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Ibrahim SS, Hassanein FEA, Zaky HW, Gamal H. Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101827. [PMID: 38493953 DOI: 10.1016/j.jormas.2024.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This study aimed to evaluate the effect of oral glutamine suspension on salivary levels of transforming growth factor beta 1 (TGF-β1), a cytokine involved in inflammation and Tumor progression, and the severity of radiation-induced oral mucositis (RIOM) in head and neck cancer patients. This is the first study to investigate the impact of glutamine on TGF-β1 levels in head and neck cancer patients with radiation induced oral mucositis (RIOM). METHODS In this randomized controlled clinical trial, 50 HNC patients were enrolled and received either glutamine oral suspension or maltodextrin as a placebo from the baseline of RIOM to the end of radiotherapy. Salivary TGF-β1 levels were measured at baseline and after treatment. Also, RIOM was assessed using the World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), the Pain Visual Analog Scale (Pain-VAS), the incidence of opioid use, and body mass index (BMI). RESULTS Glutamine significantly reduced salivary TGF-β1 levels and improved RIOM symptoms, such as pain, opioid use, and weight loss. The reduction of TGF-β1 levels was associated with the improvement of RIOM severity. CONCLUSION Glutamine may modulate the inflammatory response and enhance wound healing in RIOM by decreasing salivary TGF-β1 levels. These findings support the use of glutamine as a potential intervention for RIOM and nutritional support for improving radiation sensitivity. TRIAL REGISTRATION This study was registered on clinicalTrials.gov with identifier no. NCT05856188.
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Affiliation(s)
- Suzan S Ibrahim
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faculty of Oral and Dental medicine, Nahda university, Beni Suef, Egypt
| | - Fatma E A Hassanein
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faulty of Dentistry, King Salman International University, El-Tur, Egypt.
| | - Hany W Zaky
- Radiation Oncology, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Hadeel Gamal
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Silva ARGDA, Cunha LDO, Silva DCC, Novaes VM, Mourão AM, Vicente LCC. Immediate effects of photobiomodulation on saliva production. Codas 2024; 36:e20230224. [PMID: 38808859 PMCID: PMC11166038 DOI: 10.1590/2317-1782/20242023224pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 05/30/2024] Open
Abstract
PURPOSE To verify the immediate effects of photobiomodulation on the production of salivary flow and the correlation of demographic, anthropometric and medication use data. METHODS The study included 100 healthy individuals, aged between 18 and 76 years (mean 27.2 years), randomly split into an experimental group and a placebo group. Assessments of anthropometric measurements, self-perception of saliva production and sialometry were performed. Next, LASER irradiation was carried out at an infrared wavelength (808 nanometers) with 100 milliwatts (mw) of power at five intraoral points: on the sublingual glands and bilaterally on the submandibular and parotid glands, at doses of 9, 18 and 24 joules (J). Sialometry was repeated after each application. The control group received the same procedures with placebo equipment. RESULTS There was a statistical association in the self-perception of reduced saliva in the experimental group for the 24J dose and in sialometry and in the reduction in salivary flow for the 18J and 24J doses and an increase to 9J, in both groups. There was no association when comparing the experimental and placebo groups. Multiple multinomial regression analysis revealed that the reduction or increase in salivary flow is independent of demographic, anthropometric and medication use variables. CONCLUSION The bioinhibitory action of photobiomodulation on healthy salivary glands occurred at a dose of 18J and 24J, while the biostimulant action happened at a dose of 9J, regardless of demographic, anthropometric variables and medication use. The self-perception of reduced salivary flow occurred at 24J.
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Affiliation(s)
| | - Lucas de Oliveira Cunha
- Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | | | - Vanessa Mouffron Novaes
- Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Aline Mansueto Mourão
- Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
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Ribeiro LN, de Vasconcelos Carvalho M, de Oliveira Limirio JPJ, do Egito Vasconcelos BC, Moraes SLD, Pellizzer EP. Impact of low-level laser therapy on the quality of life of patients with xerostomia undergoing head and neck radiotherapy: a systematic review. Support Care Cancer 2024; 32:118. [PMID: 38244087 DOI: 10.1007/s00520-024-08325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE To carry out a systematic review to assess whether low-level laser therapy can improve the quality of life of patients with xerostomia undergoing head and neck radiotherapy. METHODS A systematic search was performed through Embase, Medline/PubMed, Cochrane, Scopus, Web of Science, nonpeer-reviewed clinicaltrials.gov and LILACS. The strategy included clinical studies were selected that prospectively followed or evaluated the quality of life by directly comparing the use of low-level laser therapy for xerostomia induced by head and neck radiotherapy with alternative therapies without the use of a laser. The risk of bias in the studies was assessed by RoB 2.0 and Robins I. RESULTS After all application of the predetermined criteria, four studies were included, dated between the years 2014 and 2023. Three studies described as randomized clinical trials were included, one of which was a randomized pilot study and only one was a prospective clinical trial. A total of 126 patients were evaluated, all four studies used the infrared wavelength, with two studies using the combination with the red wavelength. It was observed that low-level laser therapy can change the sensation of dry mouth, improving patients' quality of life. In addition, changes related to increased stimulated and unstimulated salivary flow were also identified. CONCLUSION The use of low-level laser therapy has promising results on xerostomia, consequently improving the quality of life of patients undergoing radiotherapy in the head and neck region.
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Affiliation(s)
- Lucas Nascimento Ribeiro
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Integrated Anatomic Pathology Center, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Marianne de Vasconcelos Carvalho
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Integrated Anatomic Pathology Center, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Pernambuco (UPE), Cícero Monteiro Street, s/n - São Cristóvão, Arcoverde, PE, 56503-146, Brazil.
| | - João Pedro Justino de Oliveira Limirio
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifácio Street 1193, Araçatuba, São Paulo, 1605000, Brazil
| | - Belmiro Cavalcanti do Egito Vasconcelos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Sandra Lúcia Dantas Moraes
- Department of Prosthodontics, School of Dentistry, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifácio Street 1193, Araçatuba, São Paulo, 1605000, Brazil
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Nayak SG, George A, Sharan K, Nayak BS, Salins N. Interventions to improve quality of life in patients with head and neck cancers receiving radiation therapy: a scoping review. Support Care Cancer 2023; 32:31. [PMID: 38102525 DOI: 10.1007/s00520-023-08197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Quality of life (QOL) is impaired in patients with head and neck cancers (HNC) due to illness and treatment-associated morbidity. Although there is evidence from the studies on interventions' role in improving QOL receiving radiation therapy, these are not systematically synthesised. In this scoping review, we searched and synthesised the evidence on interventions to improve the QOL and its impact among patients with HNCs. METHODS This scoping review was conducted using the framework proposed by Arksey and O'Malley, and the extensions suggested by Levac et al. were incorporated. Two reviewers independently searched four electronic databases using key thesaurus and free-text terms, and the data was extracted, tabulated, synthesised and reported as categories. RESULTS Seventy-nine papers reported various interventions of diverse nature such as pharmacological, physical, nutritional, complementary and alternative therapies, psychosocial, oral care related, laser and photobiomodulation therapies, rehabilitative, educational, technology-based, surgical, device-related and nurse lead interventions. Most studies reported clinically meaningful impact of interventions on QOL, although the outcome differences were often statistically insignificant. Few studies reported a combination of interventions to address the multidimensional concerns faced by patients with HNCs. None of the studies examined the impact of interventions on QOL among long-term survivors of HNCs. CONCLUSION As QOL concerns in patients with HNCs are multifaceted, more extensive studies with complex multi-component interventions and robust research designs are warranted.
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Affiliation(s)
- Shalini Ganesh Nayak
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anice George
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Krishna Sharan
- Radiotherapy & Oncology, KS Hegde Medical Academy, Nitte (Deemed to Be University), Mangalore, Karnataka, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Potrich AR, Só BB, Schuch LF, Wagner VP, Silveira FM, de Abreu Alves F, Prado-Ribeiro AC, Santos-Silva AR, Treister NS, Martins MD, Martins MAT. Impact of photobiomodulation for prevention of oral mucositis on the quality of life of patients with head and neck cancer: a systematic review. Lasers Med Sci 2023; 39:1. [PMID: 38057605 DOI: 10.1007/s10103-023-03940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023]
Abstract
The aim of this study was to perform a systematic review to evaluate the impact of photobiomodulation therapy (PBMT) for the prevention of oral mucositis (OM) on the quality of life (QoL) of patients with head and neck cancer (HNC) undergoing radiation therapy. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search strategy was performed in five electronic databases (Cochrane, Embase, PubMed, Scopus, and Web of Science). The included studies assessed the QoL of patients undergoing radiation therapy (RT) for HNC and undergoing PBMT for the management of OM. Seven articles met the eligibility criteria. Data extraction was performed in the selected studies including the PBMT parameters (active medium, application procedure, wavelength, fluence, power, irradiance, irradiation time, spot size, energy per point, schedule of irradiation, and total energy). The included studies were qualitatively analyzed, and descriptive analyses were performed. Also, summary results were evaluated for group comparison analysis. All included studies confirmed a decrease in the QoL of the patients that developed OM throughout the RT progress when compared to baseline. Of the informed cases, most of the patients who received PBMT showed grades 1 and 2 OM, while the control group showed more individuals with severe forms of OM (grades 3 and 4). In this sense, patients submitted to PBMT reported better QoL at the end of the treatment compared with the control group. PBMT used for the management of OM preserves the QoL of patients with head and neck cancer.
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Affiliation(s)
- Ana Rita Potrich
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bruna Barcelos Só
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lauren Frenzel Schuch
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Molecular Pathology Area, School of Dentistry, Universidad de la República, Montevideo, Uruguay
| | | | - Felipe Martins Silveira
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Molecular Pathology Area, School of Dentistry, Universidad de la República, Montevideo, Uruguay
| | | | - Ana Carolina Prado-Ribeiro
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Nathaniel Simon Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marco Antonio Trevizani Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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Martins AFL, Pereira CH, Morais MO, de Sousa-Neto SS, Valadares MC, Freitas NMA, Leles CR, de Mendonça EF. Effects of a mucoadhesive phytomedicine (Curcuma longa L. and Bidens pilosa L.) on radiotherapy-induced oral mucositis and quality of life of patients undergoing head and neck cancer treatment: randomized clinical trial. Support Care Cancer 2023; 31:517. [PMID: 37566179 DOI: 10.1007/s00520-023-07971-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE To assess the effect of a mucoadhesive herbal medicine containing curcuminoids and a glycerinated extract of Bidens pilosa L. (FITOPROT) in association with photobiomodulation (PBM) therapy and a Preventive Oral Care Program (POCP) compared to PBM and POCP in the treatment of radiotherapy (RT)-induced oral mucositis (ROM) and in the quality of life of these patients. METHODS A double-blind clinical trial was performed with head and neck cancer patients undergoing RT or chemoradiotherapy. Participants were randomized into two groups: Group 1 (n=27): PBM and POCP; and Group 2 (n=25): PBM, POCP and FITOPROT. The PBM protocol was daily irradiation, 660 nm, 25mW, 0.25 J/point from the first until the last day of RT. The FITOPROT was used as mouthwash twice a day. ROM was evaluated based on the scales of the World Health Organization and National Cancer Institute. The quality of life was evaluated using the University of Washington Questionnaire, OHIP-14 and Patient-Reported Oral Mucositis Symptom Scale. The MMAS-8 questionnaire was used to evaluated the adherence to POCP and FITOPROT. Data were collected at baseline, 7th, 14th, 21st, and 30th RT sessions. RESULTS No statistical differences were found between the groups for the ROM evaluation. Both groups experienced worsening of the quality of life during the RT. No statistically significant differences between groups were observed for any of the instruments evaluated. CONCLUSION The results suggest that PBM associated with FITOPROT and POCP control the severity of ROM and stabilize the QoL of patients with head and neck cancer. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC-RBR-9vddmr; UTN code: U1111-1193-2066), registered in August 8th, 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Universidade Evangélica de Goiás, Dentistry School, Av. Universitária, s/n-Cidade Universitária, Goiás, Anápolis, CEP 75083-515, Brazil
| | - Carlos Henrique Pereira
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Marília Oliveira Morais
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratory of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Universidade Federal de Goiás 5ª Avenida Esquina com Rua 240, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Elismauro Francisco de Mendonça
- Department of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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Gobbo M, Arany PR, Merigo E, Bensadoun RJ, Santos-Silva AR, Gueiros LA, Ottaviani G. Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2. Support Care Cancer 2023; 31:306. [PMID: 37115315 DOI: 10.1007/s00520-023-07749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To investigate the role of photobiomodulation (PBM) in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as quality of life (QoL), analgesia, functional impairment, and nutritional status, as well as on the impact on survival/ recurrences, radiotherapy (RT) interruption, adherence, cost-effectiveness, safety, feasibility, and tolerability. METHODS An electronic search in PubMed and Scopus databases was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel. RESULTS A total of 22 papers were included. Overall, a beneficial effect of PBM was evidenced in the amelioration of QoL, nutritional status, the reduction of pain, and functional impairment. Preventive PBM may reduce the incidence and duration of RT interruptions, potentially contributing to improved cancer treatment outcomes. PBM treatments are safe and recommended for routine use, with the caveat of avoiding direct tumor exposures where feasible. However, it does not appear to impact cancer survivorship/recurrences directly. Despite additional clinical efforts involving routine PBM use, the individual and public health benefits will positively impact oncology care. CONCLUSIONS Quality of life, pain and functional impairment, nutritional status, and survival may be effectively improved with PBM. Given its established efficacy also in reducing RT interruptions and its safety, feasibility, and tolerability, PBM should be included in the field of supportive cancer care in HNC patients. Improved understanding of PBM mechanisms and precise dose parameters is enabling the generation of more robust, safe, and reproducible protocols; thus, it is imperative to support further clinical implementation as well as both applied and basic science research in this novel field.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Treviso, Italy
| | - Praveen R Arany
- Oral Biology, Surgery and Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | | | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Luiz Alcino Gueiros
- Department of Clinic and Preventive Dentistry, Federal University of Pernambuco, Pernambuco, Brazil
| | - Giulia Ottaviani
- Department of Surgical, Medical and Health Sciences, University of Trieste, Trieste, Italy.
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Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:626-641. [PMID: 36870898 DOI: 10.1016/j.oooo.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our objective was to review the first 20 years of photobiomodulation (PBM) clinical studies for oral mucositis (OM) mitigation. STUDY DESIGN A scoping review screened controlled clinical studies. The PBM devices, protocols, and clinical outcomes were analyzed. RESULTS Seventy-five studies met the inclusion criteria. The first study dated from 1992, and the term "PBM" was first published in 2017. Public services, placebo-controlled randomized trials, and patients with head and neck chemoradiation were predominant among included studies. Prophylactic red intraoral laser protocols were mostly used. Comparing the outcomes of all protocols was unfeasible due to missing treatment parameters and nonhomogeneous measurements. CONCLUSIONS The main barrier to optimizing clinical protocols of PBM for OM was the lack of standardization in clinical studies. Although PBM use is now globally present in oncology settings and generally marked by good outcomes reported, additional randomized clinical trials with well-described methods are necessary.
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Taylor JK, Mady LJ, Baddour K, Iheagwara UK, Zhai S, Ohr JP, Zandberg DP, Gorantla VC, Ferris RL, Kim S, Duvvuri U, Kubik MW, Sridharan S, Johnson JT, Holeva KD, Quinn AE, Clump DA. A phase Ⅱ prospective trial of photobiomodulation therapy in limiting oral mucositis in the treatment of locally advanced head and neck cancer patients. World J Otorhinolaryngol Head Neck Surg 2022; 8:345-354. [PMID: 36474663 PMCID: PMC9714046 DOI: 10.1002/wjo2.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 12/31/2021] [Indexed: 04/20/2024] Open
Abstract
Objective This study aimed to compare the historical incidence rate of severe oral mucositis (OM) in head and neck cancer patients undergoing definitive concurrent chemoradiation therapy (CRT) versus a prospective cohort of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) treated with prophylactic photobiomodulation therapy (PBMT). Methods This US-based, institutional, single-arm, phase Ⅱ prospective clinical trial was initiated in 50 patients (age ≥ 18 years, Karnofsky Performance Scale Index > 60, with locally advanced HNSCC (excluding oral cavity) receiving definitive or adjuvant radiation therapy (RT) with concurrent platinum-based chemotherapy (CT). PBMT was delivered three times per week throughout RT utilizing both an intraoral as well extraoral delivery system. Primary outcome measure was incidence of severe OM utilizing both the National Cancer Institute Common Toxicity Criteria, version 4.0 (NCI-CTCAE) Grade ≥3 and the World Health Organization Mucositis Grading Scale (WHO) Grade ≥3 versus historical controls; secondary outcome measures included time to onset of severe OM following therapy initiation. Results At baseline, all patients included in final analysis (N = 47) had OM Grade 0. Average RT and CT dose was (66.3 ± 5.1) Gy and (486.1 ± 106.8) mg/m2, respectively. Severe OM was observed in 11 of 47 patients (23%, confidence interval: 12, 38). OM toxicity grade trended upward during treatment, reaching a maximum at 7 weeks (WHO: 1.8 vs. NCI-CTCAE: 1.7). Subsequently, OM grade returned to baseline 3 months following completion of RT. The mean time to onset of severe OM was (35 ± 12) days. The mean time to resolution of severe OM was (37 ± 37) days. Conclusions Compared to historical outcomes, PBMT aides in decreasing severe OM in patients with locally advanced HNSCC. PBMT represents a minimally invasive, prophylactic intervention to decrease OM as a major treatment-related side effect.
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Affiliation(s)
| | - Leila J. Mady
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Khalil Baddour
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
| | | | - Shuyan Zhai
- BiostatisticsUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - James P. Ohr
- Department of Medicine, Division of Hematology/OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Daniel P. Zandberg
- Department of Medicine, Division of Hematology/OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Vikram C. Gorantla
- Department of Medicine, Division of Hematology/OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Robert L. Ferris
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
- UPMC Department of Radiation OncologyUPMCPittsburghPennsylvaniaUSA
- BiostatisticsUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Department of ImmunologyUPMCPittsburghPennsylvaniaUSA
| | - Seungwon Kim
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
| | - Mark W. Kubik
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
- Department of Plastic and Reconstructive SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Shaum Sridharan
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
- Department of Plastic and Reconstructive SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Jonas T. Johnson
- Department of Otolaryngology—Head and Neck SurgeryUPMCPittsburghPennsylvaniaUSA
| | - Karen D. Holeva
- UPMC Department of Radiation OncologyUPMCPittsburghPennsylvaniaUSA
| | - Annette E. Quinn
- UPMC Department of Radiation OncologyUPMCPittsburghPennsylvaniaUSA
| | - David A. Clump
- UPMC Department of Radiation OncologyUPMCPittsburghPennsylvaniaUSA
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Gobbo M, Merigo E, Arany PR, Bensadoun RJ, Santos-Silva AR, Gueiros LA, Ottaviani G. Quality Assessment of PBM Protocols for Oral Complications in Head and Neck Cancer Patients: Part 1. FRONTIERS IN ORAL HEALTH 2022; 3:945718. [PMID: 35874125 PMCID: PMC9300948 DOI: 10.3389/froh.2022.945718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Radiotherapy and chemotherapy are frequently employed in head and neck cancer (HNC) patients causing significant side effects that impair life quality and prognosis. Photobiomodulation (PBM) has become a growing approach to managing such oral complications. Despite its proven efficacy and absence of contraindications, there is still a lack of universally accepted disease-specific PBM protocols. Objective A narrative review was conducted to identify the current proposals relating to the use of PBM to treat complications of oncological treatments in HNC patients. Methods An electronic search in PubMed and Scopus databases was performed with the following keywords: (“photobiomodulation” OR “PBM” OR “laser therapy” OR “LLLT” OR “laser”) AND (“head and neck cancer” OR “oral cancer”) AND (“mucositis” OR “oral mucositis” OR “dysgeusia” OR “oedema” OR “xerostomia” OR “dermatitis” OR “trismus”) until October 2021. Results A total of 35 papers were included in the narrative review. Oral mucositis was the most studied complication, and advisable protocols are conceivable. Although there is a growing interest in PBM to manage of xerostomia, radiodermatitis, pain, and trismus, literature is still scarce to propose a universally feasible protocol. Conclusions PBM therapy could significantly prevent or reduce the severity of many side effects related to cancer therapies. More research is needed to obtain recommendations over the preferable parameters.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Treviso, Italy
| | | | - Praveen R. Arany
- Oral Biology, Surgery and Biomedical Engineering, University at Buffalo, Getzville, NY, United States
| | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Luiz Alcino Gueiros
- Department of Clinic and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil
| | - Giulia Ottaviani
- Department of Surgical, Medical and Health Sciences, University of Trieste, Trieste, Italy
- *Correspondence: Giulia Ottaviani
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11
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Fiani B, Jarrah R, Nathani KR. Laser oromaxillofacial photobiomodulation therapy: molecular mechanisms, outcomes and considerations. Regen Med 2022; 17:611-615. [PMID: 35730260 DOI: 10.2217/rme-2022-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Tweetable abstract Photobiomodulation therapy is largely characterized as a safe therapeutic model that can modulate the activity of inflammatory and immune biomarkers while facilitating a metabolic response that can regenerate damaged tissue.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Cornell Medical Center/New York Presbyterian, New York, NY 10065, USA
| | - Ryan Jarrah
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55905, USA
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12
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Arantes DAC, da Silva ACG, Freitas NMA, Lima EM, de Oliveira AC, Marreto RN, Mendonça EF, Valadares MC. Safety and efficacy of a mucoadhesive phytomedication containing curcuminoids and Bidens pilosa L. extract in the prevention and treatment of radiochemotherapy-induced oral mucositis: Triple-blind, randomized, placebo-controlled, clinical trial. Head Neck 2021; 43:3922-3934. [PMID: 34655135 DOI: 10.1002/hed.26892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/22/2021] [Accepted: 09/21/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Oral mucositis (OM) is the significant complication of radio/chemotherapy treatment. This study evaluated the safety and efficacy of a mucoadhesive phytomedication containing curcuminoids and Bidens pilosa L. (FITOPROT) in the prevention/treatment of OM. METHODS Sixty-two patients were randomized into the group's intervention and placebo. Adverse effect assessment, OM grading, pain, and saliva collection were carried at the 1st, 15th, 21st, and final of radiotherapy (RT). Inflammatory salivary mediators were measured. RESULTS FITOPROT decreased the severity of OM from the 15th to the final RT, while the placebo showed an increase in the severity (p < 0.05). Intervention group had a lower number of patients with ulcerated OM at the final RT (p < 0.05). Phytomedication prevented increases of IL-8 levels and reduced the salivary nitrite during RT. CONCLUSIONS FITOPROT does not promote adverse effects, it appears to be effective at reducing the severity of OM, and it controls the concentration of pro-inflammatory mediators.
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Affiliation(s)
| | | | | | - Eliana Martins Lima
- Laboratory of Pharmaceutical Technology, Federal University of Goiás, Goiânia, Brazil
| | - Aline Carlos de Oliveira
- Laboratory of Nanosystems and Modified-Release Drugs Devices, Federal University of Goiás, Goiânia, Brazil
| | - Ricardo Neves Marreto
- Laboratory of Nanosystems and Modified-Release Drugs Devices, Federal University of Goiás, Goiânia, Brazil
| | - Elismauro Francisco Mendonça
- Department of Stomatology (Oral Pathology), Federal University of Goiás, Goiânia, Brazil.,Division of Head and Neck, Araújo Jorge Hospital, Goiânia, Brazil
| | - Marize Campos Valadares
- Laboratory of Pharmacology and Cellular Toxicology, Federal University of Goiás, Goiânia, Brazil
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13
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Golež A, Frangež I, Cankar K, Frangež HB, Ovsenik M, Nemeth L. Effects of low-level light therapy on xerostomia related to hyposalivation: a systematic review and meta-analysis of clinical trials. Lasers Med Sci 2021; 37:745-758. [PMID: 34409539 DOI: 10.1007/s10103-021-03392-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/26/2021] [Indexed: 02/06/2023]
Abstract
Hyposalivation is a condition represented by a reduced salivary flow and may include symptoms such as mouth dryness (xerostomia), loss of taste, pain, dysphagia, and dysphonia, all of which greatly affect an individual's quality of life.The aim of the present study was to systematically review the effects of low-level light therapy irradiation (photobiomodulation) on salivary gland function in patients with hyposalivation.The main question of the systematic review was: "Does low-level light irradiation therapy of the salivary glands affect salivary flow rate or indicators of salivary function (ion and protein concentrations) in patients with xerostomia or hyposalivation?" The question was based on the PICO (participant, intervention, control, outcome) principle and followed the PRISMA guidelines. Databases were explored and papers published between the years 1997 and 2020 were reviewed for the following Mesh-term keywords and their corresponding entry terms in different combinations: "Low-level light therapy," "Xerostomia," "Saliva," "Salivary glands," "Salivation."The initial sample consisted of 220 articles. Of those, 47 articles were used for full-text analysis and 18 were used for a systematic review, 14 were used in meta-analysis. According to their individual quality, most articles were classified as high quality of evidence according to the GRADE score. Meta-analysis of the evidence observed increase of unstimulated salivary flow 0.51 SMD compared to placebo (95% CI: 0.16-0.86), I2 = 50%, p = 0.005.The findings of our review revealed evidence of a beneficial effect of photobiomodulation therapy on salivary gland function. The therapy alleviates xerostomia and hyposalivation. However, these effects are reported short term only and did not induce lasting effects of photobiomodulation therapy on patients' quality of life.
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Affiliation(s)
- Aljaž Golež
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Zaloska cesta 4, Ljubljana, Slovenia
| | - Igor Frangež
- Department for Surgical Infections, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.,Department of Surgery, Faculty of Medicine, University of Ljubljana, Zaloska cesta 7, Ljubljana, Slovenia
| | - Ksenija Cankar
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Zaloska cesta 4, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Slajmerjeva 3, 1000, Ljubljana, Slovenia.,Department of Obstetrics and Gynaecology, University Medical Center Ljubljana, Slajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Maja Ovsenik
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, Ljubljana, Slovenia
| | - Lidija Nemeth
- Department of Dental Diseases and Normal Dental Morphology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, Ljubljana, Slovenia.,Division of Stomatology, University Medical Centre Ljubljana, Stomatoloska klinika, Hrvatski trg 6, 1000, Ljubljana, Slovenia
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14
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Wang YT, Ren Y, Xiao C, Liu H, Fu X, You FM. Hangeshashinto for preventing oral mucositis in patients receiving cancer treatment: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e047627. [PMID: 34059515 PMCID: PMC8169471 DOI: 10.1136/bmjopen-2020-047627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hangeshashinto has been employed for oral mucositis prevention in patients receiving cancer treatment, but the evidence has not been sufficiently robust to guide clinical decision-making. This study will therefore be undertaken to assess the effectiveness of Hangeshashinto for preventing oral mucositis in patients with cancer who are receiving treatment. METHODS AND ANALYSIS The databases will include PubMed, Embase, the Cochrane Library, Chinese databases and Japanese databases. The literature will be searched from the databases' inception until May 2021. Other sources, such as potential grey literature, reference lists from included studies and relevant systematic reviews and conference papers, will also be searched. The primary outcome is the incidence of mucositis of any severity, and the secondary outcomes are interruptions to cancer treatment, oral pain and nutritional status. The risk of bias of eligible studies will be assessed using the Cochrane Collaboration's 'risk of bias' tool. Both the Q test and I2 statistic will be performed to assess statistical heterogeneity. If I2 >50%, sensitivity and subgroup analysis will be conducted. The quality of evidence will be rated according to the Grading of Recommendations, Assessment, Development and Evaluation approach. Egger's test will be used to assess reporting bias. ETHICS AND DISSEMINATION This systematic review will evaluate only published data; therefore, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42020216145.
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Affiliation(s)
- Yu-Ting Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yifeng Ren
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Chong Xiao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Hong Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Xi Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Feng-Ming You
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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15
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Louzeiro GC, Teixeira DDS, Cherubini K, de Figueiredo MAZ, Salum FG. Does laser photobiomodulation prevent hyposalivation in patients undergoing head and neck radiotherapy? A systematic review and meta-analysis of controlled trials. Crit Rev Oncol Hematol 2020; 156:103115. [PMID: 33039721 DOI: 10.1016/j.critrevonc.2020.103115] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/07/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Head and neck radiotherapy can cause hypofunction of the salivary glands. Many studies report that laser photobiomodulation (PBM) is able to minimize radiation-induced hyposalivation, yet there is no consensus about its effects. OBJECTIVE To carry out a meta-analysis of controlled clinical trials that used PBM to prevent radiation-induced hyposalivation. METHODS A systematic search was performed through Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, LILACS and Web of Science databases. The strategy included comparisons of the effect of PBM with placebo/clinical follow-up on unstimulated and/or stimulated salivary flow in patients undergoing head and neck radiotherapy. RESULTS Six clinical trials were included, five of which were used for meta-analysis. Evidence was observed between the use of PBM and increased unstimulated salivary flow (MD 0.20 mL/min, 95 % Cl 0.10-0.30, I² = 96 %, p < 0.00001) and in stimulated salivary flow (MD 0.27 mL/min, 95 % CI 0.08-0.46, I² = 95 %, p < 0.00001). CONCLUSION PBM appears to minimize radiation-induced hyposalivation.
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Affiliation(s)
- Gabriel Campos Louzeiro
- School of Health and Life Sciences, Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Dieni da Silveira Teixeira
- School of Health and Life Sciences, Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Karen Cherubini
- School of Health and Life Sciences, Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Antonia Zancanaro de Figueiredo
- School of Health and Life Sciences, Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Gonçalves Salum
- School of Health and Life Sciences, Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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16
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Martins AFL, Morais MO, de Sousa-Neto SS, de Jesus APG, Nogueira TE, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. Photobiomodulation reduces the impact of radiotherapy on oral health-related quality of life due to mucositis-related symptoms in head and neck cancer patients. Lasers Med Sci 2020; 36:903-912. [PMID: 33113075 DOI: 10.1007/s10103-020-03167-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
To assess the effectiveness of photobiomodulation therapy (PBMT) in the oral health-related quality of life (OHRQoL) of patients with head and neck cancer undergoing radiotherapy (RT), using the Oral Health Impact Profile-14 (OHIP-14) and the Patient-Reported Oral Mucositis (OM) Symptoms Scale (PROMS), and to correlate OM degree with the PROMS and OHIP-14 scores. Forty-eight patients undergoing RT for head and neck cancer were randomly assigned into two groups: PBMT group (n = 25)-daily PBMT associated with a preventive oral care program (POCP); and control group (n = 23)-receiving POCP exclusively. OHRQoL was assessed using the PROMS and OHIP-14 questionnaires. OM degrees were classified according to the World Health Organization and the National Cancer Institute scales. Assessments were performed at the 1st, 7th, 14th, 21st, and 30th RT sessions. PBMT was effective in preventing and treating severe OM. Both groups showed increased OHRQoL impacts throughout the RT sessions; however, higher impacts were observed in the control group, mainly at the final stage of treatment (21st and 30th RT sessions). Significant correlations were found between the severity of OM and PROMS scores in the total sample and the control group at all RT periods. PROMS and OM scores were positive correlated at 14th, 21st, and 30th RT sessions in the control group, suggesting that this instrument is useful in classifying OM. PBMT was effective in treating and preventing severe OM and OM-related symptoms, and with consequent positive impacts in OHRQoL in head and neck patients undergoing RT. The PROMS scale was helpful instrument for assessment of the severity of OM. Brazilian Clinical Trials database (ReBEC - RBR-5h4y4n), registered in Aug, 24th 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Marília Oliveira Morais
- Hospital de Câncer Araújo Jorge, R. 239, 206 - Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Ana Paula Gonçalves de Jesus
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Tulio Eduardo Nogueira
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratório de Farmacologia e Toxicologia Celuular, Faculdade de Farmácia, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n, Setor Universitário, Goiânia, Goiás, 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Departamento de Radioterapia, Hospital de Câncer Araújo Jorge, R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Aline Carvalho Batista
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio Rodrigues Leles
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.
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17
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Martins AFL, Morais MO, Sousa-Neto SS, Oton-Leite AF, Pereira CH, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. The Effect of Photobiomodulation on Nitrite and Inflammatory Activity in Radiotherapy-Induced Oral Mucositis: A Randomized Clinical Trial. Lasers Surg Med 2020; 53:671-683. [PMID: 32997817 DOI: 10.1002/lsm.23328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/29/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate pro- and anti-inflammatory cytokines and nitrite salivary levels in patients with head and neck cancer receiving photobiomodulation therapy (PBMT) associated with a Preventive Oral Care Program (POCP), for prevention and control of oral mucositis (OM) during radiotherapy (RT) associated or not with chemotherapy protocol. STUDY DESIGN/MATERIALS AND METHODS In this randomized double-blinded clinical trial, 48 patients were randomly assigned to two groups: PBMT (n = 25) and Control (n = 23). In the PBMT group, patients were submitted to PBMT associated with the POCP. In the Control group, patients were submitted only to the POCP. Saliva samples were collected in the 1st (baseline), 7th, 14th, 21st, and 30th sessions of RT, and the levels of interleukin-6 (IL-6), IL-8, IL-10, IL-12p70, IL-1β, and tumoral necrosis factor-α (TNF-α) were measured using the cytometric bead array. Nitrite levels were measured by colorimetric method. OM was assessed using the World Health Organization and the National Cancer Institute scales. RESULTS Patients in the PBMT group presented less severe OM. PBMT tended to stabilize nitrite concentration levels during the RT regimen. The IL-1β concentration was associated with higher OM scores. PBMT promoted an increase in IL-12p70, TNF-α, and IL-10 concentration. CONCLUSION PBMT was effective in the prevention and control of severe OM, and its mechanism of action may be related to a better balance of inflammatory response that may favor injury control. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Allisson F L Martins
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Marília O Morais
- Setor de Odontologia do Hospital de Câncer Araújo Jorge. R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião S Sousa-Neto
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Angélica F Oton-Leite
- Setor de Odontologia do Hospital de Câncer Araújo Jorge. R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Carlos H Pereira
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Marize C Valadares
- Laboratório de Farmacologia e Toxicologia Celular da, Faculdade de Farmácia da, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n. Setor Universitário, Goiânia, Goiás, 74605-170, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Nilceana M A Freitas
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Aline C Batista
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Prevenção e Reabilitação Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio R Leles
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Elismauro F Mendonça
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
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18
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Cronshaw M, Parker S, Anagnostaki E, Mylona V, Lynch E, Grootveld M. Photobiomodulation and Oral Mucositis: A Systematic Review. Dent J (Basel) 2020; 8:dj8030087. [PMID: 32764305 PMCID: PMC7559189 DOI: 10.3390/dj8030087] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
Oral mucositis (OM) is a debilitating complication of chemotherapy, and head and neck radiotherapy. In an effort to offer the best possible advice within the limitations of published research, a systematic review with an extended discussion and commentary on dosimetry and dose delivery is presented. Using keywords as listed, Pubmed, Google Scholar and Cochrane databases were searched during a period extending from 1995 to 2019. A total of 782 abstracts were identified. A total of 50 papers were analysed, and of these, 29 satisfied criteria required for systematic review in accordance with an optimized PRISMA statement. Clinical outcome as reported was subject to analysis with respect to time of intervention, incidence and severity of oral mucositis, and pain amelioration, and a comprehensive combined univariate and multivariate statistical analysis of the methods employed was performed. Recommendations are made with respect to the timing of the intervention. Moreover, there is an extended discussion available on the treatment care rationale of photobiomodulation (PBM), and its adjunctive association with OM. In conclusion, early prophylactic application offers clear advantages in clinical management. The many studies and associated variables and covariables assessed here revealed a choice of delivery techniques, associated wavelengths and many further indices to consider with regard to the accomplishment of optical parameters. It is therefore our recommendation that clinicians use PBM as a therapy with a full and proper understanding and training in order to optimise the clinical effects achievable.
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Affiliation(s)
- Mark Cronshaw
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.A.); (V.M.); (E.L.); (M.G.)
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham B5 7EG, UK
- Correspondence:
| | - Steven Parker
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.A.); (V.M.); (E.L.); (M.G.)
| | - Eugenia Anagnostaki
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.A.); (V.M.); (E.L.); (M.G.)
| | - Valina Mylona
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.A.); (V.M.); (E.L.); (M.G.)
| | - Edward Lynch
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.A.); (V.M.); (E.L.); (M.G.)
- School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA
| | - Martin Grootveld
- Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (S.P.); (E.A.); (V.M.); (E.L.); (M.G.)
- School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA
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Effect of photobiomodulation on salivary flow and composition, xerostomia and quality of life of patients during head and neck radiotherapy in short term follow-up: A randomized controlled clinical trial. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 209:111933. [DOI: 10.1016/j.jphotobiol.2020.111933] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022]
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Hanna R, Dalvi S, Benedicenti S, Amaroli A, Sălăgean T, Pop ID, Todea D, Bordea IR. Photobiomodulation Therapy in Oral Mucositis and Potentially Malignant Oral Lesions: A Therapy Towards the Future. Cancers (Basel) 2020; 12:cancers12071949. [PMID: 32708390 PMCID: PMC7409159 DOI: 10.3390/cancers12071949] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
Photobiomodulation therapy (PBMT) is an effective treatment modality, which has the significant advantage of enhancing a patient’s quality of life (QoL) by minimising the side effects of oral cancer treatments, as well as assisting in the management of potentially cancerous lesions. It is important to note that the major evidence-based documentation neither considers, nor tackles, the issues related to the impact of PBMT on tumour progression and on the downregulation of cellular proliferation improvement, by identifying the dose- and time-dependency. Moreover, little is known about the risk of this therapy and its safety when it is applied to the tumour, or the impact on the factor of QoL. The review aimed to address the benefits and limitations of PBMT in premalignant oral lesions, as well as the conflicting evidence concerning the relationship between tumour cell proliferation and the applied dose of photonic energy (fluence) in treating oral mucositis induced by head and neck cancer (H&N) treatments. The objective was to appraise the current concept of PBMT safety in the long-term, along with its latent impact on tumour reaction. This review highlighted the gap in the literature and broaden the knowledge of the current clinical evidence-based practice, and effectiveness, of PBMT in H&N oncology patients. As a result, the authors concluded that PBMT is a promising treatment modality. However, due to the heterogeneity of our data, it needs to undergo further testing in well-designed, long-term and randomised controlled trial studies, to evaluate it with diligent and impartial outcomes, and ensure laser irradiation’s safety at the tumour site.
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Affiliation(s)
- Reem Hanna
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy; (S.D.); (S.B.)
- Department of Oral Surgery, Dental Institute, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Correspondence: ; Tel.: +93-010-353-7446
| | - Snehal Dalvi
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy; (S.D.); (S.B.)
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur 441110, India
| | - Stefano Benedicenti
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy; (S.D.); (S.B.)
| | - Andrea Amaroli
- Department of Orthopaedic Dentistry, First Moscow State Medical University (Sechenov University), Trubetzkaya Street, 8, Bldg. 2, 119146 Moscow, Russia;
| | - Tudor Sălăgean
- Department of Land Measurements and Exact Sciences, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania; (T.S.); (I.D.P.)
| | - Ioana Delia Pop
- Department of Land Measurements and Exact Sciences, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400372 Cluj-Napoca, Romania; (T.S.); (I.D.P.)
| | - Doina Todea
- Department of Pulmonology, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400332 Cluj-Napoca, Romania;
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
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Cost-effectiveness randomized clinical trial on the effect of photobiomodulation therapy for prevention of radiotherapy-induced severe oral mucositis in a Brazilian cancer hospital setting. Support Care Cancer 2020; 29:1245-1256. [PMID: 32621262 DOI: 10.1007/s00520-020-05607-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of photobiomodulation therapy (PBMT) in association with a Preventive Oral Care Program (POCP) compared with POCP alone in the treatment of radiotherapy (RT)-induced oral mucositis (OM). METHODS The cost-effectiveness was evaluated from the health provider perspective and conducted alongside a randomized, double-blind clinical trial. Participants were randomly assigned to either PBMT (n = 25) or control (n = 23) group. The PBMT group participants received PBMT associated with POCP. In the control group, patients were submitted to POCP alone. Costs were identified, quantified, and valued through observation and consultation of the hospital's financial sector database and estimated in Brazilian real and converted to international dollars using the purchasing power parity exchange rate. The incremental cost-effectiveness ratio (ICER) was estimated by considering the prevention of severe OM, interruption of RT, and oral health-related quality of life (OHRQoL) scores, measured by the OHIP-14 and patient-reported OM symptoms scale (PROMS). RESULTS The incremental cost of PBMT was $857.35, and the cost per session was $25.69. The ICER was $ 2867.39 to avoid one case of severe OM and $ 2756.75 to prevent one interruption in RT due to OM. ICER to reduce 1 point in OHIP-14 and PROMS scores were $170.79 and $31.75, respectively. CONCLUSION PBMT is more cost-effective than POCP alone in preventing severe OM, worsening of the OHRQoL, and RT interruptions. PBMT is a promising therapy, especially to avoid interruptions in oncological treatment. TRIAL REGISTRATION ReBEC-RBR-5h4y4n.
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Peng J, Shi Y, Wang J, Wang F, Dan H, Xu H, Zeng X. Low-level laser therapy in the prevention and treatment of oral mucositis: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:387-397.e9. [PMID: 32624448 DOI: 10.1016/j.oooo.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether prophylactic and therapeutic low-level laser therapy (LLLT), compared with placebo or no therapy, reduced the risk of severe oral mucositis (OM) in patients receiving chemotherapy or radiotherapy. STUDY DESIGN We searched for articles published on randomized controlled trials (RCTs) in the databases MEDLINE, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials, Web of Science, and Clinical Trials, until December 2018. RCTs were filtered on the basis of eligibility criteria, and data were analyzed by using R software 3.5.2. RESULTS Overall, 30 studies were included in the meta-analysis. Prophylactic LLLT reduced the overall risk of severe OM (relative risk [RR] = 0.40; 95% confidence interval [CI]: 0.28-0.57; P < .01). Therapeutic LLLT substantially reduced the duration of severe OM (P < .01). LLLT also reduced the overall mean grade of OM, overall incidence of severe pain, mean score of pain, and incidence of severe OM, at the most anticipated time. CONCLUSIONS Prophylactic and therapeutic LLLT can reduce the risk of severe OM in patients receiving chemotherapy or radiotherapy.
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Affiliation(s)
- Jiakuan Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yujie Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fei Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Oba MK, Innocentini LMAR, Viani G, Ricz HMA, de Carvalho Reis T, Ferrari TC, de Macedo LD. Evaluation of the correlation between side effects to oral mucosa, salivary glands, and general health status with quality of life during intensity-modulated radiotherapy for head and neck cancer. Support Care Cancer 2020; 29:127-134. [PMID: 32318870 DOI: 10.1007/s00520-020-05454-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/01/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the distribution of acute clinical complications that involve the oral cavity (oral mucositis and salivary flow), general health status (Karnofsky performance status scale (KPS) and weight), and quality of life using the worst performance throughout radiotherapy treatment by intensity-modulated radiation therapy (IMRT) in the head and neck region and to evaluate the correlation between these variables. METHODS This prospective, longitudinal study evaluated 32 patients who were undergoing IMRT for head and neck tumors. The measures were collected weekly through standardized protocols and a quality of life questionnaire (UW-QOL version 4). RESULTS The worst performance for all variables was concentrated in treatment weeks 2 and 5. Regarding quality of life, the emotional dimensions were the most affected (pain 62.86; activity 55; recreation 43.57; mood 49.97; shoulder 57.06; anxiety 42.91). There were a higher number of moderate mucositis correlations with quality of life (mucositis × KPS 0.002; mucositis × weight loss 0.03; mucositis × pain 0.001; mucositis × activity 0.002; mucositis × recreation 0.001; mucositis × swallowing 0.002; mucositis × saliva 0.006; mucositis × mood 0.007; mucositis × anxiety 0.002). CONCLUSIONS IMRT treatment severely deteriorated the patients' quality of life. There were important correlations between the clinical variables and quality of life, especially mucositis.
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Affiliation(s)
- Marina Kimie Oba
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Clinical Hospital of Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Lara Maria Alencar Ramos Innocentini
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Clinical Hospital of Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Gustavo Viani
- Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Hilton Marcos Alves Ricz
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Clinical Hospital of Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Thiago de Carvalho Reis
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Clinical Hospital of Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Tatiane Cristina Ferrari
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Clinical Hospital of Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Leandro Dorigan de Macedo
- Dentistry and Stomatology Division, Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Clinical Hospital of Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil. .,Fundação Hemocentro de Ribeirão Preto, Rua Tenente Catão Roxo, 2501, Ribeirão Preto, SP, CEP: 14051-140, Brazil.
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Morais MO, Martins AFL, de Jesus APG, de Sousa Neto SS, da Costa AWF, Pereira CH, Oton-Leite AF, de Freitas NMA, Leles CR, Mendonça EF. A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol. Support Care Cancer 2020; 28:4263-4273. [DOI: 10.1007/s00520-019-05283-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 12/23/2019] [Indexed: 01/05/2023]
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Akiyama N, Yamamoto-Fukuda T, Yoshikawa M, Kojima H. Regulation of DNA methylation levels in the process of oral mucosal regeneration in a rat oral ulcer model. Histol Histopathol 2019; 35:247-256. [PMID: 31286466 DOI: 10.14670/hh-18-147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DNA methylation is an important epigenetic mechanism for cellular maintenance. However, the methylation pattern and the key molecule regulated epigenetically in oral mucosal regeneration is unclear. In this study, we generated a rat oral ulcer model and investigated the cell proliferative activities and DNA methylation patterns immunohistochemically. We also performed immunohistochemical analysis of a regulator of epithelial stem/progenitor cell differentiation in the rat model. We demonstrated immunohistochemistry using antibodies for the molecules as follows: Ki-67, a marker of cellular proliferation; 5-methylcytosine (5-mC), a marker of DNA methylation; 5-hydroxymethylcytosine (5-hmC), a marker of DNA demethylation; Dnmt1, a maintenance DNA methyltransferase; Dnmt3a and Dnmt3b, de novo DNA methyltransferases; and Wnt5a, a regulator of stem/progenitor cell differentiation. In this model, re-epithelialization was completed at Day 4 after ulceration. Regenerating mucosal hypertrophy reached a peak at Day 5 and appeared normal at Day 14. Ki-67-positive cells increased at Day 2 and returned to normal at Day 6 after ulceration. The ratio of the expression level of 5-mC to 5-hmC declined at Day 5 and returned to normal at Day 6. The expression level of Dnmt1 had not changed compared to the normal control at every time point. On the other hand, the expression levels of Dnmt3a and Dnmt3b had decreased significantly at Day 5 and returned to normal at Day 6. Moreover, Wnt5a-positive cells increased at Day 5. In conclusion, oral mucosal regeneration was strictly regulated by DNA methylation. Moreover, Wnt5a might play a critical role in oral mucosal regeneration.
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Affiliation(s)
- Naotaro Akiyama
- Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan. .,Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomomi Yamamoto-Fukuda
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Mamoru Yoshikawa
- Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Zadik Y, Arany PR, Fregnani ER, Bossi P, Antunes HS, Bensadoun RJ, Gueiros LA, Majorana A, Nair RG, Ranna V, Tissing WJE, Vaddi A, Lubart R, Migliorati CA, Lalla RV, Cheng KKF, Elad S. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 2019; 27:3969-3983. [DOI: 10.1007/s00520-019-04890-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023]
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27
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Peralta-Mamani M, da Silva BM, da Silva Pinto AC, Rubira-Bullen IRF, Honório HM, Rubira CMF, da Silva Santos PS. Low-level laser therapy dosimetry most used for oral mucositis due to radiotherapy for head and neck cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol 2019; 138:14-23. [DOI: 10.1016/j.critrevonc.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/04/2018] [Accepted: 03/20/2019] [Indexed: 12/18/2022] Open
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Martins AFL, Nogueira TE, Morais MO, Oton-Leite AF, Valadares MC, Batista AC, Freitas NMA, Leles CR, Mendonça EF. Effect of photobiomodulation on the severity of oral mucositis and molecular changes in head and neck cancer patients undergoing radiotherapy: a study protocol for a cost-effectiveness randomized clinical trial. Trials 2019; 20:97. [PMID: 30709370 PMCID: PMC6359861 DOI: 10.1186/s13063-019-3196-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/14/2019] [Indexed: 01/28/2023] Open
Abstract
Background Oral mucositis (OM) is the most frequent and debilitating acute side effect associated with head and neck cancer (HNC) treatment. When present, severe OM negatively impacts the quality of life of patients undergoing HNC treatment. Photobiomodulation is a well-consolidated and effective therapy for the treatment and prevention of severe OM, and is associated with a cost reduction of the cancer treatment. Although an increase in the quality of life and a reduction in the severity of OM are well described, there is no study on cost-effectiveness for this approach considering the quality of life as a primary outcome. In addition, little is known about the photobiomodulation effects on salivary inflammatory mediators. Thus, this study aimed to assess the cost-effectiveness of the photobiomodulation therapy for the prevention and control of severe OM and its influence on the salivary inflammatory mediators. Methods/design This randomized, double-blind clinical trial will include 50 HNC patients undergoing radiotherapy or chemoradiotherapy. The participants will be randomized into two groups: intervention group (photobiomodulation) and control group (preventive oral care protocol). OM (clinical assessment), saliva (assessment of collected samples) and quality of life (Oral Health Impact Profile-14 and Patient-Reported Oral Mucositis Symptoms questionnaires) will be assessed at the 1st, 7th, 14th, 21st and 30th radiotherapy sessions. Oxidative stress and inflammatory cytokine levels will be measured in the saliva samples of all participants. The costs are identified, measured and evaluated considering the radiotherapy time interval. The incremental cost-effectiveness ratio will be estimated. The study will be conducted according to the Brazilian public health system perspective. Discussion Photobiomodulation is an effective therapy that reduces the cost associated with OM treatment. However, little is known about its cost-effectiveness, mainly when quality of life is the effectiveness measure. Additionally, this therapy is not supported by the Brazilian public health system. Therefore, this study widens the knowledge about the safety of and strengthens evidence for the use of photobiomodulation therapy, providing information for public policy-makers and also for dental care professionals. This study is strongly encouraged due to its clinical relevance and the possibility of incorporating new technology into public health systems. Trial registration Brazilian Registry of Clinical Trials—ReBEC, RBR-5h4y4n. Registered on 13 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3196-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Túlio Eduardo Nogueira
- Department of Prevention and Oral Rehabilitation, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marília Oliveira Morais
- Department of Stomatology, Araujo Jorge Cancer Hospital , R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Angélica Ferreira Oton-Leite
- Department of Stomatology, Araujo Jorge Cancer Hospital , R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Marize Campos Valadares
- Department of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Federal University of Goiás, 5ª Avenida Esquina com Rua 240, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-170, Brazil
| | - Aline Carvalho Batista
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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Structured review of the patient-reported outcome instruments used in clinical trials in head and neck surgery. Br J Oral Maxillofac Surg 2018; 56:161-167. [PMID: 29395443 DOI: 10.1016/j.bjoms.2017.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022]
Abstract
The number of clinical trials that relate to patients with cancer of the head and neck is growing. Patient-reported outcomes, which are rarely the primary outcome, are now an important component, and in this structured review to identify and report the characteristics of the questionnaires that have been used in these trials, we summarise the findings reported. We searched several online databases using the key terms: head and neck oncology, head and neck surgery, reconstruction, clinical trials patient-reported outcomes, questionnaires, quality of life (QoL), validated instruments, and patients' satisfaction. We screened 1342 papers to collect information about the topic of the paper, sample size, selection criteria, main advantages and disadvantages of the patient-reported outcome used, and if it was used in conjunction with another measure. A total of 54 were eligible, and from them we identified 22 questionnaires. The primary reason for using a questionnaire was its relevance to the focus of the paper, such as xerostomia, pain, or swallowing. To allow the experience of patients to be the focus of the primary outcome in a clinical trial, we recommend that the measures used should be appropriate, reliable, valid, responsive, precise, interpretable, acceptable, and feasible. The trials used validated questionnaires, but the patient-reported outcome measures tended not to be the focus. There is merit in such measures being the primary outcomes in future trials and these should be designed around an explicit hypothesis.
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Low-level laser therapy for xerostomia in primary Sjögren’s syndrome: a randomized trial. Clin Rheumatol 2017; 37:729-736. [DOI: 10.1007/s10067-017-3898-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/19/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Gonnelli FAS, Palma LF, Giordani AJ, Deboni ALS, Dias RS, Segreto RA, Segreto HRC. Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer. Radiol Bras 2016; 49:86-91. [PMID: 27141130 PMCID: PMC4851476 DOI: 10.1590/0100-3984.2014.0144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether low-level laser therapy can prevent salivary
hypofunction after radiotherapy and chemotherapy in head and neck cancer
patients. Materials and Methods We evaluated 23 head and neck cancer patients, of whom 13 received laser
therapy and 10 received clinical care only. An InGaAlP laser was used
intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2
and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7
J/cm2, three times per week, on alternate days. Stimulated
and unstimulated sialometry tests were performed before the first
radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of
treatment (N30). Results At N30, the mean salivary flow rates were significantly higher among the
laser therapy patients than among the patients who received clinical care
only, in the stimulated and unstimulated sialometry tests
(p = 0.0131 and p = 0.0143,
respectively). Conclusion Low-level laser therapy, administered concomitantly with radiotherapy and
chemotherapy, appears to mitigate treatment-induced salivary hypofunction in
patients with head and neck cancer.
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Affiliation(s)
| | - Luiz Felipe Palma
- Masters Student in Clinical Radiology, Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Adelmo José Giordani
- PhD, Physicist in Charge of the Medical Physics Sector, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Rodrigo Souza Dias
- PhD, Interim Head of the Radiotherapy Sector, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Roberto Araújo Segreto
- Tenured Associate Professor in the Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Helena Regina Comodo Segreto
- PhD, Associate Professor in the Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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The effect of preventive oral care on treatment outcomes of a cohort of oral cancer patients. Support Care Cancer 2015; 24:1663-70. [DOI: 10.1007/s00520-015-2956-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/14/2015] [Indexed: 11/27/2022]
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Abstract
Head and neck cancer is becoming more common, and survival rates are improving. Human papillomavirus-associated oropharyngeal cancer, in particular, is increasing in incidence and is associated with an excellent prognosis. However, toxicity from disease and treatment leads to long-term impairment, disability, and handicap. Currently, more than 60% of survivors have unmet needs. As the numbers of survivors increase, current models of care will be increasingly inadequate to meet their needs. Exploration of new strategies and models of care to better address quality-of-life issues and meet the needs of survivors of head and neck cancer is urgently required.
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Affiliation(s)
- Jolie Ringash
- Jolie Ringash, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Silva LC, Sacono NT, Freire MDCM, Costa LR, Batista AC, Silva GBL. The Impact of Low-Level Laser Therapy on Oral Mucositis and Quality of Life in Patients Undergoing Hematopoietic Stem Cell Transplantation Using the Oral Health Impact Profile and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Questionnaires. Photomed Laser Surg 2015; 33:357-63. [DOI: 10.1089/pho.2015.3911] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Nancy Tomoko Sacono
- Department of Stomatology, Faculty of Dentistry, Federal University of Goiás, Goiás, Brazil
| | | | - Luciane Rezende Costa
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Goiás, Goiás, Brazil
| | - Aline Carvalho Batista
- Department of Stomatology, Faculty of Dentistry, Federal University of Goiás, Goiás, Brazil
| | - Geisa Badauy Lauria Silva
- Hematopoietic Stem Cell Transplant Unit, Araújo Jorge Hospital, Associação de Combate ao Câncer de Goiás, Goiânia, Goiás, Brazil
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Doeuk C, Hersant B, Bosc R, Lange F, SidAhmed-Mezi M, Bouhassira J, Meningaud J. Current indications for low level laser treatment in maxillofacial surgery: a review. Br J Oral Maxillofac Surg 2015; 53:309-15. [DOI: 10.1016/j.bjoms.2015.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
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Oton-Leite AF, Silva GBL, Morais MO, Silva TA, Leles CR, Valadares MC, Pinezi JCD, Batista AC, Mendonça EF. Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer patients. Lasers Surg Med 2015; 47:296-305. [DOI: 10.1002/lsm.22349] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Angélica F. Oton-Leite
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Geisa Badauy L. Silva
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Marília O. Morais
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Tarcília A. Silva
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Minas Gerais; Belo Horizonte Minas Gerais 31270-901 Brazil
| | - Cláudio R. Leles
- Department of Prevention and Oral Rehabilitation, Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Marize Campos Valadares
- Laboratory of Cellular Pharmacology and Toxicology; Faculty of Pharmacy; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Juliana Castro D. Pinezi
- Radiotherapy Department of the Araújo Jorge Hospital; Association of Cancer Combat of Goiás; Goiânia Goiás 74605-070 Brazil
| | - Aline C. Batista
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Elismauro F. Mendonça
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
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Ozturan S, Sirali A, Sur H. Effects of Nd:YAG laser irradiation for minimizing edema and pain after sinus lift surgery: randomized controlled clinical trial. Photomed Laser Surg 2015; 33:193-9. [PMID: 25764523 DOI: 10.1089/pho.2014.3823] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser used for low-level laser therapy (LLLT) on pain, oral health-related quality of life (OHRQoL), and swelling after sinus lift procedure. MATERIALS AND METHODS Ten healthy patients, requiring bilateral direct sinus lift surgery, were included in this prospective, randomized study. The treatment sides were randomly assigned to LLLT or control groups. The experimental side received 8 J/cm(2) of energy density, a wavelength of 1064 nm, for 60 sec, and 0.5 W laser immediately after surgery. Swelling, pain perception, and OHRQoL were evaluated at different time intervals. The data were analyzed by the one way ANOVA. RESULTS Evaluations of postoperative pain, OHRQoL, and swelling were made. We observed that the swelling and the OHRQoL in the Nd:YAG group were significantly improved when compared with the control group on the 3rd day after surgery (p<0.05). The pain levels after surgery was almost the same for both groups, without statistically significant differences (p>0.05). There were no statistically significant differences between groups with regard to any of the parameters evaluated on the 7th day. CONCLUSIONS The results demonstrate that the 1064 nm Nd:YAG laser was effective in improving OHRQoL and reducing swelling after sinus lift surgery. Within the limitations of this study, we concluded that the 1064 nm Nd:YAG laser has beneficial effects on swelling and OHRQoL, making it suitable for LLLT.
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Affiliation(s)
- Seda Ozturan
- 1 Faculty of Dentistry, Department of Periodontology, Biruni University , Istanbul, Turkey
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Oberoi S, Zamperlini–Netto G, Beyene J, Treister NS, Sung L. Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis. PLoS One 2014; 9:e107418. [PMID: 25198431 PMCID: PMC4157876 DOI: 10.1371/journal.pone.0107418] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Objective was to determine whether prophylactic low level laser therapy (LLLT) reduces the risk of severe mucositis as compared to placebo or no therapy. METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched until February 2014 for randomized controlled trials (RCTs) comparing prophylactic LLLT with placebo or no therapy in patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT). All analyses used random effects models. RESULTS Eighteen RCTs (1144 patients) were included. Prophylactic LLLT reduced the overall risk of severe mucositis (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.20 to 0.67; P = 0.001). LLLT also reduced the following outcomes when compared to placebo/no therapy: severe mucositis at the time of anticipated maximal mucositis (RR 0.34, 95% CI 0.20 to 0.59), overall mean grade of mucositis (standardized mean difference -1.49, 95% CI -2.02 to -0.95), duration of severe mucositis (weighted mean difference -5.32, 95% CI -9.45 to -1.19) and incidence of severe pain (RR 0.26, 95% CI 0.18 to 0.37). CONCLUSION Prophylactic LLLT reduced severe mucositis and pain in patients with cancer and HSCT recipients. Future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting.
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Affiliation(s)
- Sapna Oberoi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Joseph Beyene
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Nathaniel S. Treister
- Division of Oral Medicine & Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
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Szafarowski T, Szczepanski MJ. Cancer stem cells in head and neck squamous cell carcinoma. Otolaryngol Pol 2013; 68:105-11. [PMID: 24837904 DOI: 10.1016/j.otpol.2013.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 01/24/2023]
Abstract
Recent studies have demonstrated that cancer stem cells (CSC) play an important role in the pathobiology of head and neck squamous cell carcinomas (HNSCC). This subpopulation of undifferentiated, self-renewing cells is responsible for resistance to conventional anti-cancer therapy, cancer recurrence, metastasis and ability to form a heterogeneous tumor. CSC are identified on the basis of specific markers, including membrane proteins or cell enzymes, or by using their self-renewal properties. As their resistance to standard HNSCC treatment may eventually lead to the lack of treatment success, there is an urgent need to better understanding CSC biology and identify them as potential target new treatment modality.
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Affiliation(s)
- Tomasz Szafarowski
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Head: prof. dr n. med. Antoni Krzeski, Warsaw, Poland
| | - Miroslaw J Szczepanski
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Head: prof. dr n. med. Antoni Krzeski, Warsaw, Poland; Department of Clinical Immunology, University of Medical Sciences in Poznan, Head: prof. dr n. med. Grzegorz Dworacki, Poznan, Poland.
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40
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Cancer stem cell markers in head and neck squamous cell carcinoma. Stem Cells Int 2013; 2013:319489. [PMID: 23533441 PMCID: PMC3603684 DOI: 10.1155/2013/319489] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/23/2013] [Indexed: 12/22/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the world's top ten most common cancers. Current survival rates are poor with only 50% of patients expected to survive five years after diagnosis. The poor survival rate of HNSCC is partly attributable to the tendency for diagnosis at the late stage of the disease. One of the reasons for treatment failure is thought to be related to the presence of a subpopulation of cells within the tumour called cancer stem cells (CSCs). CSCs display stem cell-like characteristics that impart resistance to conventional treatment modalities and promote tumour initiation, progression, and metastasis. Specific markers for this population have been investigated in the hope of developing a deeper understanding of their role in the pathogenesis of HNSCC and elucidating novel therapeutic strategies.
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Effect of low-level laser therapy on patient reported measures of oral mucositis and quality of life in head and neck cancer patients receiving chemoradiotherapy—a randomized controlled trial. Support Care Cancer 2012; 21:1421-8. [DOI: 10.1007/s00520-012-1684-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
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42
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Oton-Leite AF, Elias LSA, Morais MO, Pinezi JCD, Leles CR, Silva MAGS, Mendonça EF. Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy. SPECIAL CARE IN DENTISTRY 2012; 33:294-300. [DOI: 10.1111/j.1754-4505.2012.00303.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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43
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Sezer U, Eltas A, Üstün K, Şenyurt SZ, Erciyas K, Aras MH. Effects of Low-Level Laser Therapy as an Adjunct to Standard Therapy in Acute Pericoronitis, and its Impact on Oral Health-Related Quality of Life. Photomed Laser Surg 2012; 30:592-7. [DOI: 10.1089/pho.2012.3274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ufuk Sezer
- Department of Periodontology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Abubekir Eltas
- Department of Periodontology, Faculty of Dentistry, İnönü University, Malatya, Turkey
| | - Kemal Üstün
- Department of Periodontology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Süleyman Ziya Şenyurt
- Department of Periodontology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Kamile Erciyas
- Department of Periodontology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Mutan Hamdi Aras
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
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44
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Current World Literature. Curr Opin Oncol 2012; 24:454-60. [DOI: 10.1097/cco.0b013e328355876c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Santos LDFCD, Carvalho ADAT, Leão JC, Cruz Perez DED, Castro JFLD. Effect of Low-Level Laser Therapy in the Treatment of Burning Mouth Syndrome: A Case Series. Photomed Laser Surg 2011; 29:793-6. [DOI: 10.1089/pho.2011.3016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Jair Carneiro Leão
- Department of Clinical and Preventive Dentistry, Oral Medicine Unit, Federal University of Pernambuco, Recife/PE, Brazil
| | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, Oral Pathology Unit, Federal University of Pernambuco, Recife/PE, Brazil
| | - Jurema Freire Lisboa de Castro
- Department of Clinical and Preventive Dentistry, Oral Pathology Unit, Federal University of Pernambuco, Recife/PE, Brazil
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