Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial

Recent advances in cancer therapy-associated oral mucositis

Oral mucositis (OM) is a common and debilitating toxicity of cancer treatments - chemotherapy, radiotherapy, hematopoietic cell transplant, or combinations. OM is associated with severe oral pain and has negative impacts on patient function and quality of life. Additionally, OM has accompanying systemic complications that may have critical implications. These local and systemic consequences can alter cancer treatment, and add an economic burden. This review covers the clinical presentation and course of OM, differential diagnosis, clinical and economic impacts, pathogenesis, risk factors, assessment measures, biomarkers and prediction of OM, management, research advances in the development of new drugs and treatments, and big data.

Preventive versus curative photobiomodulation for oral mucositis in patients with multiple myeloma undergoing hematopoietic stem cell transplantation: which approach is more effective?

PURPOSE

There is increasing evidence that photobiomodulation (PBM) therapy is both an effective and safe approach in hematopoietic stem cell transplantation (HSCT) for both prevention and management of oral mucositis (OM), but its use in clinical practice is still limited and the timing of application is under discussion. The aim of this retrospective study was to evaluate possible differences between patients treated either with preventive or curative PBM therapy.

METHODS

The retrospective case series included 24 patients suffering from multiple myeloma who underwent the same conditioning and transplantation protocol. Patients were treated either with preventive PBM starting from the first day of conditioning up to two days post-HSCT or with curative PBM (starting at OM onset for four consecutive days). OM score, pain, and functional parameters were recorded.

RESULTS

All patients developed OM. Preventive PBM was significantly more effective in reducing OM severity (p < 0.0001) and pain (p < 0.0001) post-HSCT than curative PBM. Furthermore, we found a lower number of patients reporting discomfort in all subjective parameters (pain during swallowing, chewing, and speaking) in the preventive PBM group. No adverse events related to PBM therapy were recorded in both groups.

CONCLUSION

The timing for PBM therapy in patients undergoing HSCT is crucial: when started on the first day of conditioning, it significantly reduces both pain and OM severity, providing an important benefit also in subjective oral functions such as speaking, swallowing, and chewing, thus increasing the overall adherence to the oncological therapies.

Photobiomodulation CME part II: Clinical applications in dermatology

Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.

Neutropenic ulcers in oncology: terminology, diagnosis, and management

Neutropenic ulcerations are characterized by mucosal ulcerations which occur in the presence of neutropenia, suggesting a direct link between neutropenia and mucosal ulceration. An oral ulcer can be labeled as "neutropenic" only if the patients have primary (typically congenital) or secondary neutropenia, and neutropenia is the sole causative factor. Oral mucosal ulcers observed in patients undergoing oncologic therapy may also be termed as "neutropenic ulcers", but the pathogenesis of these oral ulcers more likely involves mucosal events related to trauma, microbial factors, and direct cytotoxicity. In cancer patients, the early appearance of oral ulcers is often attributed to oral mucositis which is a condition primarily caused by the direct mucosal cytotoxicity of chemotherapeutic agents and radiation therapy. Oral ulcers that develop later during or after active cancer therapy may result from intraoral trauma and typically manifest on non-keratinized areas of the oral mucosa which are more susceptible to mucosal damage. In patients undergoing chemotherapy, factors such as disturbances in mucosal barrier function as well as bone marrow suppression lead to reduced neutrophil count and function, and can contribute to the development of oral ulcers. While the etiology of oral ulcers in cancer therapy receiving patients can vary, it is important to emphasize that the host's response plays a crucial role in the progression and repair process of these lesions. This narrative review presents the etiopathogenesis, clinical presentation, and potential management approaches for oral ulcerations in neutropenic patients, with a particular focus on clarifying the usage of the term "neutropenic ulcer" since this term lacks diagnostic specificity and can be misleading in clinical practice regarding the underlying causes and treatment strategies.

Efficacy of Low-Level Laser Therapy for Oral Mucositis in Hematologic Patients Undergoing Transplantation: A Single-Arm Prospective Study

Oral mucositis significantly affects the quality of life in hematologic cancer patients undergoing hematopoietic stem cell transplantation. Despite global evidence supporting the efficacy of low-level laser therapy (LLLT) for mucositis prevention, its clinical adoption in Japan is limited. This study aimed to fill this gap by evaluating the safety and efficacy of LLLT in a Japanese patient population. In a single-group, non-blinded, exploratory trial, we compared 21 LLLT-treated patients against a historical control of 96 patients. The primary endpoint was the incidence of Grade ≥ 2 mucositis, based on NCI-CTCAE ver. 4.0. The LLLT group showed a significantly lower incidence of Grade ≥ 2 mucositis (23.8%) compared to the control group (64.6%) (p = 0.0006). Furthermore, Grade ≥ 2 mucositis correlated with increased oral dryness and longer hospital stays. Our study confirms the efficacy of LLLT in reducing the onset of severe oral mucositis among Japanese hematologic cancer patients, advocating for its clinical introduction as a preventive measure in Japan.

Proposal of a prophylactic photobiomodulation protocol for chemotherapy-induced oral and oropharyngeal mucositis: a randomized clinical trial

Photobiomodulation therapy (PBMT) is widely used in oncology settings, but lack of assessment standardization is the main barrier to optimization of clinical protocols. This study analyzed three PBMT protocols for preventing oral and oropharyngeal mucositis (OM) in patients undergoing chemotherapy (CT) and/or hematopoietic stem cell transplantation (HSCT). This is a preliminary randomized blind clinical trial. Group 1 received intraoral prophylactic PBMT, Group 2 received intraoral and oropharyngeal PBMT, and Group 3 received intraoral, oropharyngeal, and extraoral PBMT. The applications were from the first day of CT to day + 10. Clinicodemographic data, CT regimens, types of HSCT, hematological exams, occurrence/severity of OM, odynophagia, and OM-related opportunistic infections were assessed. Sixty participants (age range: 18-74 years) were included; 70% of them underwent CT and 30% HSCT. About 43.3% of patients had OM, while odynophagia was reported by 23.3%. Both Groups 1 and 2 revealed better results. Multivariate analysis showed that HSCT directly influenced the occurrence of OM. Individuals who had undergone allogeneic HSCT were 1.93 times more likely to develop OM (p < 0.001). Group 3 exhibited a higher frequency of OM, albeit of lower grades. This group consisted of half the population who had undergone HSCT, had the highest percentage of melphalan use, and had the lowest mean leukocyte count. The three proposed protocols were effective in preventing and reducing OM, with good tolerance and no reported adverse effects. PBMT is a safe and effective approach to OM prophylaxis in adults undergoing CT/HSCT.

Effectiveness of Photobiomodulation and Oral Cryotherapy on Oral Mucositis Among Patients Undergoing Chemotherapy Conditioning Prior to Hematological Stem Cell Transplantation

OBJECTIVES

This review evaluated the best available evidence concerning the effectiveness of photobiomodulation compared to oral cryotherapy in oral-mucositis prevention among patients with hematological stem cell transplantation (HSCT) receiving chemo-conditioning.

DATA SOURCES

An extensive search for published and unpublished studies was conducted in 11 electronic databases and reference lists. Only randomized controlled trials (RCTs) were included. Two reviewers independently screened relevant studies for eligibility, extracted data using a standardized data collection form, and appraised data using the Cochrane Risk of Bias Tool and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analyses using a random-effect model was performed using Review Manager software. Subgroup analyses were conducted to examine the differential effect of interventions across subgroups and to explore potential sources of heterogeneity. Meta-analyses included 18 RCTs (involving 1,018 patients). Both photobiomodulation and cryotherapy were effective in reducing oral-mucositis severity, severe oral-mucositis incidence, duration, and pain with small to large effect sizes. No significant differences were detected between photobiomodulation and cryotherapy across all outcomes. Subgroup analyses showed significant differences for chemo-conditioning regimens. The overall Grading Recommendations, Assessment, Development and Evaluation quality of evidence was low.

CONCLUSION

Both photobiomodulation and cryotherapy were effective nonpharmacological oral-mucositis prophylaxis and analgesia, with no significant difference in effectiveness. Chemo-conditioning regimens may influence their effectiveness. Future RCTs may directly compare the effectiveness of photobiomodulation and cryotherapy on the HSCT patients. Rigorous cost-effectiveness studies are also required.

IMPLICATIONS FOR NURSING PRACTICE

Photobiomodulation and cryotherapy can be offered to HSCT patients in clinical settings. A clinical guideline of both interventions can be also developed.

Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review

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.

Effects of Photobiomodulation on Oral Mucositis: Visualization and Analysis of Knowledge

This review article mapped and analyzed the most cited articles on the association of photobiomodulation (PBM) with oral mucositis (OM) and the evolution of clinical protocols in the area. A comprehensive search was performed on the Web of Science Core Collection (WoS-CC) database, leading to the extraction of information such as title, authors, abstract, journal name, number, average of citations, study design, year of publication, institutions, continents, countries, type of laser used, irradiated anatomical points, primary anti-cancer therapy, and laser parameters. Among those, clinical trials and literature reviews were the most common study designs. The main type of laser used was the InGaAlP diode, with a wavelength ranging from 630-660 nm, power going in 40-100 mW, and energy density ranging from 0.375-22 J/cm². As for the anatomical sites irradiated by PBM, the cheek mucosa, upper and lower lips, lateral tongue, and bottom of the mouth stood out. This analysis highlights an increasing interest in PBM as a supportive treatment in cases of OM, as well as the evolution of the technique, types of laser devices, and protocols used.

Low-Level Laser Therapy: A Literature Review of the Prevention and Reduction of Oral Mucositis in Patients Undergoing Stem Cell Transplantation

BACKGROUND

Oral mucositis (OM) is a highly debilitating complication of high-dose chemotherapy and total body irradiation used in conditioning regimens for hematopoietic stem cell transplantation (HSCT). Research has studied low-level laser therapy (LLLT) as an alternative treatment for OM because of its anti-inflammatory activity, biomodulation, and analgesic effects.

OBJECTIVES

This study reviews evidence on the effectiveness of LLLT using diode lasers on the prevention and reduction in severity of OM in patients with cancer undergoing HSCT.

METHODS

A literature search was performed in PubMed®, CINAHL®, Scopus®, and MEDLINE® databases. Six randomized controlled trials and one cohort study met the inclusion criteria.

FINDINGS

The data demonstrate promising outcomes for reducing the incidence and severity of OM using LLLT. Larger, tightly controlled clinical trials are needed in the future.

Most used photobiomodulation dosimetry parameters to treat oral mucositis after preconditioning for hematopoietic stem cell transplantation: systematic review and meta-analysis

Parameter reproducibility in photobiomodulation therapy (PBMT) is still scarce in literature for the management of oral mucositis (OM). This study aimed to identify the most used PBMT dosimetry parameters (DP) and their efficacy in OM management after preconditioning for hematopoietic stem cell transplantation (HSCT). This research was conducted according to the PRISMA guidelines. The search for primary studies was in PubMed/MEDLINE, Web of Science, Embase, BVS, and Cochrane Library. Gray literature was verified on BDTD-Ibict and Open Gray. A total of 1044 studies were identified. Nine met the eligibility criteria for qualitative assessment and 7 for meta-analysis. The studies involved 396 patients submitted to preconditioning for HSCT, 211 with PBMT and 185 without PBMT in the OM management. The WHO scale was the most used to assess OM degree. The most used parameters were 660-nm wavelength, 40-mw power, 0.16-J energy, 1-W/cm² power density, 4-J/cm² energy density, and 0.04-cm² spot size. The meta-analysis demonstrated that PBMT decreased the severity of OM, with a protection factor 20% higher than the control group (without PBMT), and when the parameters are similar to the DP mentioned, the protection factor increases to 94%. These most used DP with similarity seem to be a therapeutic strategy for the management of OM in this population.

Long-term safety of photobiomodulation therapy for oral mucositis in hematopoietic cell transplantation patients: a 15-year retrospective study

Photobiomodulation therapy (PBMT) has demonstrated efficacy in the prevention and treatment of oral mucositis (OM) in hematopoietic cell transplantation (HCT). However, based on the cell stimulation properties, its long-term safety has been questioned, mainly in relation to risk for secondary malignancies in the oral cavity. The aim of this study was to investigate if different PBMT protocols for OM control have association with immediate and late adverse effects in HCT patients. Data on autologous and allogeneic transplantation, conditioning regimen, PBMT protocols, and OM severity were retrospectively collected from medical and dental records. Presence of secondary malignancies in the oral cavity was surveyed during a 15-year follow-up. Impact of OM on overall survival was also analyzed. Different PBMT protocols for prevention and treatment of OM were recorded over the years. Severe OM (grades 3 and 4) was infrequently observed. When present, we observed a significant decrease of the overall survival. No immediate adverse effect and secondary malignancy was associated to PBMT. In conclusion, the PBMT protocols used in the study were considered safe. The low frequency of severe OM observed encourages the implementation of this technique, with a special emphasis on the dosimetry adjustments focused on the HCT context.

Effectiveness of low level laser therapy versus cryotherapy in cancer patients with oral mucositis: Systematic review and network meta-analysis

OBJECTIVE

The purpose of this network meta-analysis was to analyze the relative effects of low level laser therapy (LLLT) and/or cryotherapy in cancer patients with oral mucositis (OM).

METHODS

This literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to 2020. Only randomized control trials which involved comparisons of groups receiving the interventions of combined cryotherapy and LLLT, LLLT, cryotherapy and usual care (the control group) in patients with cancer were eligible for inclusion. The effect sizes are presented as odds ratios for the occurrence of severe, moderate and none/mild OM. The mixed treatment comparison was conducted using generalized linear mixed models to analyze the direct and indirect comparisons of interventions. The critical appraisal was assessed using Cochrane Collaboration's tool. Heterogeneity between studies was assessed using I² statistics, and publication bias was evaluated by constructing a funnel plot.

RESULTS

Twenty-six randomized controlled trials with a total enrollment of 1830 cancer patients with OM were included. The outcome of none/mild OM is desirable, and odds ratios of more than 1 favor the intervention group. Moderate and severe OM are defined as adverse outcomes, and ORs less than 1 favor the intervention group. The treatment effects of the combined cryotherapy and LLLT were better than those of usual care for none/mild and severe OM (ORs = 106.23 [95% CI = 12.15 to 929.17] and 0.01 [95% CI = 0 to 0.57], respectively). Treatment effects with cryotherapy alone and LLLT alone were better than those with usual care for none/mild and severe OM (ORs = 3.13 [95%CI = 1.56 to 6.27]; ORs = 7.56 [95%CI = 3.84 to 14.88] and 0.25 [95%CI = 0.11 to 0.54]; ORs = 0.13 [95%CI = 0.07 to 0.24], respectively). Nevertheless, for patients with none/mild OM, treatment effects with combined use of cryotherapy and LLLT were better than those with only LLT or cryotherapy (ORs = 14.06 [95%CI = 1.79 to 110.30] and 33.95 [95%CI = 3.50 to 329.65], respectively). For patients with moderate OM, treatment effect did not reach statistical significance among comparisons. The limitations include the wide variability in treatment protocols and the non-uniform outcome measurements across the studies examined.

CONCLUSION

Compared with no intervention, the treatment effects of combined cryotherapy and LLLT, laser alone, and cryotherapy alone are beneficial for the reduction of severe OM. There is no difference in treatment effects among cryotherapy and/or LLLT intervention in cancer patients with moderate OM. Results of this study provide an implicative basis for LLLT and cryotherapy as viable interventions that can significantly improve severe OM.

Photo-Biomodulation as a Prevention Modality of Oral Mucositis in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

The aim of the study was to observe the effectiveness of a photo-biomodulation (PBM) protocol for the prevention of oral mucositis (OM) in patients undergoing allogeneic hematopoietic stem cell transplantation (aHSCT). A case-control study was conducted on 40 patients undergoing aHSCT. The patients were divided into two groups; the preventive group (PG) included 20 patients (7 females and 13 males) who were subjected to intra-oral PBM for five sessions a week, starting one day before the conditioning regimen and continuing until the 10th day after transplantation (D+10). In each session, ten points on the at-risk mucosal surfaces were irradiated using a double diode laser that emits two wavelengths simultaneously at 650 nm and at 904–910 nm with the following parameters at each point: energy of 4 J, and power of 88.9 mW. The control group (CG) included 20 patients (10 females and 10 males) who were not subjected to laser therapy and were selected retrospectively to compare the obtained results. For all patients, OM was assessed by the World Health Organization (WHO) grading scale. Eight patients in the PG did not experience OM during their hospitalization period (with grade 0). Severe OM was observed in 40% of the patients in the PG, while in the CG, severe OM was shown in 85% of the patients. The mean duration of OM in the PG was significantly lower than that of CG (4.7 days in the PG and 15 days in the CG) (p < 0.001). The study demonstrated that the preventive PBM protocol reduced the severity and duration of OM in patients undergoing aHSCT.

Photobiomodulation and Oral Mucositis: A Systematic Review

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.

Low-level laser therapy in the prevention and treatment of oral mucositis: a systematic review and meta-analysis

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.

Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside

Mucositis is one of the most common debilitating side effects related to chemotherapy (CT), radiation therapy (RT), targeted agents and immunotherapy. It is a complex process potentially involving any portion of the gastrointestinal tract and injuring the mucosa, leading to inflammatory or ulcerative lesions. Mechanisms and clinical presentation can differ according both to the anatomic site involved (oral or gastrointestinal) and the treatment received. Understanding the pathophysiology and management of mucosal injury as a secondary effect of anti-cancer treatment is an important area of clinical research. Prophylaxis, early diagnosis, and adequate management of complications are essential to increase therapeutic success and, thus, improve the survival outcomes of cancer patients. This review focuses on the pathobiology and management guidelines for mucositis, a secondary effect of old and new anti-cancer treatments, highlighting recent advances in prevention and discussing future research options.

Tumor safety and side effects of photobiomodulation therapy used for prevention and management of cancer treatment toxicities. A systematic review

Photobiomodulation therapy (PBMT), also known as low-level laser therapy (LLLT), has been increasingly used for the treatment of toxicities related to cancer treatment. One of the challenges for the universal acceptance of PBMT use in cancer patients is whether or not there is a potential for the light to stimulate the growth of residual malignant cells that evaded oncologic treatment, increasing the risk for tumor recurrences and development of a second primary tumor. Current science suggests promising effects of PBMT in the prevention and treatment of breast cancer-related lymphedema and oral mucositis, among other cancer treatment toxicities. Nevertheless, this seems to be the first systematic review to analyze the safety of the use of PBMT for the management of cancer-related toxicities. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 27 articles met the search criteria. Selected studies included the use of PBMT for prevention and treatment of oral mucositis, lymphedema, radiodermatitis, and peripheral neuropathy. Most studies showed that no side effects were observed with the use of PBMT. The results of this systematic review, based on current literature, suggest that the use of PBMT in the prevention and management of cancer treatment toxicities does not lead to the development of tumor safety issues.

Examining tumor modulating effects of photobiomodulation therapy on head and neck squamous cell carcinomas

The aim of the present systematic review was to analyze studies that investigated the effects of photobiomodulation therapy on head and neck squamous cell carcinoma cells.

Oral pain associated with cancer therapy, a pain medicine perspective

Cancer therapy-induced oral mucositis (CTIOM) can cause intolerable oral pain resulting in difficulty in chewing, swallowing and speaking. Thus, leading to patients requiring aggressive measures, such as parenteral feeding, the placement of gastric feeding tubes and discontinuation of oncologic treatments. Although, pain is the debilitating symptom, current efforts seem to focus independently in the histological damage, not in pain and symptom care. Current strategies for managing pain from CTIOM entail maintaining oral hygiene and the use of oral rinses, topical anesthetics, prophylactic antimicrobials and systemic analgesics such as opioids. Novel therapies, such as methylene blue oral rinse, are being investigated, with positive outcomes. Therefore, there is a need to identify treatment modalities for pain of CTIOM. Ideally, this should be noninvasive, safe and cost-effective, while providing sustained analgesia.

Evaluation of Oral Mucositis Occurrence in Oncologic Patients under Antineoplastic Therapy Submitted to the Low-Level Laser Coadjuvant Therapy

Low-level laser therapy has been widely used in treating many conditions, including oral mucositis. The purpose of this study was to evaluate the occurrence of oral mucositis in patients undergoing antineoplastic therapy submitted to preventive and therapeutic treatment with low-level laser therapy. This cross-sectional study was carried out with 51 children and adolescents of both sexes with malignant neoplasias who developed oral mucositis and underwent low-level laser therapy. Data were collected on sex, age, type and degree of neoplasia, region affected, and remission time. 64.7% of the patients were male and were between 3 and 6 years of age (39.2%). Acute lymphoid leukemia was the most frequent neoplasm (37.3%). Regarding the maximum oral mucositis, grade 2 (41.2%) was predominant, with jugal mucosa (29.9%) and tongue (17.7%) being the most affected regions. The majority of cases presented lesion remission time between 4 and 7 days (44.0%). Most patients were young, male, and diagnosed with acute lymphoid leukemia. Predominance of grade 2 oral mucositis was observed, with jugal mucosa and tongue being the most affected regions, with the majority of cases presenting lesion remission time between 4 and 7 days. Low-level laser therapy has been shown to be an essential therapy in the prevention and treatment of these lesions, since it is a non-invasive and low-cost method.

New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury

Mucositis is a common complication of chemotherapy, radiotherapy and targeted agents. It often affects compliance to anticancer therapies as it frequently causes schedule delays, interruptions or discontinuations of treatment. Moreover, the economic impact related to the management of mucositis is topical and several estimations of additional hospital costs due to this clinical condition have been recently reported. The ability to determine risk factors for mucositis, to early detect its onset, to assess correctly the degree of this toxicity and to plan its multidisciplinary management are all key elements to guarantee the quality of life of patients and to avoid useless dose reduction or interruption of treatment. The pathogenesis of mucositis is multifactorial and it is classily subdivided into oral and gastrointestinal mucositis according to its anatomic presentation. Treatment and patients’ related factors might help in predicting the frequency and the potential degree of symptoms onset. Here we discuss about clinical presentation and pathogenesis of mucositis in relation to different kinds of treatments. Moreover, we focus on therapeutic and prevention strategies, describing past and present management according to international guidelines and the most promising new data about agents potentially able to further improve the treatment of mucositis in the next future.

Supersaturated Calcium Phosphate Rinse in Prevention and Treatment of Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplant

OBJECTIVES

Mucositis is a common morbidity in patients undergoing bone marrow transplant. Various agents have been used to prevent and treat it with variable success. Here, we assessed the efficacy of supersaturated calcium phosphate rinses in prevention and treatment of oral mucositis in patients undergoing hematopoietic stem cell transplant.

MATERIALS AND METHODS

In this retrospective study, we evaluated the records of 80 patients who underwent hematopoietic stem cell transplant and received supersaturated calcium phosphate rinses for preVention of mucositis from April 2012 to January 2016. The World Health Organization scale was used to grade mucositis. Various parameters assessed included grade of mucositis, duration of mucositis, peak mucositis day, duration of pain, peak pain day, duration of total parenteral nutrition, neutrophil engraftment (defined as absolute neutrophil count ≥ 500/μL), mean dose of fentanyl used, incidences of infections, and type of transplant. Supersaturated calcium phosphate rinses at 4 times/day were started for prevention of mucositis as soon as a patient was admitted. All patients also received betadine mouth gargles for oral hygiene.

RESULTS

Our study group included 42 autologous and 38 allogeneic hematopoietic stem cell transplant patients. Grade 1, 2, 3, and 4 mucositis levels were seen in 1, 19, 26, and 31 patients. We found no differences between our study group and historical control regarding parameters studied. Grade of mucositis was statistically significant (P < .01) when autologous transplant for myeloma was compared with autologous transplant for other diagnoses.

CONCLUSIONS

Supersaturated calcium phosphate rinses were ineffective in the management of mucositis associated with autologous and allogeneic bone marrow transplant.

Lactobacillus brevis CD2 lozenges prevent oral mucositis in patients undergoing high dose chemotherapy followed by haematopoietic stem cell transplantation

Background

Oral mucositis is a common inflammatory complication in patients undergoing high-dose chemotherapy and radiation followed by haematopoietic stem cell transplantation (HSCT). Lactobacillus brevis CD2 has been proven efficacious in preventing chemoradiotherapy-induced oral mucositis in squamous cell carcinoma of head and neck.

Methods

This phase II study aimed to evaluate the safety and efficacy of L. brevis CD2 lozenges in preventing oral mucositis in patients undergoing HSCT. Eligible patients received four to six lozenges of L. brevis CD2 per day, beginning from 4 to 7 days before initiation of chemotherapy and continuing until resolution of mucositis or till day +24.

Results

Of 31 patients enrolled, 7 (22.6%) patients did not develop any mucositis, 6 (19.4%) patients developed grade 1, 12 (38.7%) patients developed grade 2, 4 (12.9%) and 2 (6.5%) patients developed grade 3 and grade 4 mucositis, respectively. Median time to onset and for resolution of mucositis were 6 days and 8 days, respectively. No adverse events were reported with usage of study drug. However, one patient died of Klebsiella sepsis.

Conclusion

Promising results from the study encourage the use of L. brevis CD2 lozenges as a supportive care treatment option; however, a randomised, double-blind, multicentric trial in a larger population is warranted.

Trials registration number

NCT01480011 at https://www.clinicaltrials.gov/ (Registered on Nov 04, 2011).