Effect of irradiation with red and infrared laser in the treatment of oral mucositis: A pilot study with patients undergoing chemotherapy with 5-FU

Efficacy of photobiomodulation in the treatment of oral mucositis in patients undergoing antineoplastic therapy: systematic review and meta-analysis

PURPOSE

To evaluate the effectiveness of photobiomodulation in the treatment of oral mucositis.

METHODS

Systematic review and meta-analysis encompassing in the electronic databases: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, and CINAHL and in http://clinicaltrials.gov . Eligibility criteria were randomized, non-randomized, and observational studies that used photobiomodulation for the treatment of oral mucositis. The endpoints were reduction in the severity of oral mucositis, duration of lesions, and pain reduction. For data analysis, the Review Manager 5.4 program was used.

RESULTS

A total of 316 studies were identified, 297 in the electronic databases and 19 in http://clinicaltrials.gov . After removing duplicates, 260 studies were selected for title and abstract reading, of which 223 were excluded. A total of 37 studies were chosen for full reading, of which 6 were included in the review, totaling 299 patients. The treatment used was photobiomodulation. The patients were divided into two groups: the laser group used only photobiomodulation or associated with other therapies, and the control group did not use photobiomodulation. For the endpoint reduction in the severity of oral mucositis (OM), the chance of reduction of the OM was greater in the laser group as compared to the control group. For the endpoints duration of OM lesions and pain reduction, it was not possible to carry out a meta-analysis due to the high heterogeneity between studies. In the interpretation of the meta-analysis, the reduction in the severity of oral mucositis was greater in the group that received photobiomodulation.

CONCLUSION

Photobiomodulation was effective in the treatment of oral mucositis.

Management of oral mucositis: a systematic review

INTRODUCTION

Oral mucositis is one of the most common complications following chemotherapy and/or head and neck radiotherapy. Various treatments for oral mucositis have been proposed. However, there has still been no review of the most frequent and most effective type of therapy to treat oral mucositis. This systematic review aims to determine the most frequent and effective types of therapy to treat and reduce the severity of oral mucositis.

EVIDENCE ACQUISITION

The literature search was carried out using PRISMA guidelines. Publications included from 2010 to June 2021 with a clinical trial, prospective, and retrospective observational research design. The following databases were used: PubMed, Cochrane Library, and Wiley Online Library. The search was for limited articles published in English, which were screened and analyzed by three authors. The risk of bias of each study was also assessed by three authors simultaneously, using different types of instruments depending on its study design.

EVIDENCE SYNTHESIS

Forty-seven of 1274 journals were included. From 3577 subjects, oral mucositis was more common in males than females (2.12: 1), with a mean age of 56.39 (18-90 years). The most commonly used types of therapy are low-level laser therapy (396 subjects) and lysozyme-based compounds (314 subjects). Meanwhile, the most effective type of therapy is low-level laser therapy.

CONCLUSIONS

Low-level laser therapy is the most commonly used oral mucositis therapy and is also the most effective in reducing the degree of oral mucositis and associated pain.

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.

Photobiomodulation Therapy in Oral Mucositis and Potentially Malignant Oral Lesions: A Therapy Towards the Future

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.

Variability of high-dose melphalan exposure on oral mucositis in patients undergoing prophylactic low-level laser therapy

The present study outlines the clinical impact and risk factors of oral mucositis in 79 patients with multiple myeloma following high-dose melphalan for autologous transplant. All patients underwent daily prophylactic low-level indium gallium aluminum phosphate diode laser therapy (660 nm, 15 mW, 3.75 J/cm², 10 s per point) from the beginning of the conditioning regimen up to day +2. Oral mucositis assessments were made daily until hospital discharge. For analysis, oral mucositis was divided into two groups according to severity: group 1, patients with oral mucositis grade <III (n = 71) and group 2, patients with oral mucositis grade ≥III (n = 8). Univariate logistic models were used to determine the risk factors. Patients in group 1 were found to have statistically fewer days of oral pain than those in group 2 (3.94 and 6.25 days, respectively, p = 0.014). Morphine was required in 75% of patients in group 2, versus 42.25% in group 1 (p = 0.06). Risk of severe oral mucositis was associated with higher serum creatinine levels (OR = 6.10; 95% CI 1.25-31.60; p = 0.02) and older age (OR = 1.21; 95% CI 1.05-1.47; p = 0.027). Severe oral mucositis was associated with worse clinical outcomes. Older patients and those with renal dysfunction previous autologous transplant had the greatest risk for severe oral mucositis despite prophylactic laser treatment. Our results highlight the importance of further research to define the dose, application time, and number of prophylactic laser sessions in those patients with the greatest risk for severe oral mucositis.

Class IV laser therapy as treatment for chemotherapy-induced oral mucositis in onco-haematological paediatric patients: a prospective study

BACKGROUND

Oral mucositis is a debilitating side effect of chemotherapy. Laser therapy has recently demonstrated efficacy in the management of oral mucositis (OM).

AIM

This prospective study was conducted to evaluate the efficacy of class IV laser therapy in patients affected by OM.

DESIGN

Eighteen onco-haematological paediatric patients receiving chemotherapy and/or haematopoietic stem cell transplantation, prior to total body irradiation, affected by OM, were enrolled in this study. Patients were treated with class IV laser therapy for four consecutive days; the assessment of OM was performed through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through visual analogue scale. Patients completed a validated questionnaire, and photographs of lesions were taken during each session. Patients were re-evaluated 11 days after the first day of laser therapy.

RESULTS

All patients demonstrated improvement in pain sensation, and all mucositis was fully resolved at the 11-day follow-up visit, with no apparent side effects. Laser therapy was well tolerated with remarkable reduction in pain associated with oral mucositis after 1-2 days of laser therapy.

CONCLUSIONS

Given class IV laser therapy appears to be safe, non-invasive, and potentially effective, prospective, randomized, controlled trials are necessary to further assess efficacy and to determine optimal treatment parameters.

[Use of laser for the prevention and treatment of oral mucositis induced by radiotherapy and chemotherapy for head and neck cancer]

One of the complications of radiotherapy and chemotherapy is oral mucositis. Since the low energy laser is one of the most frequently recommended interventions by authors and international societies, the aim of this study is to review the scientific evidence on the use of lasers as a preventive and therapeutic in oral mucositis associated with treatment of cancer. We performed a literature search in PubMed and The Cochrane Collaboration Library, limiting the search to the last 20 years. We finally included 29 articles that contained 30 studies. Low energy laser phototherapy seems a promising intervention in both the prevention and treatment of oral mucositis associated with cancer treatment. Virtually all studies reviewed showed good results with no adverse effects and reductions in both incidence and severity of mucositis in all types of cancer treatments.