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Ly KL, Rajtboriraks M, Elgerbi A, Luo X, Raub CB. Recombinant Human Keratinocyte Growth Factor Ameliorates Cancer Treatment-Induced Oral Mucositis on a Chip. Adv Healthc Mater 2024; 13:e2302970. [PMID: 38351394 PMCID: PMC11144107 DOI: 10.1002/adhm.202302970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/06/2024] [Indexed: 02/23/2024]
Abstract
Oral mucositis (OM) is a severe complication of cancer therapies caused by off-target cytotoxicity. Palifermin, which is recombinant human keratinocyte growth factor (KGF), is currently the only mitigating treatment available to a subset of OM patients. This study used a previously established model of oral mucositis on a chip (OM-OC) comprised of a confluent human gingival keratinocytes (GIE) layer attached to a basement membrane-lined subepithelial layer consisting of human gingival fibroblasts (HGF) and human dermal microvascular endothelial cells (HMEC) on a stable collagen I gel. Cisplatin, radiation, and combined treatments are followed by a recovery period in the OM-OC to determine possible cellular and molecular mechanisms of OM under effects of KGF. Cancer treatments affected the keratinocyte layer, causing death and epithelial barrier loss. Both keratinocytes and subepithelial cells died rapidly, as evidenced by propidium iodide staining. In response to radiation exposure, cell death occurred in the apical epithelial layer, predominantly, within 24h. Cisplatin exposure predominantly promoted death of basal epithelial cells within 32-36h. Presence of KGF in OM-OC protected tissues from damage caused by cancer treatments in a dose-dependent manner, being more effective at 10 ng/mL. As verified by F-actin staining and the Alamar Blue assay, KGF contributed to epithelial survival and induced proliferation of GIE and HGF as well as HMEC within 120h. When the expression of eighty inflammatory cytokines is evaluated at OM induction (Day 12) and resolution (Day 18) stages in OM-OC, some cytokines are identified as potential novel therapeutic targets. In comparison with chemoradiation exposure, KGF treatment showed a trend to decrease IL-8 and TNF-a expression at Day 12 and 18, and TGF-β1 at Day 18 in OM-OC. Taken together, these findings support the utility of OM-OC as a platform to model epithelial damage and evaluate molecular mechanisms following OM treatment.
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Affiliation(s)
- Khanh L Ly
- Department of Biomedical Engineering, School of Engineering, The Catholic University of America, Washington, DC, 20064, USA
| | - May Rajtboriraks
- Department of Biomedical Engineering, School of Engineering, The Catholic University of America, Washington, DC, 20064, USA
| | - Ahmed Elgerbi
- Department of Biology, School of Arts and Sciences, The Catholic University of America, Washington, DC, 20064, USA
| | - Xiaolong Luo
- Department of Mechanical Engineering, School of Engineering, The Catholic University of America, Washington, DC, 20064, USA
| | - Christopher B Raub
- Department of Biomedical Engineering, School of Engineering, The Catholic University of America, Washington, DC, 20064, USA
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Franco R, Lupi E, Iacomino E, Galeotti A, Capogreco M, Santos JMM, D’Amario M. Low-Level Laser Therapy for the Treatment of Oral Mucositis Induced by Hematopoietic Stem Cell Transplantation: A Systematic Review with Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1413. [PMID: 37629703 PMCID: PMC10456364 DOI: 10.3390/medicina59081413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Oral mucositis is a common and debilitating side effect induced by stem cell transplantation that is experienced by cancer patients undergoing chemotherapy or radiation therapy. This condition involves inflammation and ulceration of the oral mucosa, leading to pain, difficulty with eating and speaking, and an increased risk of infections. Mucositis not only compromises the quality of life for cancer patients, but also affects treatment outcomes and may necessitate dose reductions or treatment delays. This scientific article provides a comprehensive overview of mucositis. The purpose of this literature review with a meta-analysis is to evaluate the efficacy of laser therapy in treating post-transplant mucositis. Materials and methods: A search of the literature from 3 May 2023 was carried out on three online databases, PubMed, Scopus, and Web of Science. Only studies that treated patients with laser therapy were considered; only studies with the placebo-treated control group were considered. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the std. mean difference between the two groups (laser and placebo). Results: There were 230 papers included in this review. Two hundred twenty-seven were excluded. Furthermore, a manual search was performed. After the search phase, three articles were considered in the study. The overall effect showed differences in the degree of mucositis in the laser-treated patients compared with the placebo group. The meta-analysis shows a reduction in the degree of mucositis in the patients treated with laser therapy (std. mean difference -1.34 [-1.98; -0.98]; C.I. 95%). Conclusions: The application of laser therapy results in decreased severity of oral mucositis from radiation and chemotherapy. Our study shows that the application of low-level laser therapy in the treatment of transplant mucositis has excellent efficacy in relieving the symptoms and severity of mucositis.
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Affiliation(s)
- Rocco Franco
- Department of Life, Health and Environmental Sciences, School of Dentistry, University of L’Aquila, 67100 L’Aquila, Italy; (R.F.); (E.L.); (E.I.); (M.C.); (M.D.)
| | - Ettore Lupi
- Department of Life, Health and Environmental Sciences, School of Dentistry, University of L’Aquila, 67100 L’Aquila, Italy; (R.F.); (E.L.); (E.I.); (M.C.); (M.D.)
| | - Enzo Iacomino
- Department of Life, Health and Environmental Sciences, School of Dentistry, University of L’Aquila, 67100 L’Aquila, Italy; (R.F.); (E.L.); (E.I.); (M.C.); (M.D.)
| | - Angela Galeotti
- Dentistry Unit, Department of Pediatric Surgery, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy;
| | - Mario Capogreco
- Department of Life, Health and Environmental Sciences, School of Dentistry, University of L’Aquila, 67100 L’Aquila, Italy; (R.F.); (E.L.); (E.I.); (M.C.); (M.D.)
| | - João Miguel Marques Santos
- Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation on Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine and Clinical Academic Center of Coimbra (CACC), 3000-548 Coimbra, Portugal
| | - Maurizio D’Amario
- Department of Life, Health and Environmental Sciences, School of Dentistry, University of L’Aquila, 67100 L’Aquila, Italy; (R.F.); (E.L.); (E.I.); (M.C.); (M.D.)
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Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM, Bossi P, Chilles A, Corby PM, Epstein JB, Elad S, Fekrazad R, Fregnani ER, Genot MT, Ibarra AMC, Hamblin MR, Heiskanen V, Hu K, Klastersky J, Lalla R, Latifian S, Maiya A, Mebis J, Migliorati CA, Milstein DMJ, Murphy B, Raber-Durlacher JE, Roseboom HJ, Sonis S, Treister N, Zadik Y, Bensadoun RJ. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol 2022; 12:927685. [PMID: 36110957 PMCID: PMC9468822 DOI: 10.3389/fonc.2022.927685] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
DisclaimerThis article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.ObjectiveThis position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).BackgroundThere is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients’ quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.MethodsA literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.ResultsThere is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.ConclusionsThere is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.
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Affiliation(s)
- Jolien Robijns
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Raj G. Nair
- Oral Medicine, Oral Pathology and Oral Oncology, Griffith University, Department of Haematology and Oncology, Gold Coast University Hospital, Gold Coast, QL, Australia
| | - Joy Lodewijckx
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Praveen Arany
- School of Dental Medicine, Oral Biology and Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Andrei Barasch
- Harvard School of Dental Medicine, Division of Oral Medicine and Dentistry, Boston, MA, United States
| | - Jan M. Bjordal
- Physiotherapy Research Group, IGS, University of Bergen, Bergen, Norway
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Anne Chilles
- Radiotherapy Department, Institut Curie, Paris, France
| | - Patricia M. Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, United States
| | - Joel B. Epstein
- City of Hope Duarte, CA and Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Sharon Elad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Reza Fekrazad
- Department of Periodontology, Dental Faculty – Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | | | - Marie-Thérèse Genot
- Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium
| | - Ana M. C. Ibarra
- Postgraduate Program on Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vladimir Heiskanen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Ken Hu
- Department of Radiation Oncology, NYU Langone Health, New York, NY, United States
| | | | - Rajesh Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, United States
| | - Sofia Latifian
- Department of Medicine, Institut Jules Bordet, Universiteí Libre de Bruxelles, Brussels, Belgium
| | - Arun Maiya
- Manipal College of Health Professions, MAHE, Manipal, India
| | - Jeroen Mebis
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Cesar A. Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida, United States
| | - Dan M. J. Milstein
- Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Barbara Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Judith E. Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Hendrik J. Roseboom
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Yehuda Zadik
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - René-Jean Bensadoun
- Department of Radiation Oncology, Centre de Haute Energie, Nice, France
- *Correspondence: René-Jean Bensadoun,
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Zadik Y, Arany PR, Fregnani ER, Bossi P, Antunes HS, Bensadoun RJ, Gueiros LA, Majorana A, Nair RG, Ranna V, Tissing WJE, Vaddi A, Lubart R, Migliorati CA, Lalla RV, Cheng KKF, Elad S. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 2019; 27:3969-3983. [DOI: 10.1007/s00520-019-04890-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/22/2019] [Indexed: 02/02/2023]
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New photobiomodulation protocol prevents oral mucositis in hematopoietic stem cell transplantation recipients—a retrospective study. Lasers Med Sci 2017; 32:2013-2021. [DOI: 10.1007/s10103-017-2314-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
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6
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Vitale MC, Modaffari C, Decembrino N, Zhou FX, Zecca M, Defabianis P. Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Lasers Med Sci 2017; 32:1423-1428. [DOI: 10.1007/s10103-017-2266-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/15/2017] [Indexed: 01/01/2023]
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Variability of high-dose melphalan exposure on oral mucositis in patients undergoing prophylactic low-level laser therapy. Lasers Med Sci 2017; 32:1089-1095. [PMID: 28512727 DOI: 10.1007/s10103-017-2211-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
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.
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Cotomacio CC, Campos L, Nesadal de Souza D, Arana-Chavez VE, Simões A. Dosimetric study of photobiomodulation therapy in 5-FU-induced oral mucositis in hamsters. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:18003. [PMID: 28129411 DOI: 10.1117/1.jbo.22.1.018003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
Oral mucositis (OM) is a debilitating consequence of cancer treatment that could be treated with photobiomodulation therapy (PBMT); however, there is no consensus about its dosimetric parameters for OM healing. The aim of this study was to compare different PBMT protocols on OM treatment, through clinical and histological analysis. Thirty hamsters were used, in an induced model of OM by 5-fluorouracil (5-FU) and superficial scratching, in seven days of follow-up. The animals were divided into five groups: control (C), which received only anesthesia and chemotherapeutic vehicle; chemotherapy (Ch), which received anesthesia, 5-FU, and scratches; laser 1 (L1), the same as Ch group, PBMT 6 ?? J / c m 2 and 0.24 J (one point); laser 2 (L2), the same as Ch group, PBMT 25 ?? J / c m 2 and 1 J (one point); and laser 3 (L3), the same as Ch group, PBMT 4 points of 0.24 J and 6 ?? J / c m 2 each. The laser used has ? = 660 ?? nm , 0.04 ?? c m 2 of spot area, and 40 mW. The best PBMT protocol to maintain lowest OM levels compared to Ch group was L1, followed by L2 and L3. Our results suggest that the application mode of PBMT and the energy delivered per area could interfere with the OM healing.
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Affiliation(s)
- Claudia Carrara Cotomacio
- University of São Paulo, Department of Biomaterials and Oral Biology, School of Dentistry, São Paulo, Brazil
| | - Luana Campos
- University of São Paulo, Department of Biomaterials and Oral Biology, School of Dentistry, São Paulo, Brazil
| | - Douglas Nesadal de Souza
- University of São Paulo, Department of Biomaterials and Oral Biology, School of Dentistry, São Paulo, Brazil
| | - Victor Elias Arana-Chavez
- University of São Paulo, Department of Biomaterials and Oral Biology, School of Dentistry, São Paulo, Brazil
| | - Alyne Simões
- University of São Paulo, Department of Biomaterials and Oral Biology, School of Dentistry, São Paulo, Brazil
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Campos L, Cruz ÉP, Pereira FS, Arana-Chavez VE, Simões A. Comparative study among three different phototherapy protocols to treat chemotherapy-induced oral mucositis in hamsters. JOURNAL OF BIOPHOTONICS 2016; 9:1236-1245. [PMID: 27105906 DOI: 10.1002/jbio.201600014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/02/2016] [Accepted: 04/03/2016] [Indexed: 06/05/2023]
Abstract
In this study, clinical, biochemical and histological analysis were used to compare different phototherapies, including LED, low and high-power laser (HPL) for the treatment of chemotherapy (CT)-induced oral mucositis (OM). One-hundred-fifty hamsters were divided into five groups: C: control; CH: CT/OM induction; L: CT/OM induction and treatment with LED (635 nm, 1.2 J), HL: CT/OM induction and treatment with HPL (808 nm, 10 J), LL: CT/OM induction and treatment with low-level laser therapy (LLLT) (660 nm, 1.2 J). OM was induced by scratches performed on check pouch mucosa after two injections of 5-Fluorouracil. The experiment lasted 10 days and OM was analyzed by specific clinical scales on days 5, 7 and 10. The animals were euthanized and the cheek pouch mucosa removed for biochemical (TNF-α concentration) and histological (light microscopy) analysis. After statistical analysis, the authors' results showed LED and LLLT therapies were efficient treatments for OM, decreasing TNF-α concentration on day 7 (p < 0.05) and completely healing the mucosa on day 10. HPL showed no interference in final healing of OM. According to the methodology used and the results obtained in the present study, LLLT and LED therapies were the best choices to decrease the severity of OM, accelerating tissue repair and decreasing the inflammatory process. Clinical evaluation of OM in Groups CH, LL, L and HL and their respective arrangement of phototherapy treatments at different time intervals (5, 7 and 10 days).
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Affiliation(s)
- Luana Campos
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
| | - Érika P Cruz
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
| | - Filipi S Pereira
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
| | - Victor E Arana-Chavez
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
| | - Alyne Simões
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
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Eduardo FDP, Bezinelli LM, Orsi MCE, Rodrigues M, Ribeiro MS, Hamerschlak N, Correa L. The influence of dental care associated with laser therapy on oral mucositis during allogeneic hematopoietic cell transplant: retrospective study. EINSTEIN-SAO PAULO 2016; 9:201-6. [PMID: 26760816 DOI: 10.1590/s1679-45082011ao1848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify decrease in frequency and severity of oral mucositis in patients submitted to dental care and laser therapy during allogeneic hematopoietic cell transplant. METHODS Medical records of patients submitted or not to dental care associated with laser therapy during allogeneic transplant were reviewed. The following data were collected: sex, age, underlying disease, myeloablative conditioning regimens, prophylaxis for graft versus host disease, extension and severity of oral mucositis, pain in the oral cavity and when swallowing, diarrhea, need of peripheral parenteral nutrition and presence of acute graft versus host disease. RESULTS Significant reduction in extension and severity of oral mucositis, as well as in frequency of oral cavity pain, was observed in patients with dental care/laser therapy (p < 0.01). There were no statistically significant differences regarding frequency of diarrhea, pain when swallowing, and need of parenteral nutrition among the groups. Significant association was found between acute graft versus host disease and pain when swallowing (p < 0.01). Acute graft versus host disease was not associated with oral mucositis severity, oral cavity pain, and diarrhea. CONCLUSION Dental care associated with laser therapy reduces the extension and severity of oral mucositis in patients with allogeneic hematopoietic transplant. Further studies are necessary to clarify the isolate efficacy of laser therapy in these conditions, mainly regarding the influence of reduced oral mucositis on the graft versus host disease.
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Affiliation(s)
| | | | | | | | | | | | - Luciana Correa
- Department of General Pathology, College of Dentistry, Universidade de São Paulo - USP, São Paulo, SP, BR
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Bezinelli L, Eduardo F, Neves V, Correa L, Lopes R, Michel-Crosato E, Hamerschlak N, Biazevic M. Quality of life related to oral mucositis of patients undergoing haematopoietic stem cell transplantation and receiving specialised oral care with low-level laser therapy: a prospective observational study. Eur J Cancer Care (Engl) 2015; 25:668-74. [DOI: 10.1111/ecc.12344] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- L.M. Bezinelli
- Dentistry School; Universidade de São Paulo (FOUSP); São Paulo Brazil
- Department of Hematopoietic Stem Cell Transplantation; Hospital Israelita Albert Einstein (HIAE); São Paulo Brazil
| | - F.P. Eduardo
- Department of Hematopoietic Stem Cell Transplantation; Hospital Israelita Albert Einstein (HIAE); São Paulo Brazil
| | - V.D. Neves
- Dentistry School; Universidade de São Paulo (FOUSP); São Paulo Brazil
| | - L. Correa
- Dentistry School; Universidade de São Paulo (FOUSP); São Paulo Brazil
| | - R.M.G. Lopes
- Department of Hematopoietic Stem Cell Transplantation; Hospital Israelita Albert Einstein (HIAE); São Paulo Brazil
| | - E. Michel-Crosato
- Dentistry School; Universidade de São Paulo (FOUSP); São Paulo Brazil
| | - N. Hamerschlak
- Clinical Research Center; Department of Hematopoietic Stem Cell Transplantation; Hospital Israelita Albert Einstein (HIAE); São Paulo Brazil
| | - M.G.H. Biazevic
- Dentistry School; Universidade de São Paulo (FOUSP); São Paulo Brazil
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12
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Eduardo FDP, Bezinelli LM, de Carvalho DLC, Lopes RMDG, Fernandes JF, Brumatti M, Vince CSC, de Azambuja AMP, Vogel C, Hamerschlak N, Correa L. Oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: clinical outcomes in a context of specialized oral care using low-level laser therapy. Pediatr Transplant 2015; 19:316-25. [PMID: 25677170 DOI: 10.1111/petr.12440] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 01/27/2023]
Abstract
OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff.
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Curra M, Pellicioli ACA, Filho NAK, Ochs G, Matte Ú, Filho MS, Martins MAT, Martins MD. Photobiomodulation reduces oral mucositis by modulating NF-kB. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:125008. [PMID: 26720873 DOI: 10.1117/1.jbo.20.12.125008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate NF-kB during 5-fluorouracil (FU)-induced oral mucositis and ascertain whether photobiomodulation (PBM), as a preventive and/or therapeutic modality, influences this transcription factor. Ninety-six male golden Syrian hamsters were allocated into four groups: control (no treatment); PBM therapeutic, PBM preventive, and PBM combined. Animals received an injection of 5-FU on days 0 and 2. On days 3 and 4, the buccal mucosa was scratched. Irradiation was carried out using a 660-nm, 40-mW diode laser at 6 J/cm(2) during 6 s/point, 0.24 J/point, for a total dose of 1.44 J/day of application. Animals were euthanized on days 0, 5, 10, and 15 (n=6). Buccal mucosa was removed for protein quantification by Western blot. Clinical analysis revealed that PBM groups exhibited less mucositis than controls on day 10. Control animals exhibited lower levels of NF-kB during mucositis development and healing. The preventive and combined protocols were associated with higher NF-kB levels at day 5; however, the therapeutic group had higher levels at days 10 and 15. These findings suggest that the preventive and/or therapeutic PBM protocols reduced the severity of oral mucositis by activating the NF-kB pathway.
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Affiliation(s)
- Marina Curra
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Ana Carolina Amorim Pellicioli
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Nélson Alexandre Kretzmann Filho
- Hospital de Clínicas de Porto Alegre, Department of Gene Therapy, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul 90950-000, Brazil
| | - Gustavo Ochs
- Hospital de Clínicas de Porto Alegre, Department of Gene Therapy, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul 90950-000, Brazil
| | - Úrsula Matte
- Hospital de Clínicas de Porto Alegre, Department of Gene Therapy, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul 90950-000, Brazil
| | - Manoel Sant'Ana Filho
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Marco Antonio Trevizani Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
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Muñoz-Corcuera M, González-Nieto A, López-Pintor Muñoz RM. [Use of laser for the prevention and treatment of oral mucositis induced by radiotherapy and chemotherapy for head and neck cancer]. Med Clin (Barc) 2014; 143:170-5. [PMID: 24216016 DOI: 10.1016/j.medcli.2013.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Marta Muñoz-Corcuera
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España.
| | - Almudena González-Nieto
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España
| | - Rosa María López-Pintor Muñoz
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España
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de Paula Eduardo F, Bezinelli LM, da Graça Lopes RM, Nascimento Sobrinho JJ, Hamerschlak N, Correa L. Efficacy of cryotherapy associated with laser therapy for decreasing severity of melphalan-induced oral mucositis during hematological stem-cell transplantation: a prospective clinical study. Hematol Oncol 2014; 33:152-8. [PMID: 24519448 DOI: 10.1002/hon.2133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/26/2013] [Indexed: 11/11/2022]
Abstract
Melphalan followed by hematopoietic stem-cell transplantation (HSCT) is the standard treatment for multiple myeloma and other hematopoietic neoplasms. However, high doses of melphalan cause severe oral mucositis (OM). The objective was to verify the efficacy of cryotherapy plus laser therapy on reduction of OM severity. HSCT patients undergoing melphalan chemotherapy (n = 71) were randomly divided into two groups according to OM treatment: oral cryotherapy performed with ice chips for 1 h 35 min followed by low-level laser therapy (InGaAIP, 660 nm, 40 mW, 6 J/cm(2) ) (n = 54) and laser therapy alone with the same protocol (n = 17). A control group (n = 33) was composed of HSCT patients treated with melphalan who received no specific treatment for OM. OM scores and clinical information were collected from D0 to D + 11. The cryotherapy/laser therapy group showed the lowest OM scores (maximum Grade I) and the lowest mean number of days (8 days) with OM in comparison with the other groups (p < 0.001). OM Grades III and IV were present with high frequency only in the control group. The association of cryotherapy with laser therapy was effective in reducing OM severity in HSCT patients who underwent melphalan conditioning.
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Affiliation(s)
| | - Leticia Mello Bezinelli
- Unit of Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Social Dentistry, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Nelson Hamerschlak
- Unit of Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luciana Correa
- General Pathology Department, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Freitas ACC, Campos L, Brandão TB, Cristófaro M, Eduardo FDP, Luiz AC, Marques MM, Eduardo CDP, Simões A. Chemotherapy-induced oral mucositis: effect of LED and laser phototherapy treatment protocols. Photomed Laser Surg 2014; 32:81-7. [PMID: 24476495 DOI: 10.1089/pho.2013.3576] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Over the last few decades, many studies have focused on the effect of lasers on the management of oral mucositis in oncologic patients treated with chemotherapy and/or radiotherapy. However, the effect of light-emitting diode (LED) has been poorly studied, and was not compared with that of laser phototherapy (LPT). For this reason, the aim of the present study was to clinically compare the effect of these two therapies on chemotherapy-induced oral mucositis (CIOM) and pain. METHODS Forty patients with CIOM were divided into two groups: G1, patients treated with LPT; G2, patients treated with LED. The treatment was administered during 10 consecutive days, with exception of weekends. LPT was applied using an InGaAlP laser (660 nm/40 mW/6.6 J cm-(2)/0.24 J per point/0.036 cm(2) of spot size). LED phototherapy was applied using 0.24 J per point/80 mW/630 nm/1 cm(2) of spot size. CIOM was assessed during each session in accordance to the World Health Organization (WHO) score. The patient self-assessed pain was scored on a visual analog scale (VAS). RESULTS The mean VAS and WHO scores were significantly smaller in the LED group (p<0.05). However, both groups required the same number of days to reach score zero for mucositis and pain (p>0.05). Moreover, in the group with severe mucositis (score III), there was a lower frequency of patients with complete healing and pain relief, with the exception of analgesia in G2, in which almost all patients were completely relieved from pain. CONCLUSIONS These findings suggest that LED therapy is more effective than LPT in the treatment of COIM, with the parameters used in the present study.
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Affiliation(s)
- Ana Carolina Carneiro Freitas
- 1 Departamento de Biomateriais e Biologia Oral, Faculdade de Odontologia - Universidade de São Paulo , São Paulo, SP, Brazil
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Lopez TCC, Martins MD, Pavesi VCS, Ferreira LS, Bussadori SK, Moreira MS, Marques MM. Effect of laser phototherapy in the prevention and treatment of chemo-induced mucositis in hamsters. Braz Oral Res 2013; 27:342-8. [DOI: 10.1590/s1806-83242013005000019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/13/2013] [Indexed: 11/22/2022] Open
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Bezinelli LM, de Paula Eduardo F, da Graça Lopes RM, Biazevic MGH, de Paula Eduardo C, Correa L, Hamerschlak N, Michel-Crosato E. Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation. Hematol Oncol 2013; 32:31-9. [DOI: 10.1002/hon.2050] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/01/2013] [Accepted: 03/09/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Letícia Mello Bezinelli
- Unit of Bone Marrow Transplantation; Hospital Israelita Albert Einstein; São Paulo Brazil
- Department of Social Dentistry; Universidade de São Paulo; São Paulo Brazil
| | | | | | | | - Carlos de Paula Eduardo
- Department of Restorative Dentistry (LELO-Special Laboratory of Lasers in Dentistry), School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Luciana Correa
- General Pathology Department, School of Dentistry; Universidade de São Paulo; São Paulo Brazil
| | - Nelson Hamerschlak
- Unit of Bone Marrow Transplantation; Hospital Israelita Albert Einstein; São Paulo Brazil
- Centro de Pesquisa Clínica; Instituto Israelita de Ensino e Pesquisa Albert Einstein; São Paulo Brazil
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Oton-Leite AF, Elias LSA, Morais MO, Pinezi JCD, Leles CR, Silva MAGS, Mendonça EF. Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy. SPECIAL CARE IN DENTISTRY 2012; 33:294-300. [DOI: 10.1111/j.1754-4505.2012.00303.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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20
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Migliorati C, Hewson I, Lalla RV, Antunes HS, Estilo CL, Hodgson B, Lopes NNF, Schubert MM, Bowen J, Elad S. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Support Care Cancer 2012; 21:333-41. [PMID: 23001179 DOI: 10.1007/s00520-012-1605-6] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to review the available literature and define clinical practice guidelines for the use of laser and other light therapies for the prevention and treatment of oral mucositis. METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible. RESULTS A new recommendation was made for low-level laser (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm(2) (2 s/point)) for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation. A new suggestion was made for low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. No guideline was possible in other populations and for other light sources due to insufficient evidence. CONCLUSIONS The increasing evidence in favor of low-level laser therapy allowed for the development of two new guidelines supporting this modality in the populations listed above. Evidence for other populations was also generally encouraging over a range of wavelengths and intensities. However, additional well-designed research is needed to evaluate the efficacy of laser and other light therapies in various cancer treatment settings.
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Affiliation(s)
- Cesar Migliorati
- Department of Diagnostic Sciences and Oral Medicine, College of Dentistry, University of Tennessee Health Sciences Center, 875 Union Avenue, suite N231, Memphis, TN 38163, USA.
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Ramalho KM, Luiz AC, de Paula Eduardo C, Tunér J, Magalhães RP, Gallottini Magalhães M. Use of laser phototherapy on a delayed wound healing of oral mucosa previously submitted to radiotherapy: case report. Int Wound J 2011; 8:413-8. [PMID: 21496209 PMCID: PMC7950754 DOI: 10.1111/j.1742-481x.2011.00788.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Radiotherapy produces both acute and delayed effects on mucosal tissues, disturbing their healing. This report shows a successful treatment with laser phototherapy (LPT) on a delayed wound healing in oral mucosa previously submitted to radiotherapy with a follow up of 3 years. A 47-year-old patient treated 6 months earlier for tongue squamous cell carcinoma by surgery and radiotherapy presented with a mass in the operated area. Biopsy showed chronic inflammatory infiltrate around a residual polyglactin suture. After 2 months there was a painful mucosal dehiscence on the biopsy site. LPT was performed using a semiconductor laser with 660-nm wavelength (InGaAlP) and spot size of 0·04 cm(2) . The parameters applied were 40 mW, 4 Jcm(2) /point, 0·16 J/point, 2·4 J/session. The irradiation was performed punctually, through contact mode in 15 points (4 seconds/point), on top of and around the lesion, during ten sessions. The wound healed completely after ten sessions. This treatment proved to be conservative and effective, inducing healing of a chronic wound in a tissue previously submitted to radiotherapy.
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Affiliation(s)
- Karen M Ramalho
- Stomatology Department, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil
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A randomized controlled trial of visible-light therapy for the prevention of oral mucositis. Oral Oncol 2011; 47:125-30. [DOI: 10.1016/j.oraloncology.2010.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/16/2010] [Accepted: 11/22/2010] [Indexed: 01/01/2023]
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Eduardo FDP, Bezinelli LM, Hamerschlak N, Andrade CT, Morelli LR, Corrêa L. Oral care in Brazilian bone marrow transplant centers. Rev Bras Hematol Hemoter 2011; 33:15-20. [PMID: 23284237 PMCID: PMC3521429 DOI: 10.5581/1516-8484.20110008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/05/2010] [Indexed: 11/30/2022] Open
Abstract
Background Oral care is a fundamental procedure for the success of the hematopoietic stem cell transplantation, particularly regarding the control of oral infectious diseases. Information about oral care protocols and the inclusion of dental professionals in transplantation medical staff is poorly known. Objective The aim of this study was to carry out a survey about the protocols of Brazilian dental professionals with regard to oral care of HSCT patients. Methods A questionnaire was mailed to 36 Brazilian transplant centers with questions about basic oral care protocols, the indication of specific mouthwashes, antibiotic therapy regimens, laser therapy, and treatment of oral mucositis and graft-versus-host disease. All the respondent centers (n = 12) have dentists as members of the HSCT medical staff. Results The majority indicate non-alcoholic chlorhexidine (n = 9; 75.0%) and sodium bicarbonate (n = 5; 41.7%) as routine mouthwashes. Laser therapy was frequently indicated (n= 9; 75.0%), mainly in the prevention of oral mucositis and in oral pain control. In the post-transplant period, antibiotic therapy was only indicated for invasive dental treatments (n= 8; 66.7%). Several treatments for graft-versus-host disease were mentioned without a trend towards establishing a standard protocol. Conclusion Basic oral care constitutes regular assessment in the routine treatment of hematopoietic stem cell transplantation patients in Brazilian centers.
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