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Chan X, Tay L, Yap SJ, Wu VX, Klainin-Yobas P. Effectiveness of Photobiomodulation and Oral Cryotherapy on Oral Mucositis Among Patients Undergoing Chemotherapy Conditioning Prior to Hematological Stem Cell Transplantation. Semin Oncol Nurs 2023; 39:151405. [PMID: 36935333 DOI: 10.1016/j.soncn.2023.151405] [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: 07/04/2022] [Revised: 12/16/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES This review evaluated the best available evidence concerning the effectiveness of photobiomodulation compared to oral cryotherapy in oral-mucositis prevention among patients with hematological stem cell transplantation (HSCT) receiving chemo-conditioning. DATA SOURCES An extensive search for published and unpublished studies was conducted in 11 electronic databases and reference lists. Only randomized controlled trials (RCTs) were included. Two reviewers independently screened relevant studies for eligibility, extracted data using a standardized data collection form, and appraised data using the Cochrane Risk of Bias Tool and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analyses using a random-effect model was performed using Review Manager software. Subgroup analyses were conducted to examine the differential effect of interventions across subgroups and to explore potential sources of heterogeneity. Meta-analyses included 18 RCTs (involving 1,018 patients). Both photobiomodulation and cryotherapy were effective in reducing oral-mucositis severity, severe oral-mucositis incidence, duration, and pain with small to large effect sizes. No significant differences were detected between photobiomodulation and cryotherapy across all outcomes. Subgroup analyses showed significant differences for chemo-conditioning regimens. The overall Grading Recommendations, Assessment, Development and Evaluation quality of evidence was low. CONCLUSION Both photobiomodulation and cryotherapy were effective nonpharmacological oral-mucositis prophylaxis and analgesia, with no significant difference in effectiveness. Chemo-conditioning regimens may influence their effectiveness. Future RCTs may directly compare the effectiveness of photobiomodulation and cryotherapy on the HSCT patients. Rigorous cost-effectiveness studies are also required. IMPLICATIONS FOR NURSING PRACTICE Photobiomodulation and cryotherapy can be offered to HSCT patients in clinical settings. A clinical guideline of both interventions can be also developed.
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Affiliation(s)
- Xin Chan
- Staff nurse, Alexandra Hospital, Singapore, Singapore
| | - Lyn Tay
- Staff nurse. National University Hospital, Singapore, Singapore
| | - Shi Jed Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vivien Xi Wu
- Assistant Professor, Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Associate ProfessorAlice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, Singapore, Singapore.
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Colella G, Boschetti CE, Vitagliano R, Colella C, Jiao L, King-Smith N, Li C, Nuoh Lau Y, Lai Z, Mohammed AI, Cirillo N. Interventions for the Prevention of Oral Mucositis in Patients Receiving Cancer Treatment: Evidence from Randomised Controlled Trials. Curr Oncol 2023; 30:967-980. [PMID: 36661723 PMCID: PMC9858113 DOI: 10.3390/curroncol30010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Oral mucositis is a common and most debilitating complication associated with cancer therapy. Despite the significant clinical and economic impact of this condition, there is little to offer to patients with oral mucositis, and the medications used in its management are generally only palliative. Given that mucositis is ultimately a predictable and, therefore, potentially preventable condition, in this study we appraised the scientific literature to evaluate effective methods of prevention that have been tested in randomised controlled trials (RCTs). Published high-level evidence shows that multiple preventative methods are potentially effective in the prevention of oral mucositis induced by radiotherapy, chemotherapy, or both. Anti-inflammatory medications (including benzydamine), growth factors and cytokines (including palifermin), cryotherapy, laser-and-light therapy, herbal medicines and supplements, and mucoprotective agents (including oral pilocarpine) showed some degree of efficacy in preventing/reducing the severity of mucositis with most anticancer treatments. Allopurinol was potentially effective in the prevention of radiotherapy-induced oral mucositis; antimicrobial mouthwash and erythropoietin mouthwash were associated with a lower risk of development of severe oral mucositis induced by chemotherapy. The results of our review may assist in highlighting the efficacy and testing the effectiveness of low-cost, safe preventative measures for oral mucositis in cancer patients.
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Affiliation(s)
- Giuseppe Colella
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Emiliano Boschetti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Rita Vitagliano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Chiara Colella
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Lebei Jiao
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Natalie King-Smith
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Chong Li
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Yii Nuoh Lau
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Zacchaeus Lai
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Ali Ibrahim Mohammed
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
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Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:626-641. [PMID: 36870898 DOI: 10.1016/j.oooo.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our objective was to review the first 20 years of photobiomodulation (PBM) clinical studies for oral mucositis (OM) mitigation. STUDY DESIGN A scoping review screened controlled clinical studies. The PBM devices, protocols, and clinical outcomes were analyzed. RESULTS Seventy-five studies met the inclusion criteria. The first study dated from 1992, and the term "PBM" was first published in 2017. Public services, placebo-controlled randomized trials, and patients with head and neck chemoradiation were predominant among included studies. Prophylactic red intraoral laser protocols were mostly used. Comparing the outcomes of all protocols was unfeasible due to missing treatment parameters and nonhomogeneous measurements. CONCLUSIONS The main barrier to optimizing clinical protocols of PBM for OM was the lack of standardization in clinical studies. Although PBM use is now globally present in oncology settings and generally marked by good outcomes reported, additional randomized clinical trials with well-described methods are necessary.
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Biala M. Low-Level Laser Therapy: A Literature Review of the Prevention and Reduction of Oral Mucositis in Patients Undergoing Stem Cell Transplantation. Clin J Oncol Nurs 2022; 26:293-299. [PMID: 35604727 DOI: 10.1188/22.cjon.293-299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oral mucositis (OM) is a highly debilitating complication of high-dose chemotherapy and total body irradiation used in conditioning regimens for hematopoietic stem cell transplantation (HSCT). Research has studied low-level laser therapy (LLLT) as an alternative treatment for OM because of its anti-inflammatory activity, biomodulation, and analgesic effects. OBJECTIVES This study reviews evidence on the effectiveness of LLLT using diode lasers on the prevention and reduction in severity of OM in patients with cancer undergoing HSCT. METHODS A literature search was performed in PubMed®, CINAHL®, Scopus®, and MEDLINE® databases. Six randomized controlled trials and one cohort study met the inclusion criteria. FINDINGS The data demonstrate promising outcomes for reducing the incidence and severity of OM using LLLT. Larger, tightly controlled clinical trials are needed in the future.
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Most used photobiomodulation dosimetry parameters to treat oral mucositis after preconditioning for hematopoietic stem cell transplantation: systematic review and meta-analysis. Support Care Cancer 2022; 30:3721-3732. [PMID: 35013780 DOI: 10.1007/s00520-022-06817-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
Parameter reproducibility in photobiomodulation therapy (PBMT) is still scarce in literature for the management of oral mucositis (OM). This study aimed to identify the most used PBMT dosimetry parameters (DP) and their efficacy in OM management after preconditioning for hematopoietic stem cell transplantation (HSCT). This research was conducted according to the PRISMA guidelines. The search for primary studies was in PubMed/MEDLINE, Web of Science, Embase, BVS, and Cochrane Library. Gray literature was verified on BDTD-Ibict and Open Gray. A total of 1044 studies were identified. Nine met the eligibility criteria for qualitative assessment and 7 for meta-analysis. The studies involved 396 patients submitted to preconditioning for HSCT, 211 with PBMT and 185 without PBMT in the OM management. The WHO scale was the most used to assess OM degree. The most used parameters were 660-nm wavelength, 40-mw power, 0.16-J energy, 1-W/cm2 power density, 4-J/cm2 energy density, and 0.04-cm2 spot size. The meta-analysis demonstrated that PBMT decreased the severity of OM, with a protection factor 20% higher than the control group (without PBMT), and when the parameters are similar to the DP mentioned, the protection factor increases to 94%. These most used DP with similarity seem to be a therapeutic strategy for the management of OM in this population.
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Stolze J, Boor M, Hazenberg MD, Brand HS, Raber-Durlacher JE, Laheij AMGA. Oral health-related quality of life of patients with oral chronic graft-versus-host disease. Support Care Cancer 2021; 29:6353-6360. [PMID: 33884507 PMCID: PMC8464572 DOI: 10.1007/s00520-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
Purpose Symptoms of oral chronic graft-versus-host-disease (cGVHD) may significantly affect the oral health–related quality of life (OHRQoL). This study aimed to assess the OHRQoL in patients with oral cGVHD and to examine whether oral cGVHD symptoms, mucosal cGVHD, and salivary gland function correlated with OHRQoL. Methods Patients referred to the oral cGVHD outpatient clinic were included. Severity of oral mucosal cGVHD, oral cGVHD symptoms, and OHRQoL was assessed by the NIH OMS, NIH OSS, and OHIP-14, respectively. Unstimulated and stimulated whole salivary flow rates were determined and categorized into “hyposalivation,” “normal salivary flow,” and “hypersalivation.” Results Of 56 included patients, 80% had mild, moderate, or severe oral mucosal cGVHD. Mean total score of OHRQoL was 16.5 (±11.7), negatively affected by functional problems. Patients reported highest scores regarding oral sensitivity and xerostomia. Significant correlations were found between severity of oral pain and OHRQoL and between oral sensitivity and OHRQoL. No correlation was found between oral mucosal cGVHD and OHRQoL. Patients with hyposalivation, normal salivary flow, and hypersalivation reported equal levels of OHRQoL. Conclusion Results demonstrate that the OHRQoL was mostly negatively affected by complaints of oral pain and oral sensitivity and less by the severity of oral mucosal cGVHD assessed by the NIH OMS score. Special attention of (oral) health care professionals for patients with oral cGVHD is mandatory to alleviate their symptoms and improve OHRQoL.
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Affiliation(s)
- Juliette Stolze
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands
- Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marlou Boor
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands
| | - Mette D Hazenberg
- Department of Hematology Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands
- Department of Oral Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands.
- Department of Preventive Dentistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Lai CC, Chen SY, Tu YK, Ding YW, Lin JJ. Effectiveness of low level laser therapy versus cryotherapy in cancer patients with oral mucositis: Systematic review and network meta-analysis. Crit Rev Oncol Hematol 2021; 160:103276. [PMID: 33716203 DOI: 10.1016/j.critrevonc.2021.103276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/01/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this network meta-analysis was to analyze the relative effects of low level laser therapy (LLLT) and/or cryotherapy in cancer patients with oral mucositis (OM). METHODS This literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to 2020. Only randomized control trials which involved comparisons of groups receiving the interventions of combined cryotherapy and LLLT, LLLT, cryotherapy and usual care (the control group) in patients with cancer were eligible for inclusion. The effect sizes are presented as odds ratios for the occurrence of severe, moderate and none/mild OM. The mixed treatment comparison was conducted using generalized linear mixed models to analyze the direct and indirect comparisons of interventions. The critical appraisal was assessed using Cochrane Collaboration's tool. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot. RESULTS Twenty-six randomized controlled trials with a total enrollment of 1830 cancer patients with OM were included. The outcome of none/mild OM is desirable, and odds ratios of more than 1 favor the intervention group. Moderate and severe OM are defined as adverse outcomes, and ORs less than 1 favor the intervention group. The treatment effects of the combined cryotherapy and LLLT were better than those of usual care for none/mild and severe OM (ORs = 106.23 [95% CI = 12.15 to 929.17] and 0.01 [95% CI = 0 to 0.57], respectively). Treatment effects with cryotherapy alone and LLLT alone were better than those with usual care for none/mild and severe OM (ORs = 3.13 [95%CI = 1.56 to 6.27]; ORs = 7.56 [95%CI = 3.84 to 14.88] and 0.25 [95%CI = 0.11 to 0.54]; ORs = 0.13 [95%CI = 0.07 to 0.24], respectively). Nevertheless, for patients with none/mild OM, treatment effects with combined use of cryotherapy and LLLT were better than those with only LLT or cryotherapy (ORs = 14.06 [95%CI = 1.79 to 110.30] and 33.95 [95%CI = 3.50 to 329.65], respectively). For patients with moderate OM, treatment effect did not reach statistical significance among comparisons. The limitations include the wide variability in treatment protocols and the non-uniform outcome measurements across the studies examined. CONCLUSION Compared with no intervention, the treatment effects of combined cryotherapy and LLLT, laser alone, and cryotherapy alone are beneficial for the reduction of severe OM. There is no difference in treatment effects among cryotherapy and/or LLLT intervention in cancer patients with moderate OM. Results of this study provide an implicative basis for LLLT and cryotherapy as viable interventions that can significantly improve severe OM.
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Affiliation(s)
- Chih-Chin Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiau-Yee Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Wei Ding
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Martins AFL, Morais MO, de Sousa-Neto SS, de Jesus APG, Nogueira TE, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. Photobiomodulation reduces the impact of radiotherapy on oral health-related quality of life due to mucositis-related symptoms in head and neck cancer patients. Lasers Med Sci 2020; 36:903-912. [PMID: 33113075 DOI: 10.1007/s10103-020-03167-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
To assess the effectiveness of photobiomodulation therapy (PBMT) in the oral health-related quality of life (OHRQoL) of patients with head and neck cancer undergoing radiotherapy (RT), using the Oral Health Impact Profile-14 (OHIP-14) and the Patient-Reported Oral Mucositis (OM) Symptoms Scale (PROMS), and to correlate OM degree with the PROMS and OHIP-14 scores. Forty-eight patients undergoing RT for head and neck cancer were randomly assigned into two groups: PBMT group (n = 25)-daily PBMT associated with a preventive oral care program (POCP); and control group (n = 23)-receiving POCP exclusively. OHRQoL was assessed using the PROMS and OHIP-14 questionnaires. OM degrees were classified according to the World Health Organization and the National Cancer Institute scales. Assessments were performed at the 1st, 7th, 14th, 21st, and 30th RT sessions. PBMT was effective in preventing and treating severe OM. Both groups showed increased OHRQoL impacts throughout the RT sessions; however, higher impacts were observed in the control group, mainly at the final stage of treatment (21st and 30th RT sessions). Significant correlations were found between the severity of OM and PROMS scores in the total sample and the control group at all RT periods. PROMS and OM scores were positive correlated at 14th, 21st, and 30th RT sessions in the control group, suggesting that this instrument is useful in classifying OM. PBMT was effective in treating and preventing severe OM and OM-related symptoms, and with consequent positive impacts in OHRQoL in head and neck patients undergoing RT. The PROMS scale was helpful instrument for assessment of the severity of OM. Brazilian Clinical Trials database (ReBEC - RBR-5h4y4n), registered in Aug, 24th 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Marília Oliveira Morais
- Hospital de Câncer Araújo Jorge, R. 239, 206 - Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Ana Paula Gonçalves de Jesus
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Tulio Eduardo Nogueira
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratório de Farmacologia e Toxicologia Celuular, Faculdade de Farmácia, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n, Setor Universitário, Goiânia, Goiás, 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Departamento de Radioterapia, Hospital de Câncer Araújo Jorge, R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Aline Carvalho Batista
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio Rodrigues Leles
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.
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Mohsen A, Tenore G, Rocchetti F, Del Vecchio A, Ricci R, Barberi W, Cartoni C, Iori AP, Pippi R, Polimeni A, Romeo U. Photo-Biomodulation as a Prevention Modality of Oral Mucositis in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. APPLIED SCIENCES 2020; 10:7479. [DOI: 10.3390/app10217479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The aim of the study was to observe the effectiveness of a photo-biomodulation (PBM) protocol for the prevention of oral mucositis (OM) in patients undergoing allogeneic hematopoietic stem cell transplantation (aHSCT). A case-control study was conducted on 40 patients undergoing aHSCT. The patients were divided into two groups; the preventive group (PG) included 20 patients (7 females and 13 males) who were subjected to intra-oral PBM for five sessions a week, starting one day before the conditioning regimen and continuing until the 10th day after transplantation (D+10). In each session, ten points on the at-risk mucosal surfaces were irradiated using a double diode laser that emits two wavelengths simultaneously at 650 nm and at 904–910 nm with the following parameters at each point: energy of 4 J, and power of 88.9 mW. The control group (CG) included 20 patients (10 females and 10 males) who were not subjected to laser therapy and were selected retrospectively to compare the obtained results. For all patients, OM was assessed by the World Health Organization (WHO) grading scale. Eight patients in the PG did not experience OM during their hospitalization period (with grade 0). Severe OM was observed in 40% of the patients in the PG, while in the CG, severe OM was shown in 85% of the patients. The mean duration of OM in the PG was significantly lower than that of CG (4.7 days in the PG and 15 days in the CG) (p < 0.001). The study demonstrated that the preventive PBM protocol reduced the severity and duration of OM in patients undergoing aHSCT.
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Miranda-Silva W, Knebel FH, Tozetto-Mendozo TR, Palmieri M, da Fonseca FP, Camargo AA, Braz-Silva PH, Fregnani ER. Herpesviruses in the oral cavity of patients subjected to allogeneic hematopoietic stem cell transplantation and its relationship with oral mucositis. Clin Oral Investig 2020; 24:3597-3608. [PMID: 32036434 DOI: 10.1007/s00784-020-03234-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study was performed to characterise oral shedding of herpesviruses in patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT) and to investigate its relationship with oral mucositis (OM). MATERIALS AND METHODS PCR and enzymatic digestion were conducted to identify oral shedding of herpesviruses and its correlation with OM development in 31 patients. The samples were collected at three sites in the oral cavity and at 5 times during follow-up; two additional collections were made from patients who developed ulcerative OM. RESULTS HSV-1, EBV, CMV, HHV-6A, HHV-6B, and HHV-7 were detected in 4.97%, 16.02%, 4.41%, 2.20%, 3.31%, and 68% of the oral mucosal samples, respectively; 4.41%, 16.57%, 5.52%, 2.20%, 5.52%, and 63.53% of supragingival samples, respectively, and 4.41%, 18.23%, 2.76%, 1.65%, 2.75%, and 35.91% of subgingival samples, respectively. OM was diagnosed in 13 patients. The presence of HHV-7 in C1 (oral mucosa: p = 0.032) and C2 (supragingival: p = 0.009; subgingival: p = 0.002) was significantly increased in patients who developed OM, and patients exhibiting HHV-7 shedding in the oral cavity were 3.32-fold more likely to develop OM. CONCLUSIONS Patients who developed OM showed higher HHV-7 shedding in the oral cavity at nadir (immediately prior to OM development), suggesting modifications to the inflammatory microenvironment. CLINICAL RELEVANCE HHV-7 may be involved in oral dysbiosis in HSCT-related OM; enhanced understanding of its role in the pathogenesis of OM may lead to the development of strategies for managing and preventing this common side effect of alloHSCT.
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Affiliation(s)
- Wanessa Miranda-Silva
- Department of Oral Medicine, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91-Bela Vista, São Paulo, SP, Brazil
| | | | | | - Michelle Palmieri
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Felipe Paiva da Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Paulo Henrique Braz-Silva
- Laboratory of Virology, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Eduardo Rodrigues Fregnani
- Department of Oral Medicine, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91-Bela Vista, São Paulo, SP, Brazil.
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Stolze J, Vlaanderen KCE, Raber-Durlacher JE, Brand HS. The impact of hematological malignancies and their treatment on oral health-related quality of life as assessed by the OHIP-14: a systematic review. Odontology 2020; 108:511-520. [PMID: 31955297 DOI: 10.1007/s10266-019-00479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
Patients with hematologic cancers often develop acute and chronic oral complications from their disease and its treatment. These problems could change patients' oral health-related quality of life (OHRQoL) negatively. Quality of life (QoL) has become an increasingly important outcome measure in oncology. This systematic literature review evaluates the impact of hematological malignancies and their treatment on OHRQoL as assessed by the Oral Health Impact Profile (OHIP-14) questionnaire. Medline through Pubmed and Web of Science were searched through April 2017. Two randomized controlled trials, one cohort study, one cross-sectional study, and one case-control study were included. Heterogeneity across the included studies did not allow for meta-analysis. OHIP-14 domains that were frequently given the highest scores were functional limitation (67%), physical pain (50%), physical disability (50%), and psychological discomfort (33%). The domains that were frequently given the lowest scores were social handicap (100%), social disability (100%), and psychological disability (67%). Insufficient evidence is available to draw any robust conclusions regarding OHRQoL assessed by the OHIP-14 in individuals with hematological malignancies. However, functional limitations because of problems with oral mucosal tissues, the dentition, or dentures, seem to have a larger negative impact on the OHRQoL than social aspects associated with oral health problems. Well-designed larger studies are required to determine effects of hematological malignancies as well as acute and long-term effects of their treatment on patients' OHRQoL.
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Affiliation(s)
- Juliette Stolze
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands
| | - Kim C E Vlaanderen
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands. .,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
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Parker S, Cronshaw M, Anagnostaki E, Bordin-Aykroyd SR, Lynch E. Systematic Review of Delivery Parameters Used in Dental Photobiomodulation Therapy. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:784-797. [PMID: 31573388 DOI: 10.1089/photob.2019.4694] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: This systematic review of published data critically appraises the consistency in the reported delivery parameters used in photobiomodulation (PBM) therapies research within clinical dentistry and makes reporting recommendations for future clinical protocols. Background: Key to the standardization of randomized clinical trials and associated peer-reviewed articles is the disclosure of all laser and light-emitting diode operating parameters. The current status shows a lack of full parameters and significantly impacts on the ability to integrate published data with current and future investigation into clinical PBM therapy. Materials and methods: Search engines, PubMed, Google Scholar, and Cochrane, were scanned for investigation into the effects of PBM therapy research within clinical dentistry. Key words "Low-Level-Laser," "PBM," "Photobiomodulation," "Oral" and "Therapy" were used and a total of 754 articles identified, spanning a period of 9 years and 1 month between February 2009 and March 2018. Only human clinical trials were considered. Fifty-two articles were included in this investigation and the reported basic delivery parameters used in PBM therapies research were considered for each clinical trial. Results: The overall reported basic delivery parameters used in PBM therapies research were too inadequate to be able to be replicated in further studies. These included parameters related to the power meter, beam cross-sectional dynamics, fluence, and wider aspects of dosimetry. Conclusions: The delivery parameters used in PBM therapy research within clinical dentistry, investigated in this study, presented a wide variation in their recording or nonrecording of all significant elements needed to have scientific validity. A constant inconsistency in delivering valid, reliable, PBM therapy doses, to target tissues was also identified. The lack of consensus in delivering a sound protocol for PBM therapy, is partly due to the lack of adequate reported materials and methods, which are essential for replication of individual studies. One way to resolve this problem is for Journals to insist on all comprehensive parameter records, used in PBM therapies, to be part of author guidelines in submitting articles of studies on PBM therapy in clinical dentistry.
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Affiliation(s)
- Steven Parker
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Mark Cronshaw
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Eugenia Anagnostaki
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | | | - Edward Lynch
- School of Dental Medicine, University of Nevada, Las Vegas, Nevada
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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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14
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Effect of photobiomodulation therapy on reducing the chemo-induced oral mucositis severity and on salivary levels of CXCL8/interleukin 8, nitrite, and myeloperoxidase in patients undergoing hematopoietic stem cell transplantation: a randomized clinical trial. Lasers Med Sci 2017; 32:1801-1810. [DOI: 10.1007/s10103-017-2263-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/11/2017] [Indexed: 12/16/2022]
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Preradiotherapy dental extractions and health-related quality of life. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:672-679. [DOI: 10.1016/j.oooo.2016.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/25/2016] [Accepted: 07/30/2016] [Indexed: 11/30/2022]
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Instruments to measure the quality of life in patients with oral mucositis undergoing oncological treatment: a systematic review of the literature. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:457-466. [PMID: 29421290 DOI: 10.1016/j.bmhimx.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Oral mucositis (OM) is an inflammatory reaction of the oropharyngeal mucosa to cumulative chemotherapy (CT) and radiation therapy (RT), affecting one or more parts of the digestive tract along with the quality of life (QoL) of the patient. The goal of this study was to identify valid and reliable tools to evaluate QoL related to OM. METHODS A systematic review of the literature was conducted up to May 2016. Articles were selected by peers using the PubMed database through a search following the inclusion and exclusion criteria and STAndards for the Reporting of Diagnostic accuracy studies (STARD) checklist with a cut-off point ≥ 70%. RESULTS We identified four relevant articles that described instruments to assess the QoL related to OM in patients undergoing cancer treatment. CONCLUSIONS The evaluation of the QoL in patients with OM is a difficult scenario because of its multiple variables. The knowledge of this relationship is limited because general instruments of oral health or cancer therapy are commonly used for evaluation. However, valid instruments are already available for estimating the impact of OM on the QoL from the patient's perspective.
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