utilize a larger and more diverse sample of individuals, in order to support these findings and fully understand the clinical potential of Vitamin E and Pentoxifylline in oncology. Abbreviations HNC Head and Neck Cancer RT Radiotherapy PTX Pentoxifylline Vit E Vitamin E OSCC Oral Squamous Cell Carcinoma SCC Squamous Cell Carcinoma WDSCC Well-Differentiated Squamous Cell Carcinoma MDSCC Moderately Differentiated Squamous Cell Carcinoma PDSCC Poorly Differentiated Squamous Cell Carcinoma TGF-β1 Transforming Growth Factor Beta 1 TGF-α Transforming Growth Factor Alpha PDE Phosphodiesterase DNA Deoxyribonucleic Acid IQR Interquartile Range SD Standard Deviation IEC Institutional Ethics Committee IHD Ischemic Heart Disease CKD Chronic Kidney Disease ANOVA Analysis of Variances Declarations Ethics approval and consent to participate This retrospective study was approved by the Institutional Ethics Committee .As the study involved analysis of previously recorded anonymized patient data, the requirement for informed consent was waived by the ethics committee. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Clinical Trial Number: Clinical trial number: not applicable. Funding This research received no external funding. Author Contribution A.B. and C.D. wrote the main manuscript text and collected data and guidanceE. wrote and reviwed manuscript Acknowledgements The authors would like to thank the staff of Shree Krishna Hospital for their support in facilitating access to medical records for this study. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to patient confidentiality and institutional restrictions but are available from the corresponding author on reasonable request. References Dhanuthai K, Rojanawatsirivej S, Thosaporn W, Kintarak S, Subarnbhesaj A, Darling M, Kryshtalskyj E, Chiang CP, Shin HI, Choi SY, Lee SS, Aminishakib P. Oral cancer: A multicenter study. Med Oral Patol Oral Cir Bucal. 2018 Jan 1;23(1):e23-e29. 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Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis. Eur J Oral Sci. 2009;117:541–6. Laura QM, Chow MD. Head and Neck Cancer. N Engl J Med. 2020;382:60–72. Ford P, Farah C. Early detection and diagnosis of oral cancer: Strategies for improvement. J Cancer Policy. 2013;1:e2–7. McGurk M, Chan C, Jones J, O’Regan E, Sherriff M. Delay in diagnosis and its effect on outcome in head and neck cancer. Br J Oral Maxillofac Surg. 2005;43:281–4. Dörr W. The pathogenesis of normal tissue side effects. In: Michael Joiner, Albert van der Kogel editor(s). Basic Clinical Radiobiology. 4th Edition. London: Hodder Arnold, 2009. DrugBank. Pentoxifylline. http://www.drugbank.ca/drugs/ DB00806 (accessed 17 February 2016). Food US. Drug Administration. Approval history of pentoxifylline. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=TRENTAL (accessed 17 February 2016). 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Health Policy. 1990;16(3):199–208. Chandra Mouli PE, Senthil B, Parthiban S, Malarvizhi AE, Priya R, Subha R. Antioxidants and its role in Oral Cancer- a review. Indian J Sci. 2012;1:113–15. Vikas Fotedar S, Fotedar RK, Seam MK, Gupta. Oral Cancer and Prevention. Int J Pharm Sci Invention. 2013;2:16–20. Rai Balwant. Salivary Levels Vitamin E and C in Different Histological Grading of Oral Cancer. Pesquisa Brasileira em Odontopediatria e Clin Integrada. 2008;8:123–25. Chitra S, Shyamala CS, Devi. Effect of vitamin E on protein bound carbohydrate complexes in radiation treated oral squamous cell carcinoma patients. Indian J Clin Biochem. 2008;23:92–4. Broughton G, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg. 2006;117(7):e1–S. –32e-S. Gutiérrez-Fernández A, Inada M, Balbín M, et al. Increased inflammation delays wound healing in mice deficient in collagenase-2 (MMP-8). FASEB J. 2007;21(10):2580–91. Deree J, Martins JO, Melbostad H, et al. Insights into the regulation of TNF-α production in human mononuclear cells: the effects of non-specific phosphodiesterase inhibition. Clinics. 2008;63(3):321–8. Bhat VB, Madyastha KM. Antioxidant and radical scavenging properties of 8- oxo derivatives of xanthine drugs pentoxifylline and lisofylline. Biochem Biophys Res Commun. 2001;288(5):1212–7. https://. handbook-5-1.cochrane.org/chapter_9/9_6_2_what_are_subgroup_analyses.htm#:~ :text=Subgroup%20analyses%20involve%20splitting%20all,such%20as%20different%20geographical%20locations. Sayed R, El Wakeel L, Saad AS, Kelany M, El-Hamamsy M. Pentoxifylline and vitamin E reduce the severity of radiotherapy-induced oral mucositis and dysphagia in head and neck cancer patients: a randomized, controlled study. Med Oncol. 2019;37(1):8. 10.1007/s12032-019-1334-5 . PMID: 31748905. Ferreira PR, Fleck JF, Diehl A, Barletta D, Braga-Filho A, Barletta A, Ilha L. Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial. Head Neck. 2004;26(4):313 – 21. 10.1002/hed.10382 . PMID: 15054734. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9391601","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":624884041,"identity":"5c87e2c1-c8c6-4f43-8c42-a0645a7369e8","order_by":0,"name":"Vishal A. Patel","email":"","orcid":"","institution":"Shree Krishna Hospital","correspondingAuthor":false,"prefix":"","firstName":"Vishal","middleName":"A.","lastName":"Patel","suffix":""},{"id":624884042,"identity":"c14015ae-c7b7-4438-b67d-2ec0391790fc","order_by":1,"name":"Sohilkhan R. 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The oropharynx includes the tonsils, base of the tongue, posterior and lateral walls of the pharynx, and soft palate. The hypopharynx includes the pyriform fossa, lateral and posterior walls of the hypopharynx, and postcricoid area, and the larynx includes the supraglottic, glottic, and subglottic areas.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Betel quid chewing with areca nut and lime markedly raises the risk of oral cancer in the Indian subcontinent, certain areas of Southeast Asia, and Taiwan. Alcohol ingestion is also a dose-dependent independent risk of cancer development.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Oral cancer, which is nearly always squamous cell carcinoma (OSCC), constitutes 90% of malignancies in the oral cavity, and has a propensity for lymphatic spread.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Men are 2 to 3 times more likely to develop oral cancer accompanied by oral cavity (including pharyngeal) neoplasms ranked the sixth most common malignancy in the world.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOne of the frequent consequences of OSCC is lymph node metastases, where differentiation has an important role in the development of metastases. Lymphatic spread to the neck is directly associated with the tumoral thickness, depth of invasion, and T stage.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Worldwide, about 400,000 new oral cancers are diagnosed and reported each year, with two-thirds being from Asian countries, including Bangladesh, Pakistan, India, Indonesia, and Sri Lanka.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In high-risk countries, oral cancer accounts for almost 25% of all newly diagnosed cancers. There is a rising incidence among individuals under 40, however, the peak age is more than 60. It has a poor prognosis of less than 40% overall five-year survival rate, while early-stage detection of stages I and II increases survival to \u0026gt;\u0026thinsp;80%.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOn average, nearly 50% of oral cancers are diagnosed at later stages (stages III and IV) primarily because most early symptoms are absent and patients typically do not seek medical treatment for their symptoms. After more than one month of a diagnostic delay, the risk of advanced disease only increases, often due to patient inaction or misdiagnosis by healthcare professionals.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e The prognosis of survival declines with tumor location, with lip cancer having a better prognosis than oropharyngeal cancer. Clinically and pathologically staged at diagnosis appear to be the most important factors affecting survival.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Early diagnosis is linked to improved prognosis, a reduction in morbidity caused by treatment, and a better survival rate associated with treatment.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Fearure, although there is better awareness, it takes substantial time for the proportion of patients presenting with advanced disease to shift. Overall, there has been no significant shift in patients presenting with advanced disease over the past 40 years.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRadiation therapies have an essential role in the management of cancer as a curative treatment in about 40% of cases and as a palliative treatment in others.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Radiation therapies produce both early and late toxicities that affect normal tissues. DNA damage from radiation results in early and late effects, with severe esophagitis being one of the later negative effects that can stop treatment or lead to the necessity for treatment modifications.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Patients treated with head and neck radiation therapies often suffer a variety of acute and late effects.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Acute toxicity causes significant patient distress and outcomes in terms of treatment efficacy and exacerbated comorbidities, leading to increases in late complications.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Despite modern radiotherapy conformal techniques, and improved oral hygiene techniques, oral toxicity could still create a substantial problem for many patients.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Science has examined the inhibition of transforming growth factor-beta (TGF-β1) as a radioprotectant which can affect inflammatory responses and improve patient outcomes.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVitamin E acts as an antioxidant through inhibition of TGF-β1 synthesis, and pentoxifylline, a non-specific phosphodiesterase (PDE) inhibitor, inhibits transcriptional expression of TGF-β1.\u003csup\u003e17\u003c/sup\u003e The combination of pentoxifylline and vitamin E has been shown to reverse osteoradionecrosis demonstrating significant ability to reduce radiation damage.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e In addition, the effect of this combination has been shown to significantly reduce acute and subacute radiation lung injury in lung cancer patients receiving concurrent chemoradiotherapy.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Based on these studies, we conducted this study to examine the impact of pentoxifylline and vitamin E on acute radiation induced toxicity for head and neck cancer patients.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVitamin E has been identified as an antioxidant with potential benefits for managing oral lesions. It works by interfering with the activation and detoxification of tobacco-specific nitrosamines, which are carcinogenic. Several antioxidants have been studied for oral cancer prevention, including β-carotene, provitamin A, vitamin C, vitamin E, zinc, selenium, and spirulina.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e The tocopherol family includes alpha, beta, gamma and delta forms of vitamin E, with alpha-tocopherol as the most biologically active form. It serves as a strong antioxidant, eliminates free radicals, and inhibits the formation of nitrosamines, which contribute to carcinogenesis. Vitamin E has been proven in studies to downregulate mutant p53, activate wild-type p53, and produce antiangiogenic effects by opposing transforming growth factor-alpha (TGF-α). Other research has reported no toxicity from vitamin E, and patients with oral leukoplakia taking vitamin E had clinical and histological improvement.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eResearch indicates that oral cancer patients have weakened antioxidant defenses (vitamins E and C) and increased oxidative stress, leading to a higher susceptibility to DNA damage. Supplementation with these antioxidants may aid in disease management.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Additionally, vitamin E has been shown to benefit patients with radiotherapy-treated oral squamous cell carcinoma by reducing glycoconjugate levels, which may serve as a marker for treatment response.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWound healing comprises four phases: hemostasis, inflammation, proliferation, and remodeling of the tissues, where controlling inflammation represents a key part of the process. If inflammatory processes are inappropriately activated, healing will be impaired.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Pentoxifylline (PTX), which has anti-inflammatory and antioxidant properties, inhibits synthesis of inflammatory mediators, reduces leukocyte function, and reduces oxidative stress as a result of decreased production of oxygen-free radical species.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Thus, PTX may also contribute to accelerated wound healing and may limit tissue damage from radiation. As such, PTX may offer adjunctive therapy with vitamin E in the management of oral cancer.\u003c/p\u003e \u003cp\u003eDue to the rising rates of oral cancer and the poor prognosis of the disease, it is important to establish effective treatment and prevention strategies. Antioxidants such as vitamin E work to reduce oxidative stress and inhibit carcinogenesis while pentoxifylline (PTX) is anti-inflammatory and helps with healing. PTX and vitamin E have both shown a reduction in toxicity from radiation therapy and improvements in overall health and treatment tolerance in individuals with cancer. Although there is a growing body of literature supporting the use of PTX and vitamin E as treatment options, more studies are needed in order to develop clinical standards for each. The goal of this study is to assess the effects of PTX and vitamin E in reducing acute radiation-induced effects in head and neck patients, potentially leading to additional option to improve prognosis and quality of life.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study aims to determine if pentoxifylline and Vitamin E impact recovery outcomes following surgery and/or radiotherapy in patients with Head and Neck cancers. We are particularly interested in determining the effect of pentoxifylline and Vitamin E on recovery after radiotherapy (e.g., wound healing, pain, incidence of radiotherapy side effects) for patients with oropharyngeal cancers who have undergone surgery and radiotherapy.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePrimary Objective\u003c/h3\u003e\n\u003cp\u003eThe main aim for this retrospective analysis is to examine the effect of Vitamin E and pentoxifylline on the healing rate of chronic wounds in Head and Neck cancer patients who have had surgical care and radiation treatment. We are primarily interested in determining if the use of Vitamin E and pentoxifylline compared to patients receiving standard of care has better wound healing outcomes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSecondary Objectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the effect of Vitamin E and pentoxifylline on pain management in post-operative and post-radiation phases among Head and Neck cancer patients, including the reduction in pain intensity.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess whether the use of Vitamin E and pentoxifylline is associated with a decreased incidence and severity of radiation-related side effects, such as mucositis, xerostomia, and dysphagia in Head and Neck cancer patients.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo conduct subgroup analyses based on variables such as cancer stage, and radiation dosage to identify specific patient groups that may benefit the most from the administration of Vitamin E and pentoxifylline.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe primary objective focuses on the specific outcome of wound healing, while the secondary objectives encompass a broader range of post-treatment recovery outcomes, including pain management, and the incidence of radiation-related side effects, to provide a comprehensive assessment of the combined effects of these interventions in Head and Neck cancer patients.\u003c/p\u003e\n\u003ch3\u003eStudy Design and Source Data\u003c/h3\u003e\n\u003cp\u003eThis study was a retrospective case-control analysis. The data was collected from M.S. Patel Cancer Centre and the Medical Records Department of Shree Krishna Hospital and Medical Research Centre, Gokal Nagar, Karamsad, Anand, Gujarat, India.\u003c/p\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eA retrospective analysis was conducted on medical records of oral cancer patients who received both Vitamin E and Pentoxifylline postoperatively. Data collection included information on dosage, duration, complications, and treatment outcomes. Statistical analysis was performed to assess wound healing, pain management, and radiation-related side effects.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;18 years.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConfirmed diagnosis of oral cancer.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUnderwent surgical treatment for oral cancer.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAvailability of complete medical records, including postoperative management details.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eReceived a combination of Vitamin E and Pentoxifylline postoperatively.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIncomplete medical records.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of allergies or adverse reactions to Vitamin E or Pentoxifylline.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePresence of significant comorbidities that could affect the analysis (any of the three: Stroke, Ischemic Heart Disease (IHD), or Chronic Kidney Disease (CKD).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eIn the study, a total of 206 patients participated, divided into two groups of 103 patients each. Group 1 (the treatment group) received Pentoxifylline and Vitamin E tablets and Group 2 (the control group) did not receive either of the two medications. In order to determine the appropriate statistical tests into comparison analyses a normality test was conducted for the continuous/numeric outcome variables such as pain score and wound healing. Normality was assessed using the Shapiro-Wilk, Kolmogorov-Smirnov, Cramer-von Mises and Anderson-Darling tests, where all tests were rated with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, rejected the null hypothesis and concluded the data was not normality distributed. Based on the finding of non-normality of the data non-parametric statistical tests were used: For continuous variables (i.e. pain score), the Wilcoxon rank sum (Mann-Whitney U-test) test was used in place of the two-sample t-test, as non-parametric approaches are mean focused (i.e. medians are compared rather than means), which is appropriate in non-normal situation. For categorical variables that had greater than two categories (e.g. cancer stage, histology), the Kruskal-Wallis test was used in place of ANOVA as a non-parametric test. Subgroup analyses were noted to explore differences in treatment outcomes based on either cancer stage. The aim was to determine whether postoperative wound healing, pain control, and radiation-related side effects differed between treatment and control groups under the different cancer stages (i.e. did the results differ in stage I as compared to stage II). The subgroup analyses were specified in accordance to guidance provided in the Cochrane Handbook.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, 206 patients diagnosed with oral cancer recruited in this study, they were divided into two groups consisting of 103 patients: a treatment group and a control group.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e80 (77.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e71 (68.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e151 (73.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e23 (22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e32 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e55 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (4.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (5.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (5.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e35-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (30.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (27.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59 (28.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e45-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (27.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32 (31.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 (29.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e55-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21 (20.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27 (26.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48 (23.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e65+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (17.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (9.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (13.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 (A): Gender Distribution across Treatment and Control Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 (B): Age Distribution across Treatment and Control Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the study there were 23 women (22.3%) and 80 men (77.7%) in the treatment group. In comparison, there were 32 women (31.1%) and 71 men (68.9%) in the control group. In total, there were 55 women (26.7%) and 151 men (73.3%) in both groups (Table 1A).\u003c/p\u003e\n\u003cp\u003eA sum total of 206 patients were randomly split into two groups, treatment and control, to study whether Vitamin E and Pentoxifylline decreased postoperative recurrence of oral cancer. Patients were surveyed into diferent group stratifications by age with equal distributions. The use of stratifications by age minimizes confounding related to age to better evaluate the benefit of treatment for the different age strata in each age group. (Table 1B).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNon-smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e75 (72.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e84 (81.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e159 (77.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eCurrent Smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e25 (24.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e11 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e36 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eFormer Smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e8 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e11 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChewing Tobacco Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e52 (50.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e59 (57.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e111 (53.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e46 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e34 (33.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e80 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eFormer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e5 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e10 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e15 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 2 (A) : Smoking Status across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 2 (B): Chewing Tobacco Use Status across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eAnalysis of the smoking status of 206 patients was done to determine if smoking status had an effect on postoperative outcome. Of note, 77.2% of patients were non-smokers, whereas 17.5% were current smokers and 5.3% were previous smokers. This demographic analysis of patients provided the opportunity for a more complete examination of smoking status as a factor in treatment outcomes (Table 2A).\u003c/p\u003e\n\u003cp\u003eThe study evaluated tobacco status in a cohort of 206 oral cancer patients who were randomized into treatment or control groups. Of the 206 participants, 53.9% were non-tobacco users, 38.8% were current tobacco users, and 7.3% were former tobacco users. It is important to be aware of the distribution of non-users, current users, and former users, as tobacco use is a risk factor for oral cancer and may be of consideration in the postoperative period (Table 2B).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e97 (94.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e98 (95.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e195 (94.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e5 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e8 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eOccasionally (beer)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (1.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 3: Alcohol Use Status across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eAlcohol consumption among the 206 study participants was low, with 94.7% being non-users, 3.9% regular users, and 1.45% occasional beer drinkers. The minimal variation between treatment and control groups ensures comparability in evaluating the effects of vitamin E and pentoxifylline on postoperative outcomes (\u003cstrong\u003eTable 3)\u003c/strong\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e21 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e18 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e39 (18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e82 (79.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e85 (82.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e167 (81.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 4 (A): Presence of Comorbidities Across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 4 (B): Types of Comorbidities Across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe study recorded comorbidities to evaluate their impact on postoperative outcomes in oral cancer patients. Among the 206 participants, 18.9% had comorbidities, with minimal variation between the treatment and control groups, ensuring reliable comparisons of intervention effectiveness (Table 4A).\u003c/p\u003e\n\u003cp\u003eThe categorization of comorbidities provides valuable insights into their potential impact on postoperative recovery in oral cancer patients. Hypertension, being the most prevalent condition (15.5%), may influence healing outcomes, while diabetes (5.8%) and less frequent conditions like ischemic heart disease and stroke (0.5% each) highlight individual health variations. Understanding these factors helps in assessing prognostic differences and guiding targeted postoperative care strategies.(Table 4B)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e51.6 \u0026plusmn; 11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e51.5 \u0026plusmn; 12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e51.6 \u0026plusmn; 12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Average Weight across Treatment and Control Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean weight of patients in both treatment (51.6 kg, SD = 11.9 kg) and control groups (51.5 kg, SD = 12.5 kg) remained consistent, minimizing potential bias due to body mass differences. This uniformity helps isolate the effects of the treatment regimen, as variations in body weight can influence medication metabolism and overall recovery (Table 5).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eStage-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e6 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e9 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eStage-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e22 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e19 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e41 (19.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eStage-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e49 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e33 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e82 (39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eStage-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e26 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e48 (46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e74 (35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 6: Distribution of Cancer Stages across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe distribution of cancer stages in the study participants, shows that considerably more control patients had Stage 4 (advanced CA), in comparison to the treatment group; this is of importance, as advanced stages have been shown to relate to poorer recovery and treatment outcomes. For the 206 participants, the balance of Stage 1 and Stage 2 cases were fairly similar between groups, however, within the treatment group, Stage 3 was the most common. However Stage 4 had a vastly higher percentage in the control group (46.6% vs. 25.2% treatment group). The determinants for this higher stage of advanced disease is of importance when assessing the effectiveness of vitamin E and pentoxifylline in postoperative recovery. Thus, the findings suggest that the stage of disease may potentially affect treatment response and the overall prognosis and interpretation of the findings needs to be within the context of disease severity. (Table 6)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eMDSCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e62 (60.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e69 (67.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e131 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eWDSCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e19 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e13 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e32 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eSCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e12 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e7 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e19 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePDSCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e7 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e8 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e15 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eUndifferentiated SCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e6 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e9 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 7: Distribution of Histological Types across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eWhen determining the behavior of the tumor and the response to therapy, the histological distribution of these types among participants in each group is important. The majority of patients, about two-thirds, had a diagnosis of moderately differentiated squamous cell carcinoma (MDSCC) that accounted for 63.6% of the entire patient sample in both treatment and placebo groups. Well-differentiated squamous cell carcinoma (WDSCC) was next among the histological types followed by SCC, poorly differentiated squamous cell carcinoma (PDSCC), and undifferentiated squamous cell carcinoma. As we have presented data on the histological subtypes of our sample, this is an additional reason to evaluate the efficacy of treatment as it relates the level of tumor differentiation since it is possible that tumors from different histological subtypes may respond differently to vitamin E and pentoxifylline. These histological subtypes may also be supportive for future treatment decisions and prognostication post-operatively (table 7).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Site (Anatomical Location)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Treatment (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: Control (N=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Site (Anatomical Location)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eBuccal Mucosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e40 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e51 (49.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e91 (44.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eBuccal Mucosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eTongue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e39 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e35 (34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e74 (35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eTongue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ePharynx (includes oro-, hypo-, nasopharynx)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e7 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e4 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e11 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ePharynx (includes oro-, hypo-, nasopharynx)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ePalate and Tonsil(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e5 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e5 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ePalate and Tonsil(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eLarynx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e6 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e3 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e9 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eLarynx\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eLip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e4 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eLip\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eAlveolus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e3 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eAlveolus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eCa cervix\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eCa cervix\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eNasal Wall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eNasal Wall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003e\u003cstrong\u003eTable 8: Distribution of Primary Anatomical Sites across Treatment and Control Groups\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe site of the oral cancer lesion is important to treatment response and prognosis. The most prevalent sites of lesions in the study population were the buccal mucosa (44.2%), tongue (35.9%), pharynx (5.3%), palate or tonsils (4.9%) and larynx (4.4%). Other sites that were less common included the lip (2.4%), alveolus (1.5%), cervix (1.0%) and nasal wall (0.5%).This distribution illustrates the concept of anatomical site directing potential therapeutic route, e.g., anatomical sites may influence treatment effects after surgery with vitamin E or pentoxifylline, type of surgery or toxicity may also play a role. Identifying these patterns also helps with the same possible treatment options based on treatability of the lesion or tumor location (Table 8).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e74 (71.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e75 (72.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e149 (72.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1.0*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e29 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e28 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e57 (27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9: Radiation-Related Side Effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe occurrence of side effects was similar within the treatment group (71.8%) and control group (72.8%), with a total of 149 events in treatment groups (72.3%). By applying the Fisher\u0026apos;s exact test (p = 1.0), no observed differences were noted between the groups. Therefore, we interpreted that the adverse effects of radiation were comparable across treatment groups (Table 9).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Side Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls (n=103)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDysphagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.30*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e31 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e39 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e70 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e72 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e64 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e136 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMucositis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.26*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e46 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e55 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e101 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e57 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e48 (46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e105 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eXerostomia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.0026*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e9 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e15 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e94 (91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e97 (94.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e191 (92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10: Specific Types of Radiation-Related Side Effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA p-value of 0.30 signifies that 70 cases (34.0%) of the study had dysphagia, with 31 cases (30.1%) being patients and 39 cases (37.9%) being controls. For mucositis, a total of 101 cases (49.0%) were reported, for a p-value of 0.26, consisting of 46 patients (44.7%) and 55 controls (53.4%). Xerostomia was reported in 6 controls (5.8%) and 9 patients (8.7%), for a total of 15 cases (7.2%) of xerostomia with a p-value of 0.0026* demonstrating there was a significant difference in the incidence of xerostomia between the groups.(Table 10)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound Healing Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eNo Wound Present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e41 (39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e36 (35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e77 (37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eHealing in Progress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e48 (46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e42 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e90 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 11: Wound Healing Status and Rate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the categorization of wound healing, the category \u0026apos;No wound present\u0026apos; was seen in 41 patients (39.8%) and in 36 controls (35.0%). The category \u0026apos;Healing in progress\u0026apos; included 48 patients (46.6%) and in 42 controls (40.8%). Furthermore, there was a significant difference in the rates of wound healing between groups. The median wound healing for the group of patients was 17 days (IQR = 8) compared to 30 days (IQR = 18) for the control group with a p-value of 0.0002. Median Wound Healing Rate (Days) were as follows: Patients = 17 (IQR = 8), Controls = 30 (IQR = 18); p-value = 0.0002.(Table 11)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003eControls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003e4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 12: Pain Scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median pain scores also indicated a significant difference, with patients reporting a median score of 1 (IQR = 2) compared to 4 (IQR = 5) in controls, with a p-value \u0026lt;.0001. These findings highlight significant differences in pain management and wound healing between the patient and control groups, suggesting potential impacts of treatment modalities on these outcomes.(Table 12)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Score - Patients (Median [IQR])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Score - Controls (Median [IQR])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e7 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 169px;\"\u003e\n \u003cp\u003e0.5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e5 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 169px;\"\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 143px;\"\u003e\n \u003cp\u003eStage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 169px;\"\u003e\n \u003cp\u003e0 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e4 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e. Comparison of pain scores between patient and control group by Cancer Stages\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFootnote: IQR= Inter Quartile Range\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*Non-parametric Wilcoxon Sum Sign Rank Test (Mann-Whitney U test), p-value\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen analyzing pain scores in patients and controls across cancer stages, there were significant differences across several stages. No difference was statistically significant at Stage 1 (p=0.50). At Stage 2, however, patients scored significantly lower pain (median=0.5, IQR=2) than controls (median=5, IQR=4) with a significant difference (p=0.0004). At Stage 3, the results showed a trend towards significance (p=0.05), suggesting pain management strategies were possibly becoming effective in utilizing benefits (Table 16). The overall largest difference was measured at Stage 4 when no pain was expressed in patients (median=0, IQR=1) compared to controls (median=4, IQR=3) that was highly significant (\u0026lt;0.0001). This data indicates that through specific therapy application (i.e., pentoxifylline and vitamin E), the patient population managed their pain better than observed re-engagement measures among stage designated control subjects. The difference in pain scores was lower than significant observed in Stage 1 due to a natural expression of lower pain levels or established protocols exhibiting their maximum effectiveness as disease progressed (Table 13).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient (Median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (Median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 175px;\"\u003e\n \u003cp\u003e16 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 168px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 175px;\"\u003e\n \u003cp\u003e14 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e23 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 175px;\"\u003e\n \u003cp\u003e19.5 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e30 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 131px;\"\u003e\n \u003cp\u003eStage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 175px;\"\u003e\n \u003cp\u003e17 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 126px;\"\u003e\n \u003cp\u003e30 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eComparison of wound healing rate (days) between patient and control group by Cancer Stages\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFootnote\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIQR= Inter Quartile Range\u003c/p\u003e\n\u003cp\u003e*Non-parametric Wilcoxon Sum Sign Rank Test (Mann-Whitney U test), p-value\u003c/p\u003e\n\u003cp\u003eThe evaluation of wound healing rates among the several stages of cancer showed a significant difference between the groups of patients and controls. Controls in Stage 1 were not available for comparison. In Stage 2, the patients had significantly better wound healing than the controls with a median of 14 (IQR=4 days), compared to controls with a median of 23 (IQR=11 days), resulting in a p-value of 0.01. Wound healing was observed to be markedly faster in Stage 3 patients (median=19.5, IQR=9 days) compared to controls (median=30, IQR=18), resulting in a p-value of 0.03. Stage 4 had indications of faster healing with patients compared to controls with a reduced median of 17 days (IQR=11 days), and controls at a median of 30 (IQR=18), resulting in a p-value of 0.05. This data provides interesting evidence that pentoxifylline, vitamin E, and similar therapies could accelerate healing with Stages 2, 3, and 4 patients being encouraged that some form of intervention could be beneficial in the postoperative recovery period for oral cancer patients (Table 14).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage 1 (n=9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage 2 (n=41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient (n=6)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=3)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient (n=22)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=19)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation related efftects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e15 (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e16 (84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(a).\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRadiation-Related Side Effects by Cancer Stages\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003evariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage 3 (n=82)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer Stage 4 (n=74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient (n=49)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=33)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient (n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=48)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003ep-value*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation related efftects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e36 (73.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e21 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e18 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e36 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e13 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e12 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e8 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e12 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(b).\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRadiation-Related Side Effects by Cancer Stages\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFootnote:\u003c/p\u003e\n\u003cp\u003e*Fisher\u0026apos;s exact test, p-value\u003c/p\u003e\n\u003cp\u003eAnalysis of the adverse effects of radiation for each of the cancer stages AM discussed found no significant difference between treatment and control groups. For Stage 1 (n=9), a p-value of 1.0 indicates that the treatment made no difference in the occurrence of side effects, while it should be acknowledged that the small sample size could undermine the strength of this conclusion. The small sample size could limit the strength of any conclusion, even though the p-value was strongly correlated with revealing that the treatment was not notably beneficial for moderating radiation related side effects. Similarly, Stage 2 (n=41) demonstrated a p-value of 0.29, indicating that the treatment made no difference in treatment outcome between groups, once again showing that the treatment did not significantly moderate radiation related side effects during this stage of treatment either. For Stage 3 (n=82), p-value (0.46) also found no significant difference, thereby further supporting the conclusion that the treatment may not have meaningfully impacted the adverse effects of radiation during this stage of treatment. For Stage 4 (n=74), while Stage 4 was the most advanced cancer stage with the most number of cases analyzed, and therefore the final course of treatment, a p-value of 0.59 demonstrated no significant difference between the treatment versus control group. Therefore, continuing to follow patients throughout systematically their treatment, across cancer stages, will again consistently show that the treatment did not significantly become an advantage for moderating radiation related side effects ( see Table 15 a,b).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Radiation Dosage(Gy)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Radiation Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Wound Healing(Days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Pain Score(0-10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e30GY/10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e11 radiations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003eno wound healing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e30GY/10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e21 radiations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003eno wound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003epatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e60Gy/30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e34 radiations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003eTable 16. Analysis of Specific Cases with Metastasis\u003c/h3\u003e\n\u003cp\u003eThe analysis demonstrates differences between both the control group and the treatment group in maximum dose, healing, and pain scores. The control group was given a prescribed 30 Gy total, which was given in ten gaming sessions. Some patients received as much as twenty-one sessions of treatment, a likely confounding aspect related to individual need. The treatment group was given a higher cumulative radiation dose (60 Gy) total, prescribed for thirty gaming sessions, which demonstrates a more assertive prescription. While wound healing was uneventful in the control group, the analyst described one participant as not exhibiting any wound healing. Healing was evident with the treatment group with one report of an average of 14 days to heal, as well as one participant simply stating that she \u0026ldquo;healed.\u0026rdquo; The pain scores did vary in the control group; for example, one participant reported a pain score of 5 (moderate pain) while a second participant did not have a pain score. Although treatment in relation to these multifactorial applications warrants exploration, it is worthy of note that one treated patient did report no pain during the dose escalation radiation sessions. Although the analysis of these findings provided meaningful insight into factors affecting healing and pain, the sample size did not allow the ability to conclude any specific relationship to dose. All treatment pathways should still remain individualized, however studies with a better sample size had greater potential to observe effects dose might have on pain and the radiation or wound healing processes (Table 16).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation Dosage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation Duration (Days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound Healing (Days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Score (0-10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation Dosage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e62 Gy / 31#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e62 Gy / 31#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e70 Gy / 35#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e70 Gy / 35#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e30 Gy / 10#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003cstrong\u003e. (a)\u003c/strong\u003e \u003cstrong\u003ePain Score,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eControl Group (6 Cases)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation Dosage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation Duration (Days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound Healing (Days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Score (0-10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e66 Gy / 30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e64 Gy / 32#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e64 Gy / 31#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e64 Gy / 32#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003cstrong\u003e. (b)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePain Score,\u003c/strong\u003e \u003cstrong\u003ePatient/Treatment Group (4 Cases)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo additional analysis was performed for recurrence due to limited sample size (n=10)\u003c/p\u003e\n\u003cp\u003eFootnotes: 9999 indicates no wound present and 0 indicates no wound healing\u003c/p\u003e\n\u003cp\u003eThe assessment examines the comparison of radiation dosage, wound healing, and pain scores between the treatment and control groups. The control group experienced radiation dosages variable from 30 to 70 Gy over 11 to 35 days, with two of those patients calling it \u0026quot;no wound present,\u0026quot; and this is quite advanced with a clinical situation that is very individualized. The treatment group allowed for a more rigorous standardization, with treatment in the range of 64 to 66 Gy over 18 to 33 days. The pain scores of the control group was also significantly variable (0-8), suggesting implications with pain experience or management; whereas the treatment group indicated, generally, lower reported scores (0-3), suggesting significantly less pain control. Wound healing was also variable; one patient treated ultimately healed in 14 days, was otherwise no reported wounds for the other two treatments. On the whole, the treatment group had less variability in the radiation exposure, lower pain scores, and potentially better management. If there is some level of consistency in cancer treatment with some level of standardization, there would likely be better patient outcomes than patients treated with variability in the control group (Table 17A,B).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation dosage (Gy/fraction)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient (n=103), count(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=103),\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ecount(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e30GY/10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e30GY/30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e32GY/10#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e45GY/15#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e50.4GY/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e60GY/30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e11 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e62GY/30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e62GY/31#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e26 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e42 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e62GY/32#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e63GY/32#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e64GY/30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e64GY/31#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e64GY/32#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e26 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e31 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e57 (27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e65GY/32#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e66GY/30#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e66GY/33#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e22 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e37 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e70GY/33#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e19 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e22 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e70GY/35#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e11 (10.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable. 18 (a) Analysis of Radiation Dosage Details across Patient and Control Groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (\u0026plusmn;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (\u0026plusmn;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (\u0026plusmn;SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eRadiation duration (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e27.2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e29.4 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e28.3 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable. 18 (b) Analysis of Radiation duration\u003c/p\u003e\n\u003cp\u003eBoth groups received the same common dosages of radiation, including 62 Gy / 32# (27.7%), 62 Gy / 31# (20.4%), 66 Gy / 33# (18.0%), and 70 Gy / 33# (10.7%); however, higher dosages (66 Gy and above) were more common for the patient group (specifically the dosages of 70 Gy / 33# while the control group was more likely to receive the dose of 70 Gy / 35#). Lower dosages (like 30 Gy) were infrequently utilized, almost exclusively in the control group.As seen with codings 106 or higher, treatment doses suggest a more organized, intensive treatment plan for the patient group (likely indicative of severity of disease, level of therapeutic intervention, etc.) while the variably used dosages within the control group are more suggestive of non standard treatment, which may influence very high or low treatable attributes unique to the clinic. Further analysis would be required to assess treatment dosages in relation to clinical outcomes, treatment acceptance, or effectiveness (Table 18 a,b).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn order to assess the efficacy of the combination of Vitamin E and Pentoxifylline on outcomes such as pain scores, healing time, and radiotherapy side effects in various cancer patients stages, this study researched large samples of cancer patients who were randomized to either treatment or control group. The outcome showed that the treatment group, especially the patients of more advanced disease stage had significantly reduced levels of pain. The treatment group patients with Stage 2 cancer had a median pain score that was lower than the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), while the Stage 4 patients also had a median pain level that was lower than controls (p\u0026thinsp;=\u0026thinsp;0.0004). This is in part an indication that the treatment worked to significantly reduce pain in the treatment group patients with more advanced cancer because of the anti-inflammatory component of the different treatment regiments. The Stage 1 patients in the treatment group did not significantly differ from median pain scores which may also be the effect of early stages of cancer that usually has low baseline pain levels. The analysis of subgroups on rate of wound closure also supported treatment for wound care, especially at stages when faster wound closure is important for quality of life and healing purposes. The second, third and fourth stage patients in the treatment group also healed quicker than the control group with statistically sound differences p = .01, p = .03, p = .05 respectively. The results are consistent with previous findings of Vitamin E and Pentoxifylline potentially improving blood flow and oxygenation at the wound site, which supports more rapid tissue healing.\u003c/p\u003e \u003cp\u003eWhile the treatment did demonstrate some efficacy with respect to the alleviation of pain and wound healing, there was no statistically significant reduction in the incidence of radiation side effects at any stage of cancer treatment. This indicates that, despite its ability to address certain symptoms of cancer therapy, the original study suggests that it does not appear to ameliorate the sensitivity to radiation-induced damage. This finding supports the complex biology of radiation toxicity and suggests that more targeted approaches may be necessary for future studies. In our study consideration of incidences of dry mouth as a relatively common side effect of radiation treatment, the frequency of the incidence was statistically different (higher in the treatment group) between treatment and control groups. The incidence of xerostomia (the effect) was significantly greater in the treatment group with p-values (P\u0026thinsp;=\u0026thinsp;0.0026). This finding indicates the treatment, Pentoxifylline and Vitamin E, has effect in the prevention of xerostomia in patients undergoing radiation therapy for cancer. This finding is critical especially when considering overall quality of life for patients suffering from this effect since dry mouth can have significant implications on comfort and nutrition.\u003c/p\u003e \u003cp\u003eThe examination of radiation dose levels and type of partition provides an opportunity to gain further understanding of the treatment strategies. Interestingly, there were more patients in the treatment group with radiation doses above the average (66GY/33# and 70GY/33#), which indicated this group was possibly more likely to receive the more aggressive treatment. Additional consideration of the association between increased radiation exposure and patient outcomes is warranted, specifically if the increased radiation exposure of the treatment group was a contributing factor in providing improved pain and wound healing. Both Sayed's research and the current research examined the effectiveness of Pentoxifylline and Vitamin E on mitigating radiation induced complications in head and neck cancer patients, though the distinction in respective \"areas of interest\" did vary, yet both approaches determined efficacy. With Sayed's research involving a prospective randomized controlled trial, it specifically evaluated how the treatment combination of Pentoxifylline and Vitamin E affected the incidence, intensity, onset, and duration of oral mucositis and dysphagia. The outcomes of Sayed's work demonstrated that the treatment combination produced no change in these issues regarding incidence or onset; however, the treatment did produce significant reductions in intensity and length of time of these radiation concerns. This ultimately resulted in decreased length of stay and treatment interruptions for patients undergoing radiation. The current research went beyond looking only at the respective side effects of dyphagia and oral mucositis, and examined overall patient healing rates and pain. Overall, the research produced significant improvements in the areas of patient healing rate from radiation and pain improvement, particularly with patients with a more advanced disease state. Similar to Sayed's findings, it is important to note that our analysis did not show a significantly decreased incidence of patient's experiencing side effects related to radiation. Both studies demonstrate the variation in response based on the specific side effects in the context of patient history regarding stage of disease and the benefit the treatment therapy has on the improved patient outcome through the ongoing treatment related to radiation.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBoth Ferreira's and our project examine the possible protective properties of Vitamin E for head and neck cancer patients receiving radiation therapy but use different methodology and endpoints. Ferreira's project evaluated the impact of Vitamin E on the number and severity of oral mucositis in patients undergoing standard radiation therapy, and found significant reductions in both symptomatic mucositis as well as pain. Our research looked at the impact of using both Pentoxifylline and Vitamin E in treating radiation related side effects more broadly, such as pain and wound healing in patients who had potentially different stages of cancer. While both research pointed toward a reduction in pain, our trial was not centered on oral mucositis, but was focused on examining overall side effects, wound healing and pain level, and showed improved outcomes particularly in patients with advanced disease. Thus, it is clear that, while both research calling attention to the efficacy of Vitamin E in promoting beneficial side effects in patients undergoing radiation, the specific and overall impacts of vitamin E may be different in patients groups depending on various factors, including study design and patient population.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study indicates potential benefit to using vitamin E and pentoxifylline for the relief of pain and healing of wounds in patients with cancer, especially those with advanced disease. However, if some of the side effects of radiation treatment do not improve, alternative treatment pathways may indeed be considered to alleviate some of the side effects sustained by radiation that impact the patient's quality of life. Future research should seek to expand our knowledge of the mechanisms of these treatments to allow the desired outcomes for patients and healthcare providers. This will include determining the optimum doses, exploring combinations with other efficacious medicinal agents, as well as evaluate long term goal of outcomes such as survival and quality of life. In addition, a systematic and comprehensive assessment of the impact of radiation prescriptions of treatment outcome will raise therapeutic strategies in many stages, and in many clinical situations related to cancer. Expanding the knowledge of how treatment pathways impact care and outcomes for who remains clinically relevant in order provide the most optimal personalized clinical practice for the cancer patient. The bottom line may translate to an enhanced prognosis [outcomes] and quality of life for patients suffering from cancer.Due to the limited size and homogeneity in geography of the site of the study, generalizing the results of this study to another larger, more heterogeneous group of individuals with diverging clinical and demographic characteristics may be difficult, if not somewhat impractical. The retrospective nature of the data may also indicate potential validity threats to the data collected and impacting reliability of the results, conclusions and generalizability due to conditions of the data collected in the retrospective process.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study assessed differences in outcomes between patients who received Vitamin E and Pentoxifylline and a control group regarding wound healing, pain scores, and side effects from radiation in patients with cancer undergoing treatment. The results indicate significant improvements in wound healing and decreased pain scores in the treatment group, particularly in advanced cancer stages (2, 3, and 4), suggesting that the combined therapy may have benefitted certain complications of radiation therapy. However, there were not any significant differences in incidence of radiation side effects across cancer stage and between groups. These results indicate that adjunctive therapy can improve quality of life with reliability of treatment in patients with cancer receiving radiation therapy. More studies are warranted, however, including randomized controlled trials that utilize a larger and more diverse sample of individuals, in order to support these findings and fully understand the clinical potential of Vitamin E and Pentoxifylline in oncology.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHNC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHead and Neck Cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRadiotherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTX\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePentoxifylline\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVit E\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVitamin E\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOral Squamous Cell Carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSquamous Cell Carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWDSCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWell-Differentiated Squamous Cell Carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDSCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModerately Differentiated Squamous Cell Carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePDSCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePoorly Differentiated Squamous Cell Carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTGF-β1\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTransforming Growth Factor Beta 1\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTGF-α\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTransforming Growth Factor Alpha\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePDE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhosphodiesterase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDeoxyribonucleic Acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIEC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Ethics Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIHD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIschemic Heart Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Kidney Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variances\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This retrospective study was approved by the Institutional Ethics Committee .As the study involved analysis of previously recorded anonymized patient data, the requirement for informed consent was waived by the ethics committee. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical Trial Number:\u003c/h2\u003e \u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.B. and C.D. wrote the main manuscript text and collected data and guidanceE. wrote and reviwed manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to thank the staff of Shree Krishna Hospital for their support in facilitating access to medical records for this study.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to patient confidentiality and institutional restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDhanuthai K, Rojanawatsirivej S, Thosaporn W, Kintarak S, Subarnbhesaj A, Darling M, Kryshtalskyj E, Chiang CP, Shin HI, Choi SY, Lee SS, Aminishakib P. Oral cancer: A multicenter study. Med Oral Patol Oral Cir Bucal. 2018 Jan 1;23(1):e23-e29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldstein BY, Chang SC, Hashibe M, La Vecchia C, Zhang ZF. Alcohol consumption and cancers of the oral cavity and pharynx from 1988 to 2009: an update. Eur J Cancer Prev. 2010;19:431\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivera C. Essentials of oral cancer. Int J Clin Exp Pathol. 2015 Sep 1;8(9):11884-94. PMID: 26617944; PMCID: PMC4637760.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005;104(6):1129\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilverman S, Kerr AR, Epstein JB. Oral and Pharyngeal Cancer Control and Early Detection. 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Pentoxifylline. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.drugbank.ca/drugs/ DB00806\u003c/span\u003e\u003cspan address=\"http://www.drugbank.ca/drugs/ DB00806\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed 17 February 2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFood US. Drug Administration. Approval history of pentoxifylline. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview\u0026amp;DrugName=TRENTAL\u003c/span\u003e\u003cspan address=\"http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview\u0026amp;DrugName=TRENTAL\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed 17 February 2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePareek P, Samdariya S, Sharma A, Gupta N, Shekhar S, Kirubakaran R. Pentoxifylline and vitamin E alone or in combination for preventing and treating side effects of radiation therapy and concomitant chemoradiotherapy. Cochrane Database Syst Rev. 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatyar RR, Patyar S. Role of drugs in the prevention and amelioratioof radiation induced toxic effects. Eur J Pharmacol. 2018;819:207\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMisirlioglu CH, Demirkasimoglu T, Kucukplakci B, Sanri E, Altundag K. Pentoxifylline and alpha-tocopherol in preventionof radiation-induced lung toxicity in patients with lung cancer. Med Oncol. 2007;24(3):308\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons AJ, Brennan PA. Pentoxifylline\u0026mdash;a review of its use in osteoradionecrosis. Br J Oral Maxillofac Surg. 2017;55(3):230\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEuroQolGroup. EuroQol\u0026mdash;a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199\u0026ndash;208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra Mouli PE, Senthil B, Parthiban S, Malarvizhi AE, Priya R, Subha R. Antioxidants and its role in Oral Cancer- a review. Indian J Sci. 2012;1:113\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVikas Fotedar S, Fotedar RK, Seam MK, Gupta. Oral Cancer and Prevention. Int J Pharm Sci Invention. 2013;2:16\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRai Balwant. Salivary Levels Vitamin E and C in Different Histological Grading of Oral Cancer. Pesquisa Brasileira em Odontopediatria e Clin Integrada. 2008;8:123\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChitra S, Shyamala CS, Devi. Effect of vitamin E on protein bound carbohydrate complexes in radiation treated oral squamous cell carcinoma patients. Indian J Clin Biochem. 2008;23:92\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBroughton G, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg. 2006;117(7):e1\u0026ndash;S. \u0026ndash;32e-S.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuti\u0026eacute;rrez-Fern\u0026aacute;ndez A, Inada M, Balb\u0026iacute;n M, et al. Increased inflammation delays wound healing in mice deficient in collagenase-2 (MMP-8). FASEB J. 2007;21(10):2580\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeree J, Martins JO, Melbostad H, et al. Insights into the regulation of TNF-α production in human mononuclear cells: the effects of non-specific phosphodiesterase inhibition. Clinics. 2008;63(3):321\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhat VB, Madyastha KM. Antioxidant and radical scavenging properties of 8- oxo derivatives of xanthine drugs pentoxifylline and lisofylline. Biochem Biophys Res Commun. 2001;288(5):1212\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ehttps://. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehandbook-5-1.cochrane.org/chapter_9/9_6_2_what_are_subgroup_analyses.htm#:~\u003c/span\u003e\u003cspan address=\"http://handbook-5-1.cochrane.org/chapter_9/9_6_2_what_are_subgroup_analyses.htm#:~\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e:text=Subgroup%20analyses%20involve%20splitting%20all,such%20as%20different%20geographical%20locations.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSayed R, El Wakeel L, Saad AS, Kelany M, El-Hamamsy M. Pentoxifylline and vitamin E reduce the severity of radiotherapy-induced oral mucositis and dysphagia in head and neck cancer patients: a randomized, controlled study. Med Oncol. 2019;37(1):8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12032-019-1334-5\u003c/span\u003e\u003cspan address=\"10.1007/s12032-019-1334-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31748905.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira PR, Fleck JF, Diehl A, Barletta D, Braga-Filho A, Barletta A, Ilha L. Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial. Head Neck. 2004;26(4):313\u0026thinsp;\u0026ndash;\u0026thinsp;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/hed.10382\u003c/span\u003e\u003cspan address=\"10.1002/hed.10382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15054734.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9391601/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9391601/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eRadiation therapy is a cornerstone of cancer treatment, but its side effects, including pain, delayed wound healing, and radiation-induced complications, significantly impact patients' quality of life. Pentoxifylline and Vitamin E have been suggested as adjunct therapies to mitigate these adverse effects. This study evaluates the efficacy of these agents in improving pain scores, wound healing, and radiation-related complications in cancer patients.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study aims to assess the effectiveness of Pentoxifylline and Vitamin E in reducing pain, enhancing wound healing, and minimizing radiation-induced side effects in patients undergoing radiation therapy.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed clinical data from cancer patients receiving radiation therapy, divided into a treatment group (Pentoxifylline and Vitamin E) and a control group. Patients were categorized based on cancer stage and treatment regimens. Data on radiation dosage, pain scores, wound healing rates, and radiation-related side effects were collected and statistically analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePatients in the treatment group, particularly those in advanced cancer stages, experienced significantly lower pain scores compared to controls (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 for Stage 2 and 0.0004 for Stage 4). Wound healing was notably faster in Stages 2, 3, and 4, with statistically significant improvements (p\u0026thinsp;=\u0026thinsp;0.01, 0.03, and 0.05, respectively). However, the treatment group did not show a reduction in radiation-induced side effects, with an unexpected increase in xerostomia cases (p\u0026thinsp;=\u0026thinsp;0.0026). Radiation dose analysis revealed that patients in the treatment group were more likely to receive higher radiation doses (66Gy/33# and 70Gy/33#), suggesting a potentially more aggressive treatment approach.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe combination of Pentoxifylline and Vitamin E appears to provide significant pain relief and improved wound healing, particularly in advanced cancer stages. However, its impact on radiation-induced side effects remains unclear, with a potential association with increased xerostomia. Further research is required to optimize treatment protocols, refine dosage strategies, and explore the mechanisms underlying these effects to improve supportive care in cancer patients undergoing radiation therapy.\u003c/p\u003e","manuscriptTitle":"Retrospective Analysis Of The Combined Effects Of Vitamin E And Pentoxifylline In Post- Radiation Recovery Of Head And Neck Cancer Patients At Tertiary Care Center, Anand","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 07:00:53","doi":"10.21203/rs.3.rs-9391601/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"423ba8b6-7374-4a17-b9f9-2143bd130053","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T09:59:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 07:00:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9391601","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9391601","identity":"rs-9391601","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}