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Oliveira SV, Batista JVF, Gutierres GG, Silva NP, Lino-Dos-Santos-Franco A, Rodrigues MFSD, Cecatto RB. The supportive use of photobiomodulation on salivary glands: a narrative review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:2793-2805. [PMID: 38189964 DOI: 10.1007/s00405-023-08425-8] [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: 09/07/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Radiotherapy is one of the main strategies used in the treatment of cancer patients and it can cause early or late xerostomia and/or hyposalivation. Therapeutic management of xerostomia includes oral hygiene, sialogenic agents among others. METHODS This study reviews the use of extra-oral salivary glands photobiomodulation in treating xerostomia and/or hyposalivation after radiotherapy and performs a meta-analysis of this data. RESULTS After a broad search of the literature, eight clinical studies were selected. DISCUSSION In a safe way, the studies found that extra-oral stimulation of the salivary glands has benefits in the hyposalivation and changes in salivary flow resulting from lesions by radiotherapy. A meta-analysis found significant values in pain comparing the pre- and post-treatment moments (MD - 3.02, I2 95%, IC - 5.56; - 0.48) and for stimulated salivary flow at 30 days after the end of radiotherapy (MD 2.90, I2 95%, IC 1.96; 3.84). CONCLUSION The most promising parameters comprise wavelengths between 630 and 830 nm, radiant exposure from 2 to 10 J/cm2, two-to-three times a week, before the radiotherapy damage, and homogeneously in the glands. Therefore, Light-Emitting Diode (LED) stimulation of larger areas than the punctual stimulation of small millimeters of the Low-Level Laser Therapy (LLLT) appears to be promising.
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Affiliation(s)
- Susyane Vieira Oliveira
- Biophotonics-Medicine Post-Graduate Program, Universidade Nove de Julho/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - João Victor Falcão Batista
- School of Medicine of Universidade Nove de Julho UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Gabriela Godinho Gutierres
- School of Medicine of Universidade Nove de Julho UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Nicole Pantojo Silva
- School of Medicine of Universidade Nove de Julho UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Adriana Lino-Dos-Santos-Franco
- Biophotonics-Medicine Post-Graduate Program, Universidade Nove de Julho/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | | | - Rebeca Boltes Cecatto
- Biophotonics-Medicine Post-Graduate Program, Universidade Nove de Julho/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil.
- School of Medicine of University of Sao Paulo, Instituto de Reabilitação Lucy Montoro HCFMUSP, IMREA Morumbi, R. Jandiatuba, 580 - Vila Andrade, São Paulo, SP, 05716-150, Brazil.
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Lairedj K, Klausner G, Robijns J, Arany PR, Bensadoun RJ. [Photobiomodulation in the prevention and the management of side effects of cancer treatments: Bases, results and perspectives]. Bull Cancer 2024; 111:314-326. [PMID: 37858427 DOI: 10.1016/j.bulcan.2023.08.011] [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: 04/06/2023] [Revised: 07/11/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Assess the current and potential indications of photobiomodulation (PBM) therapy and their level of evidence in the prevention or treatment of side effects related to oncology treatments (radiation therapy, and to a minimal extent favored and hematopoietic stem cell transplants). And report on the recommended modalities (parameters and doses) of PBM therapy. MATERIALS AND METHODS The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that evaluated PBM in the prevention or management side effects related to cancer treatments. The keywords used were "photobiomodulation"; "low level laser therapy"; "acute oral mucositis"; "acute dysphagia"; "acute radiation dermatitis"; "lymphedema"; "xerostomia"; "dysgeusia"; "hyposalivation"; "lockjaw"; "bone necrosis"; "osteoradionecrosis"; "radiation induced fibrosis"; "voice and speech alterations"; "palmar-plantar erythrodysesthesia"; "graft versus host disease"; "peripheral neuropathy"; "chemotherapy induced alopecia". Prospective studies were included, while retrospective cohorts and non-original articles were excluded from the analysis. RESULTS PBM in the red or infrared spectrum has been shown to be effective in randomized controlled trials in the prevention and management of certain complications related to radiotherapy, in particular acute mucositis, epitheliitis and upper limb lymphedema. The level of evidence associated with PBM was heterogeneous, but overall remained moderate. The main limitations were the diversity and the lack of precision of the treatment protocols which could compromise the efficiency and the reproducibility of the results of the PBM. For other effects related to chemo/radiation therapy (dysgeusia, osteonecrosis, peripheral neuropathy, alopecia, palmar-plantar erythrodysaesthesia) and haematopoietic stem cell transplantation (graft versus host disease), treatment with PBM suffers from a lack of studies or limited studies at the origin of a weakened level of proof. However, based on these results, it was possible to establish safe practice parameters and doses of PBM. CONCLUSION Published data suggest that PBM could therefore be considered as supportive care in its own right for patients treated with radiation, chemotherapy, immunotherapy, hormone therapy or targeted therapies, whether in clinical practice or clinical trials. therapies. However, until solid data have been published on its long-term safety, the use of PBM should be considered with caution and within the recommended parameters and doses, particularly when practiced in areas of known or possible tumours. In this case, the patient should be informed of the theoretical benefits and risks of PBM in order to obtain informed consent before treatment.
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Affiliation(s)
- Kamel Lairedj
- Médecine générale, centre de santé Saint-Paul, 32, Delmas rue Louverture # 44, Delmas, Haïti; Université républicaine d'Haïti, # 22, Delmas 55, Lalue Ave John-Brown # 293 Bis, 1640 Port-au-Prince, Haïti
| | - Guillaume Klausner
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France; Polyclinique Maymard, 13, rue Marcel-Paul, 20200 Bastia, France
| | - Julien Robijns
- Hasselt University, Faculty of Medicine and Life Sciences, Martelarenlaan 42, 3500 Hasselt, Belgique
| | - Praveen R Arany
- University at Buffalo, Oral Biology, Surgery and Biomedical Engineering, Buffalo, New York, États-Unis
| | - René-Jean Bensadoun
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France; Département d'oncologie-radiothérapie, Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
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Schepanski N, Costa FS, Machado EFM, Pacheco MN, Amaral CDB, Machado RC, Nogueira ARA, Brancher JA, Sassi LM, de Araujo MR. Evaluation of photobiomodulation therapy (PBMT) on salivary flow and composition in head and neck cancer patients undergoing radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:253-263. [PMID: 38218654 DOI: 10.1016/j.oooo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/13/2023] [Accepted: 11/04/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Assess the impact of photobiomodulation therapy (PBMT) on xerostomia, salivary flow rate (SFR) and composition in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). STUDY DESIGN Thirty patients undergoing RT (65 Gy) for HNC were enrolled. Saliva and xerostomia evaluations collected pre- and post-PBMT-RT. PBMT involved irradiation of extra and intraoral points, 15-20 sessions, 2-3 times/week. SFR, trace elements, total protein, alkaline phosphatase, xerostomia, and pH were analyzed. RESULTS The average age was 60.7 years. After treatment, there was not a significant reduction in SFR and there was no difference on xerostomia. Significant reductions in Al, Cd, Fe, Ni, P, and Sb concentrations were observed, along with a significant increase in Mg concentration. Sample data were organized into 3 groups based on a self-organizing map. Low concentrations of Al, As, Co, Cr, Cu, Fe, Mn, Mo, S, Sr, and Zn were the primary discriminatory factors for group A, while group B consisted of post-PBMT-RT samples with high concentrations of Ca, K, Mg, Na, and S. CONCLUSIONS PBMT prevented a significant reduction in SFR and xerostomia induced by radiation therapy. These findings suggest that PBMT prevents salivary gland damage minimizing the decline in salivary flow.
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Affiliation(s)
- Natalia Schepanski
- Department of Stomatology, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | | | - Clarice D B Amaral
- Department of Chemistry, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | - João Armando Brancher
- Pontifícia Universidade Católica do Paraná, Escola de Ciências da Vida, Curitiba, PR, Brazil
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Lopez-Garzon M, López-Fernández MD, Ruíz-Martínez AM, Galván-Banqueri P, Lozano-Lozano M, Tovar-Martín I, Postigo-Martin P, Ariza-Vega P, Artacho-Cordón F, Fernández-Lao C, Cantarero-Villanueva I, Fernández-Gualda MÁ, Arroyo-Morales M, Ruíz-Villaverde R, Galiano-Castillo N. Efficacy of photobiomodulation therapy combined with mobile health education in patients with head and neck cancer suffering from chronic xerostomia after radiotherapy: protocol for a three-arm, randomised, placebo-controlled, double-blinded study. BMJ Open 2024; 14:e078068. [PMID: 38267245 PMCID: PMC10824058 DOI: 10.1136/bmjopen-2023-078068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION The role of photobiomodulation (PBM) therapy for oral tissue damage induced by cancer treatment is currently unclear, and there is low-quality to moderate-quality evidence supporting the use of this approach for treating xerostomia and/or hyposalivation. Consequently, patients with head and neck cancer increasingly turn to basic oral hygiene to alleviate salivary gland dysfunction, and their adherence can be improved by mobile health (mHealth) education. The primary objective of this study will be to analyse the effects of different doses of PBM therapy (7.5 J/cm2 vs 3 J/cm2) plus mHealth education on quality of life (QoL), oral health, salivary secretion and salivary gland ultrasound assessment at postintervention and at the 6-month follow-up in patients with head and neck cancer after radiotherapy compared with those in control group. METHODS AND ANALYSIS A prospective, three-arm, randomised, placebo-controlled, double-blinded study will be conducted among patients with head and neck cancer suffering from chronic xerostomia. A total of 20 patients per arm will be included and randomly assigned to receive 7.5 J/cm2 of PBM, 3 J/cm2 of PBM or placebo therapy. PBM therapy will be applied during 24 sessions at 22 points extra and intraorally two times per week for 3 months, combined with a mobile application (https://www.laxer.es). The assessments will be recorded at the beginning of the study, at postintervention and at the 6-month follow-up. The primary outcomes will be QoL, oral health, salivary secretion and salivary gland ultrasound. The pain pressure threshold, functional performance, mood and sleep quality will be secondary indicators. ETHICS AND DISSEMINATION This study received ethics approval from the Andalusian Biomedical Research Ethics Portal (2402-N-21 CEIM/CEI Provincial de Granada) according to the Declaration of Helsinki for Biomedical Research. The results of this study will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05106608.
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Affiliation(s)
- Maria Lopez-Garzon
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - María Dolores López-Fernández
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
| | - Alba Maria Ruíz-Martínez
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pilar Galván-Banqueri
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mario Lozano-Lozano
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Isabel Tovar-Martín
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Paula Postigo-Martin
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Physical Activity for HEaLth Promotion (PA-HELP), Department of Physical and Sport Education, Sports Sciences Faculty, University of Granada, Granada, Spain
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiology and Physical Medicine, Medicine Faculty, University of Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Carolina Fernández-Lao
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Irene Cantarero-Villanueva
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Miguel Ángel Fernández-Gualda
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
| | - Manuel Arroyo-Morales
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Ricardo Ruíz-Villaverde
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Medical Surgical Dermatology and Venereology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Noelia Galiano-Castillo
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
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Coelho CPES, de Melo JLMA, Nunes FDPES, Guimarães MDCM, Heller D, Grisi DC, Dame-Teixeira N. Clinical management of salivary gland hypofunction in patients with head and neck cancer: a scoping review of physical salivary stimulation methods. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:442-458. [PMID: 37380576 DOI: 10.1016/j.oooo.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE(S) This scoping review aims to map the scientific literature on the therapies currently available for physical salivary stimulation in individuals with hyposalivation caused by radiotherapy. STUDY DESIGN Studies were included when they comprised the target population of adult individuals receiving radiotherapy of the head and neck region and who developed or were at risk of developing hyposalivation. Two reviewers selected the studies and extracted data on the type of physical salivary stimulation therapy used, the degree of glandular tissue involvement, and the percentage of salivary flow alteration. Therapies were classified according to either prophylactic application (before/during radiotherapy) or therapeutic application (post-radiotherapy). RESULTS Sixteen articles were included: 4 tested transcutaneous electrical nerve stimulation (TENS), 3 studied low-level lasers, 7 researched acupunctures, and 2 investigated acupuncture-like TENS. The outcomes of the prophylactic studies indicated beneficial effects (similar salivary flow or reduced salivary flow loss), although most studies did not include a comparable control group. Therapeutic studies presented conflicting results. CONCLUSION(S) Prophylactic therapies of physical salivary stimulation may produce better effects than therapeutic applications. However, the protocols best indicated could not be defined. Well-designed, controlled clinical trials should be researched in the future to support the clinical recommendation of any of these treatments.
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Affiliation(s)
| | | | | | | | - Debora Heller
- Post Graduate Program in Dentistry, Cruzeiro do Sul University, São Paulo, Brazil; Experimental Research, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Periodontology, UT Health San Antonio, San Antonio, TX, USA
| | - Daniela Corrêa Grisi
- Department of Dentistry, School of Health Sciences, University of Brasília, Brasília, Brazil
| | - Naile Dame-Teixeira
- Department of Dentistry, School of Health Sciences, University of Brasília, Brasília, Brazil; Division of Oral Biology, School of Dentistry, University of Leeds, UK.
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Gobbo M, Rico V, Marta GN, Caini S, Ryan Wolf J, van den Hurk C, Beveridge M, Lam H, Bonomo P, Chow E, Behroozian T. Photobiomodulation therapy for the prevention of acute radiation dermatitis: a systematic review and meta-analysis. Support Care Cancer 2023; 31:227. [PMID: 36952036 PMCID: PMC10034256 DOI: 10.1007/s00520-023-07673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Approximately 95% of patients undergoing radiotherapy (RT) experience radiation dermatitis (RD). Evidence has suggested that photobiomodulation therapy (PBMT) can stimulate skin renewal and minimize RD. The aim of the present paper was to investigate the efficacy of PBMT in RD prevention through a comprehensive literature review. METHODS A literature search of Ovid MEDLINE, Embase, and Cochrane databases was conducted from 1980 to March 2021 to identify RCT on the use of PBMT for RD prevention. Forest plots were developed using RevMan software to quantitatively compare data between studies. RESULTS Five papers were identified: four in breast and one in head and neck cancer patients. Patients receiving PBMT experienced less severe RD than the control groups after 40 Gray (Gy) of RT (grade 3 toxicity: Odds Ratio (OR): 0.57, 95% CI 0.14-2.22, p = 0.42) and at the end of RT (grade 0 + 1 vs. 2 + 3 toxicity: OR: 0.28, 95% CI 0.15-0.53, p < 0.0001). RT interruptions due to RD severity were more frequent in the control group (OR: 0.81, 95% CI 0.10-6.58, p = 0.85). CONCLUSION Preventive PBMT may be protective against the development of severe grades of RD and reduce the frequency of RT interruptions. Larger sample sizes and other cancer sites at-risk of RD should be evaluated in future studies to confirm the true efficacy of PBMT, also in preventing the onset of RD and to finalize a standardized protocol to optimize the technique. At present, starting PBMT when RT starts is recommendable, as well as performing 2 to 3 laser sessions weekly.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca'Foncello Hospital, Treviso, Italy
| | - Victoria Rico
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA
| | | | - Mara Beveridge
- Department of Dermatology, University Hospitals, Cleveland, OH, USA
| | - Henry Lam
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Edward Chow
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
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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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Efficacy of Photobiomodulation in Reducing Symptomatology and Improving the Quality of Life in Patients with Xerostomia and Hyposalivation: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11123414. [PMID: 35743485 PMCID: PMC9225194 DOI: 10.3390/jcm11123414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Objectives: To evaluate the efficacy of photobiomodulation (PBM) treatment in patients with xerostomia and hyposalivation and assess their quality of life over a one year of follow-up. Material and methods: A single-blind randomized controlled trial. A total of 60 patients with xerostomia were included (30 PBM cases and 30 placebo controls). Photobiomodulation was performed with a diode laser (810 nm, 6 J/cm2), while the controls underwent simulated treatment. One weekly session was carried out for a total of 6 weeks (total six sessions). The study parameters were recorded at baseline, after three and six weeks, and at one year post-treatment. Xerostomia was assessed using a salivary flow visual analog scale (VAS) and the Xerostomia Inventory (XI). The Hospital Anxiety and Depression (HAD) scale, Oral Health Impact Profile (OHIP-14), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were also administered. Results: The patients subjected to PBM therapy showed a significant improvement of xerostomia based on the drainage test, and of oral quality of life (p < 0.001). The depression score of the HAD (HAD-D) and the ESS showed improvement, though without reaching statistical significance (p > 0.05). The placebo group showed significant changes in the xerostomia VAS score at 6 weeks (p = 0.009), with no variations in any of the other studied parameters (p > 0.05). The beneficial effects of the diode laser in the PBM group persisted at one year post-treatment. Conclusions: Photobiomodulation with the diode laser is effective in patients with xerostomia and hyposalivation, and thus should be taken into account as a treatment option.
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Parke SC, Langelier DM, Cheng JT, Kline-Quiroz C, Stubblefield MD. State of Rehabilitation Research in the Head and Neck Cancer Population: Functional Impact vs. Impairment-Focused Outcomes. Curr Oncol Rep 2022; 24:517-532. [PMID: 35182293 DOI: 10.1007/s11912-022-01227-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Management of head and neck cancer (HNC) typically involves a morbid combination of surgery, radiation, and systemic therapy. As the number of HNC survivors grows, there is growing interest in rehabilitation strategies to manage HNC-related comorbidity. In this review, we summarize the current state of HNC rehabilitation research. RECENT FINDINGS We have organized our review using the World Health Organization's International Classification of Function (ICF) model of impairment, activity, and participation. Specifically, we describe the current research on rehabilitation strategies to prevent and treat impairments including dysphagia, xerostomia, dysgeusia, dysosmia, odynophagia, trismus, first bite syndrome, dysarthria, dysphonia, lymphedema, shoulder syndrome, cervicalgia, cervical dystonia and dropped head syndrome, deconditioning, and fatigue. We also discuss the broader impact of HNC-related impairment by exploring the state of rehabilitation literature on activity, participation, psychosocial distress, and suicidality in HNC survivors. We demonstrate that research in HNC rehabilitation continues to focus primarily on impairment-driven interventions. There remains a dearth of HNC rehabilitation studies directly examining the impact of rehabilitation interventions on outcomes related to activity and participation. More high-quality interventional studies and reviews are needed to guide prevention and treatment of functional loss in HNC survivors.
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Affiliation(s)
- Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Arizona, Phoenix, USA.
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre Toronto, Ontario, Canada
| | - Jessica Tse Cheng
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, TX, Houston, USA
| | - Cristina Kline-Quiroz
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, TN, Nashville, USA
| | - Michael Dean Stubblefield
- Department of Physical Medicine and Rehabilitation - Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, NJ, 07052, West Orange, USA
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10
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Moskvin SV, Strazhev SV. [Low-level laser therapy in oncology - what's new? Analysis of 2018-2021 publications]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:56-66. [PMID: 36538405 DOI: 10.17116/kurort20229906156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Low-level laser therapy (LLLT) is included in the Federal project «Fight against oncological diseases», which provides for equipping all specialized medical institutions in Russia with the appropriate devices until 2026. PURPOSE OF THE STUDY Publications analysis on the use of LLLT in oncology. MATERIAL AND METHODS To search for publications, databases and libraries were used: PubMed, Scopus, ResearchGate, Google Scholar, J-STAGE, eLibrary.ru for the period 2018-2021. For analysis, publications were selected that are of interest from the point of view of improving the methodology of LLLT, the prospects for the development of this method in the prevention, treatment and rehabilitation of patients. A total of 223 publications were found, including 39 reviews and meta-analyses, mostly in English (165) and Portuguese (41). RESULTS AND DISCUSSION The inclusion of LLLT in the ISOO/MASCC/ASCO recommendations for the treatment of complications such as mucositis, salivary gland hypofunction and xerostomia caused by non-surgical methods of treating cancer patients should be considered as a promising trend. An extremely low level of quality of LLLT techniques was noted, most often the replacement with meaningless «doses», «fluences» instead of the necessary parameters: wavelength, operating mode, power, frequency, exposure, etc. The use of only local illumination instead of systemic methods of LLLT does not allow obtaining the best results of treatment and prevention. Eliminating the shortcomings of treatment protocols with a focus on Russian experience, when laser blood illumination (intravenously or externally) and laser acupuncture are also necessarily carried out with local illumination of the lesion, will bring the effectiveness of LLLT to a qualitatively new, higher level.
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Affiliation(s)
- S V Moskvin
- Academy of Postgraduate Education of Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russia
| | - S V Strazhev
- City Polyclinic No.212 of the Department of Health of the City of Moscow - Branch No. 70, Moscow, Russia
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11
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Klausner G, Troussier I, Canova CH, Bensadoun RJ. Clinical use of photobiomodulation as a supportive care during radiation therapy. Support Care Cancer 2021; 30:13-19. [PMID: 34623486 DOI: 10.1007/s00520-021-06518-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Guillaume Klausner
- Oncology - Radiotherapy, Pierre and Marie Curie University, Paris Sorbonne University, 91-105 Boulevard de l'Hôpital, 75013, Paris, France
| | - Idriss Troussier
- Oncology - Radiotherapy, Centre de Haute Énergie (CHE), 10 Boulevard Pasteur, 06000, Nice, France.,Radio-Oncology, University Hospitals of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Charles-Henry Canova
- Oncology - Radiotherapy, Centre de Haute Énergie (CHE), 10 Boulevard Pasteur, 06000, Nice, France
| | - René-Jean Bensadoun
- Oncology - Radiotherapy, Centre de Haute Énergie (CHE), 10 Boulevard Pasteur, 06000, Nice, France.
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12
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Recovery from Idiopathic Facial Paralysis (Bell’s Palsy) Using Photobiomodulation in Patients Non-Responsive to Standard Treatment: A Case Series Study. PHOTONICS 2021. [DOI: 10.3390/photonics8080341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diminished facial movement and marked facial asymmetry can lead to a consistent psychological burden. Bell′s palsy (BP) is one of the most common causes of facial nerve illness, which comes with unilateral acute facial paresis. Nowadays, no clear guidelines for treating BP are available. We carried out a case series study to test the efficacy of photobiomodulation (PBM) therapy in patients with BP non-responsive to standard treatment. The study was experimentally performed at the Department of Surgical and Diagnostic Sciences, University of Genoa (Genoa, Italy), in accordance with case report guidelines. Patients were referred to our department by colleagues for evaluation to be included in the case series because no consistent improvement was observed at least 3 months from the diagnosis of BP. All the patients interrupted their pharmacological therapy before the initiation of PBM therapy. PBM therapy (808 nm, 1 W irradiated in continuous-wave for 60 s on spot-size 1 cm2; 1 W/cm2; 60 J/cm2; and 60 J) was administered every 2 days until complete resolution. Evaluation of the House-Brackmann scale was performed before and after treatments. Fourteen patients were screened as eligible for the study. Patients were Caucasians (36% females and 64% males) with a mean age ± standard deviation of 56.07 ± 15.21 years. Eleven patients out of 14, who experienced BP a maximum of 6 months, completely recovered through PBM. The three patients that did not show improvement were those who had experienced BP for years. PBM could be a supportive therapy for the management of BP in patients non-responsive to standard treatment. However, randomized controlled trials are necessary to sustain our encouraging results, exclude bias, and better explain the boundary between the time from diagnosis and the recovery of BP through PBM therapy.
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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: 8] [Impact Index Per Article: 2.7] [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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Klausner G, Bensadoun RJ, Champion A, Benzaquen D, Canova CH, Claren A, Mancuso V, Suhl J, Balard R, Troussier I. [State of art of photobiomodulation in the management of radiotherapy adverse events: Indications and level of evidence]. Cancer Radiother 2021; 25:584-592. [PMID: 34272181 DOI: 10.1016/j.canrad.2021.06.025] [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: 06/02/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the current and potential indications of photobiomodulation (PBM) and their level of evidence in the prevention or management of radiation therapy-related side effects. MATERIALS AND METHODS The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that have assessed PBM in the prevention or management of radiotherapy-related side effects. The keywords used were "photobiomodulation"; "low level laser therapy"; "acute oral mucositis"; "acute dysphagia"; "acute radiation dermatitis"; "lymphedema"; "xerostomia"; "hyposalivation"; "trismus"; "bone necrosis"; "osteoradionecrosis"; and "radiation induced fibrosis". Prospective studies were included, whereas retrospective cohorts and non-original articles were excluded from the analysis. RESULTS PBM in the red or infrared spectrum has demonstrated efficacy in randomized controlled trials in the prevention and management of radiotherapy-related side effects, especially acute oral mucositis, acute radiation dermatitis, and upper extremity lymphedema. The level of evidence associated with PBM was heterogeneous, but overall was still moderate. The main shortcomings were the diversity and lack of detail in treatment protocols, which could have compromised efficiency and reproducibility of PBM results. CONCLUSION The published data suggest that PBM may be considered as a full-fledged supportive care for patients treated with radiotherapy, or at least in the setting of a therapeutic clinical trial. However, until strong evidence has been published on its long-term safety, the use of PBM should be considered with caution, specifically when applied near areas with proven or potential tumors. The patient should be informed of the theoretical benefits and risks of PBM in order to obtain his informed consent before treatment.
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Affiliation(s)
- G Klausner
- Oncologie - radiothérapie, université Pierre-et-Marie-Curie, Paris Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - R J Bensadoun
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France
| | - A Champion
- Oncologie - radiothérapie, hôpital Latour, avenue J.-D.-Maillard 3, 1217 Meyrin, Suisse
| | - D Benzaquen
- Radio-oncologie, hôpitaux universitaire de Genève (HUG), rue Gabrielle-Perret-Gentil 4, 1205 Genève, Suisse
| | - C H Canova
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France
| | - A Claren
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France
| | - V Mancuso
- Médecine générale, 40 bis, rue Marcel-Miquel, 92130 Issy-Les-Moulineaux, France
| | - J Suhl
- Médecine interne - médecine vasculaire, hôpital Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - R Balard
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France
| | - I Troussier
- Oncologie - radiothérapie, centre de haute énergie (CHE), 10, boulevard Pasteur, 06000 Nice, France; Médecine interne - médecine vasculaire, hôpital Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
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