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Braguês R, Marvão MF, Correia P, Silva RM. Oral Mucositis Management in Children under Cancer Treatment: A Systematic Review. Cancers (Basel) 2024; 16:1548. [PMID: 38672630 PMCID: PMC11048343 DOI: 10.3390/cancers16081548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as cryotherapy, low-level laser therapy, and natural compounds for this condition. The aim of this systematic review was to identify and compare therapies for the management of cancer treatment-induced oral mucositis in pediatric patients. From 2655 articles obtained in initial searches, 39 articles were considered in this systematic review, after applying inclusion/exclusion criteria. Low-level laser therapy, palifermin, honey, and zinc demonstrated reductions in oral mucositis incidence, duration, severity, and pain reported by the patient. Although there are several therapies in place for the prevention and treatment of oral mucositis in children, evidence of their efficacy is still inconclusive to establish accurate clinical protocols.
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Affiliation(s)
- Ricardo Braguês
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
| | - Maria Francisca Marvão
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
| | - Patrícia Correia
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
- Universidade Católica Portuguesa, Center for Interdisciplinary Research in Health (CIIS), 3504-505 Viseu, Portugal
| | - Raquel M. Silva
- Universidade Católica Portuguesa, Faculty of Dental Medicine, 3504-505 Viseu, Portugal; (R.B.); (M.F.M.); (P.C.)
- Universidade Católica Portuguesa, Center for Interdisciplinary Research in Health (CIIS), 3504-505 Viseu, Portugal
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Pritchard M, Ogg SW, Bosi J, Mandrell BN. Utilization of Photobiomodulation for the Prevention and Treatment of Oral Mucositis. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:107-113. [PMID: 38377968 DOI: 10.1177/27527530231214525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Background: Oral mucositis is a significant and common toxicity experienced by patients who receive high-dose chemotherapy as a preparatory regimen for a hematopoietic cell transplant (HCT). Photobiomodulation (PBM) has been found to be feasible with significant efficacy in preventing the progression of oral mucositis in adult patients undergoing HCT. The purpose of this study was to determine the feasibility and efficacy of PBM in pediatric oncology patients undergoing HCT. Method: Forty children and adolescents admitted to the transplant unit for an allogeneic HCT for acute lymphoblastic leukemia or acute myeloid leukemia were treated daily at six sites until day + 20 or engraftment. Results: There were 1,035 patient encounters, with successful treatment of four or more sites during 979 patient encounters for a feasibility 93.3% CI [0.926, 0.039]. We had estimated a meaningful effect size of 20% for PBM and estimated 51% of patients treated with PBM would have at least one day or more of Grade 3 mucositis. The rate of patients who received PBM and developed Grade 3 mucositis was 20% CI [0.091, 0.356]. Patients treated with PBM had fewer days of hospitalization (p = .009) and less severe mucositis in comparison to the matched control group (p = .03). Conclusion: PBM is feasible and effective in preventing and treating oral mucositis and is now supported by the Children's Oncology Group for prevention and treatment of oral mucositis in patients undergoing an allogeneic HCT or receiving head/neck radiation.
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Affiliation(s)
- Michele Pritchard
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Susan W Ogg
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Judy Bosi
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
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da Cruz Santos LB, Ramos-Pinto MB, Zerbato RM, Ferreira MEMG, Schmidt-Filho J, Martins MD, Alves FA. Window therapeutic of extraoral photobiomodulation for prevention of oral mucositis in HSCT patients: additional arm. Support Care Cancer 2023; 32:27. [PMID: 38097854 DOI: 10.1007/s00520-023-08243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE This study aimed to evaluate the efficacy of 1W extraoral photobiomodulation (EOPBM) and to compare with our previous results of 2W EOPBM and intraoral photobiomodulation (IOPBM) protocols in the management of oral mucositis (OM) related to hematopoietic stem cell transplantation (HSCT). METHODS A total of 30 patients underwent autologous or allogenic HSCT. Experimental protocol of 1W EOPBM was performed daily beginning in the first day of the conditioning regimen until 5 days after transplantation. The application areas included six points on the face and three points on the cervical area. Additional application of IOPBM was performed if patients had ulcered mucositis. Its severity was assessed daily according to WHO (World Health Organization) and NCI (National Cancer Institute) scales. Oral and oropharynx pains were scored daily by visual analogue scale (VAS). RESULTS The 1W EOPBM protocol was well tolerated without any complaints. Of total, 13 patients were male and 17 were female and the mean age was 49.3 years old. Most patients (21 patients - 70%) received autologous HSCT, and 24 patients (80%) underwent myeloablative conditioning (MAC) regime and 6 patients (20%) reduced intensive conditioning regime. Nineteen patients (63.3%) developed OM according to WHO criteria, 3 patients grade I, 10 grade II and 6 grade III. NCI mucositis grades were similar to WHO grades. OM outcomes of 1W EOPBM were similar when compared to our previous groups and no significant differences were observed. No differences were found between pain and the protocols (1W EOPBM, IOPBM and 2W EOPBM). CONCLUSION This 1W EOPBM protocol seemed to be as effective as IOPBM and 2W EOPBM in the prevention of OM in HSCT patients. In addition, we might assume that there is a window of application on EOPBM.
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Affiliation(s)
- Letícia Beatriz da Cruz Santos
- Stomatology Department, A.C. Camargo Cancer Center, R: Prof. Antônio Prudente, 211, Bairro: Liberdade, São Paulo, 01509-900, Brazil
| | - Mariana Bitu Ramos-Pinto
- Stomatology Department, A.C. Camargo Cancer Center, R: Prof. Antônio Prudente, 211, Bairro: Liberdade, São Paulo, 01509-900, Brazil
| | - Rodolfo Maestrello Zerbato
- Stomatology Department, A.C. Camargo Cancer Center, R: Prof. Antônio Prudente, 211, Bairro: Liberdade, São Paulo, 01509-900, Brazil
| | | | | | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Fabio Abreu Alves
- Stomatology Department, A.C. Camargo Cancer Center, R: Prof. Antônio Prudente, 211, Bairro: Liberdade, São Paulo, 01509-900, Brazil.
- Stomatology Department, School of Dentistry, Sao Paulo University, Sao Paulo, Brazil.
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Khalil M, Hamadah O, Saifo M. Preconditioning with Photobiomodulation as an Effective Method in Preventing Chemotherapy-Induced Oral Mucositis: A Systematic Review. Photobiomodul Photomed Laser Surg 2023; 41:597-607. [PMID: 37976239 DOI: 10.1089/photob.2023.0075] [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] [Indexed: 11/19/2023] Open
Abstract
Background: Given the suffering experienced by cancer patients, effective solutions must be found to prevent the most painful and debilitating side effects of anticancer treatment. The use of photobiomodulation (PBM) with specific parameters has been proposed to prevent oral mucositis in adults undergoing hematopoietic stem cell transplantation as well as in head and neck cancer patients receiving radiotherapy alone without chemotherapy. No recommendations were possible for patients undergoing chemotherapy alone. This systematic review aims to analyze the effectiveness of preconditioning by PBM in preventing chemotherapy-induced oral mucositis. Methods: This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA, Checklist and registered at the International Prospective Register of Systematic Reviews (PROSPERO). We searched and identified articles of the subsequent bibliographic databases: PubMed and Cochrane. Revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used to assess the risk of bias of studies included in this review. Results: There were only six clinical trials examining the efficacy of PBM therapy in the primary prevention of chemotherapy-induced oral mucositis. All of the studies used lasers, except for one study that compared lasers with light-emitting diodes. The wavelength ranges from 630 to 830 nm. Irradiation parameters varied among the included studies. All studies showed good results for the use of PBM in the prevention of oral mucositis except for one study that found no benefit for the laser application. Conclusions: PBM has been shown to be effective in preventing oral mucositis when applied to healthy tissues. Finding the optimal protocol has been difficult due to the variability between studies, and therefore, further well-designed, controlled, blinded studies are recommended to precisely determine irradiation parameters and the number of sessions. This review has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023397771.
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Affiliation(s)
- Marwa Khalil
- Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Omar Hamadah
- Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria
- The Higher Institute for Laser Research and Applications, Damascus University, Damascus, Syria
| | - Maher Saifo
- Department of Medical Oncology, Faculty of Medicine, Damascus University, Damascus, Syria
- Albairouni University Hospital, Damascus University, Damascus, Syria
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Agbele AT, Dehpour AR, Jafari RM, Mahdavi SRM, Elyassi A, Seydi M, Bagheri M, Ala M, Roudsari BA, Hejazi M. Development and Application of Prototype System Based on Light-Emitting Diode Arrays (660 nm) with a Top Hat Beam Profile in Order to Optimize Photobiomodulation Protocols for Treatment of Radiation-Induced Oral Mucositis in Rats. Photobiomodul Photomed Laser Surg 2023; 41:622-631. [PMID: 37890115 DOI: 10.1089/photob.2023.0021] [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] [Indexed: 10/29/2023] Open
Abstract
Background: Oral mucositis (OM) is a common adverse effect of radiation to the head and neck. Recent research has shown that extra oral photobiomodulation (EO-PBM) reduces the severity of OM. However, appropriate EO-PBM therapy parameters for OM severity reduction have not been documented. Objective: This work aims to optimize EO-PBM radiation parameters for lowering the severity of radiation-induced OM in rats by establishing a photobiomodulation (PBM) treatment system based on light-emitting diode arrays with top-hat beam profile. Methods: The 36 rats are separated into 2 control groups and 4 groups receiving PBM treatment. The PBM groups are exposed to irradiance between 4 and 24 J/cm2 at 660 nm. The cheek pouch mucosa is removed after scarification for biochemical and histological examination. Student's t-test, and one-way analysis of variance (ANOVA) followed by Tukey's Multiple were applied to compare the statistical significance of differences between control groups and PBM treatment groups. Results: Statistical analysis reveals that PBM irradiation at 12 J/cm2 (200 sec) with a flatness of 0.8 and a diameter of 3 cm substantially decreased the level of inflammatory cytokines compared with the positive control group. Conclusions: Our results indicate that the designed treatment PBM system is capable of delivering the optical parameters necessary for therapeutic treatment.
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Affiliation(s)
- Alaba Tolulope Agbele
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Mohammad Jafari
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Rabi Mehdi Mahdavi
- Department of Cell Biology and Anatomy, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arash Elyassi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Seydi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Bagheri
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Ala
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Arji Roudsari
- Department of Cell Biology and Anatomy, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Marjaneh Hejazi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Cotomacio CC, Yshikawa BK, Calarga CC, Arana-Chavez VE, Simões A. Red, infrared, and simultaneous laser-wavelengths irradiation effects on 5-fluorouracil-induced oral mucositis in hamsters. JOURNAL OF BIOPHOTONICS 2023; 16:e202300156. [PMID: 37420314 DOI: 10.1002/jbio.202300156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
The association of more than one wavelength for photobiomodulation therapy (PBMT) to treat oral mucositis (OM) is unusual in the literature. Thus, this study aims to compare the simultaneous irradiation effects with their isolated application to treat OM. In order of that, 48 male Syrian hamsters were divided into 4 groups: Chemotherapy (Ch), which received only a OM induction protocol (5-fluorouracil chemotherapy and superficial oral mucosa scratches); red laser (RL), which received the OM induction and a PBMT protocol at 660 nm; infrared laser (IRL), which received the OM induction, and a PBMT protocol at 808 nm; and the RL + IRL group, which received the simultaneous application, of 660 and 808 nm wavelengths. Clinical (OM grade classification), histological (light microscopy analysis with H&E and collagen staining), immunohistochemical (TNF-α expression), and biochemical (TNF-α and hydroxyproline concentration) analyzes were performed after 7 and 10 days. Mainly on the 10th day, the RL and IRL groups showed lower OM grades and faster microscopic repair process, with greater expression of collagen fibers and lower TNF-α levels, besides the higher hydroxyproline concentrations, mainly in comparison with the Ch group. In conclusion, in this study, the simultaneous protocol did not present superior results than the isolated irradiations.
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Affiliation(s)
- Claudia C Cotomacio
- School of Dentistry, Paulista University (UNIP), São Paulo, SP, Brazil
- Department of Dentistry, Pediatric Oncology Institute/Support Group for Children and Adolescents with Cancer (GRAACC), São Paulo, Brazil
| | - Bianca K Yshikawa
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo (FOUSP), São Paulo, SP, Brazil
| | - Caio C Calarga
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo (FOUSP), São Paulo, SP, Brazil
| | - Victor E Arana-Chavez
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo (FOUSP), São Paulo, SP, Brazil
| | - Alyne Simões
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo (FOUSP), São Paulo, SP, Brazil
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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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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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Miranda-Silva W, da Fonseca FP, Gomes AA, Mafra ABB, Rocha V, Fregnani ER. Oral mucositis in paediatric cancer patients undergoing allogeneic hematopoietic stem cell transplantation preventively treated with professional dental care and photobiomodulation: Incidence and risk factors. Int J Paediatr Dent 2022; 32:251-263. [PMID: 34115428 DOI: 10.1111/ipd.12850] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral mucositis (OM) is an important side effect related to allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it has been associated with a significative reduction of quality of life. A negative impact of OM in paediatric patients could result in increased use of parenteral feeding and opioids, longer periods of hospitalization, and a higher risk of systemic infection. AIM To investigate the clinical features and clinical outcomes associated with OM development and severity in hematological cancer paediatric patients undergoing allo-HSCT who underwent professional dental care (PDC) and photobiomodulation (PBM) as prophylactic treatment. DESIGN Medical data and OM presentation were retrieved retrospectively from all patients younger than 18 years who received allo-HSCT between 2013 and 2016. The incidence of OM was assessed and graded by two oral medicine specialists following the WHO guidelines, and it was correlated with clinical parameters. RESULTS Forty-nine consecutive paediatric patients were included. OM was diagnosed in 73.5% of patients, and in 36.1% of patients, OM was classified as severe. Acute lymphoblastic leukemia as a primary diagnosis and the use of a myeloablative regimen were associated with OM development. The primary diagnosis and use of total body irradiation (TBI) were associated with aggressive OM. Neither the incidence nor the severity of OM affected the overall survival, whereas only the use of a myeloablative regimen and a high body mass index (BMI) were determinants of lower OM-free survival rates. CONCLUSIONS A myeloablative conditioning and a high BMI were observed to be independent prognostic determinants of a lower OMFS rate. The cluster analysis allowed us to outline patient profiles with greater susceptibility to the development and severity of oral mucositis, which seems to be a useful tool to determine the risk of OM in paediatric patients.
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Affiliation(s)
| | - Felipe Paiva da Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alessandra Araujo Gomes
- Bone Marrow Transplant Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,Pediatric Hematology-Oncology Unit, ITACI/ICR-HCFMUSP, São Paulo, Brazil
| | - Ana Beatriz Bechara Mafra
- Bone Marrow Transplant Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,Pediatric Hematology-Oncology Unit, ITACI/ICR-HCFMUSP, São Paulo, Brazil
| | - Vanderson Rocha
- Bone Marrow Transplant Unit, Hospital Sírio-Libanês, São Paulo, Brazil.,Department of Hematology, Hemotherapy and Cell Therapy, USP, São Paulo, Brazil.,Department of Hematology, NHS-BT, University of Oxford, Oxford, UK
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Adnan A, Yaroslavsky AN, Carroll JD, Selting W, Juliano AF, London WB, Sonis ST, Duncan CN, Treister NS. The Path to an Evidence-Based Treatment Protocol for Extraoral Photobiomodulation Therapy for the Prevention of Oral Mucositis. FRONTIERS IN ORAL HEALTH 2022; 2:689386. [PMID: 35048034 PMCID: PMC8757848 DOI: 10.3389/froh.2021.689386] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Oral mucositis is a painful complication of hematopoietic stem cell transplantation for which photobiomodulation therapy (PBMT) is a safe and effective intervention. Extraoral delivery of PBMT has clinical advantages over intraoral delivery but requires additional dosimetric considerations due to the external tissue layers through which the light must propagate before reaching the oral mucosa. Additionally, to date there has been no dose modeling study, a task essential to developing a justified treatment protocol. We review here some of the complexities surrounding extraoral photobiomodulation therapy and offer that may help guide researchers toward an evidence-based treatment protocol for the prevention of oral mucositis.
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Affiliation(s)
- Ather Adnan
- Texas A&M University Health Science Center, College of Medicine, Houston, TX, United States
| | - Anna N Yaroslavsky
- Advanced Biophotonics Laboratory, Department of Physics and Applied Physics, University of Massachusetts Lowell, Lowell, MA, United States.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Wayne Selting
- Department of Surgical Science and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Wendy B London
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, United States
| | - Stephen T Sonis
- Department of Surgery, Divisions of Oral Medicine and Dentistry, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Biomodels LLC., Waltham, MA, United States
| | - Christine N Duncan
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, United States
| | - Nathaniel S Treister
- Department of Surgery, Divisions of Oral Medicine and Dentistry, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
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11
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Ramos-Pinto MB, de Lima Gusmão TP, Schmidt-Filho J, Jaguar GC, Martins MD, Alves FA. Intraoral versus extraoral photobiomodulation therapy in the prevention of oral mucositis in HSCT patients: a randomized, single-blind, controlled clinical trial. Support Care Cancer 2021; 29:6495-6503. [PMID: 33905011 DOI: 10.1007/s00520-021-06228-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
To compare the efficacy of intraoral and extraoral photobiomodulation (PBM) protocols for the prevention of oral mucositis (OM) in hematopoietic stem cell transplantation (HSCT) patients. A total of 60 patients was randomized into intraoral PBM (IOPBM) and extraoral PBM (EOPBM) groups. Both PBM protocols were well tolerated and no side effects were observed. EOPBM session times were one fourth of IOPBM durations. Of 60 patients, 35 (58.3%) developed ulcerated OM between day +3 and day +12. No intergroup difference was observed in OM healing times (p = 0.424). The lateral border of the tongue was the most common site affected in both groups. However, the incidence of mucositis on buccal mucosa was significantly reduced in the EOPBM group (p = 0.021). Young patients (OR.5.35, 95%CI 0.94-30.4, p = 0.058) and those who had received myeloablative conditioning (OR.55.1, 95%CI 2.69-1129.3, p = 0.009) were more likely to develop ulcerated OM, whereas autologous HSCT recipients (OR 0.079, 95% CI 0.009-0.67, p = 0.021) had a lower probability of developing ulcerated OM independent of PBM protocol. EOPBM protocol was as effective as IOPBM in the management of OM in HSCT patients, with the advantage of shorter treatment sessions. Trial registration number: RBR-7nww56. Date of trial registration submission: 30th September 2019.
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Affiliation(s)
| | | | | | | | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fábio Abreu Alves
- Stomatology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil. .,Stomatology Department, School of Dentistry, Sao Paulo University, Sao Paulo, Brazil. .,Departamento de Estomatologia, AC Camargo Cancer Center, R: Prof. Antônio Prudente, 211, Bairro: Liberdade, São Paulo, SP, CEP: 01509-900, Brazil.
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12
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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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13
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Tomaževič T, Potočnik U, Cizerl D, Jazbec J. Optimization of Photobiomodulation Protocol for Chemotherapy-Induced Mucositis in Pediatric Patients. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:466-471. [PMID: 32678713 DOI: 10.1089/photob.2019.4794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To determine optimal settings of a specific diode laser for reducing the severity of oral mucositis (OM) in pediatric patients. Background: Photobiomodulation (PBM) has been reported to reduce the severity of chemotherapy-induced OM. Treatment parameters for PBM are difficult to determine due to different reports in the literature. Materials and methods: Patients with OM graded WHO 3 or 4 were randomly assigned to three groups with different laser settings (group A: power 250 mW, the energy density 8.8 and 15.5 J/cm2 for WHO grade 3 and 4, respectively; group B: power 500 mW, energy density as in group A; group C: power 250 mW, energy density was half of groups A and B). PBM was performed on all lesion areas. The mean number of PBM sessions to a decrease from WHO 3 or 4 to WHO 2, 1, or 0 was calculated for each patient. Multiple linear regression was used to determine whether the test groups differed in the mean number of sessions to a decrease of OM. Results: The mean number of PBM sessions to reduce from severe mucositis to mild or no mucositis was 3.8 [standard deviation (SD) = 3.5] in group A, 4.4 (SD = 2.3) in group B, and 4.0 (SD = 2.7) in group C. The differences in the number of PBM sessions for OM severity decrease were not statistically significantly different among the three study groups. Conclusions: Because of the lack of statistically significant differences between the groups, more patient practical laser parameters could be applied, that is, a shorter irradiation time.
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Affiliation(s)
- Tanja Tomaževič
- Department of Paediatric and Preventive Dentistry, Dental Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Daša Cizerl
- Department of Paediatric and Preventive Dentistry, Dental Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Janez Jazbec
- Department of Oncology and Haematology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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14
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Fornaini C, Arany P, Rocca JP, Merigo E. Photobiomodulation in Pediatric Dentistry: A Current State-of-the-Art. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:798-813. [DOI: 10.1089/photob.2019.4722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Carlo Fornaini
- UFR Odontologie, Laboratoire MicOralIS (Microbiologie Orale, Immunothérapie et Santé) EA7354, Université Nice Sophia Antipolis, Nice, France
- Group of Applied ElectroMagnetics, Department of Engineering and Architecture, University of Parma, Parma, Italy
- Dentistry, Special Needs and Maxillo–Facial Surgery Unit, Hospital “Guglielmo da Saliceto”, Piacenza, Italy
| | - Praveen Arany
- Oral Biology and Biomedical Engineering, University of Buffalo, Buffalo, New York
| | - Jean-Paul Rocca
- UFR Odontologie, Laboratoire MicOralIS (Microbiologie Orale, Immunothérapie et Santé) EA7354, Université Nice Sophia Antipolis, Nice, France
| | - Elisabetta Merigo
- UFR Odontologie, Laboratoire MicOralIS (Microbiologie Orale, Immunothérapie et Santé) EA7354, Université Nice Sophia Antipolis, Nice, France
- Dentistry, Special Needs and Maxillo–Facial Surgery Unit, Hospital “Guglielmo da Saliceto”, Piacenza, Italy
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15
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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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16
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Noirrit-Esclassan E, Valera M, Vignes E, Munzer C, Bonal S, Daries M, Vaysse F, Puiseux C, Castex M, Boulanger C, Pasquet M. Photobiomodulation with a combination of two wavelengths in the treatment of oral mucositis in children: The PEDIALASE feasibility study. Arch Pediatr 2019; 26:268-274. [DOI: 10.1016/j.arcped.2019.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/20/2019] [Accepted: 05/22/2019] [Indexed: 01/08/2023]
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17
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Donohoe C, Bosi JK, Sykes A, Lu Z, Mandrell B. Clinical Characteristics of Children and Adolescents Undergoing Hematopoietic Cell Transplantation Who Develop Oral Mucositis. Oncol Nurs Forum 2019; 45:457-462. [PMID: 29947353 DOI: 10.1188/18.onf.457-462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of children and adolescents undergoing hematopoietic cell transplantation (HCT) who develop oral mucositis. SAMPLE & SETTING 45 patients who underwent HCT from July 2015 to May 2016 at St. Jude Children's Research Hospital in Memphis, Tennessee. METHODS & VARIABLES Clinical factors were described as transplantation type, mucositis severity or grade, mucositis duration, days to engraftment, total parenteral nutrition (TPN) support, IV opioid pain management use during mucositis, positive blood or oral cultures, and length of hospitalization, then compared across mucositis grade. RESULTS 24 patients had grade 3 or greater mucositis onset from day -3 to day 9 of transplantation; of these, 23 required IV opioid medication to treat mucosal pain. Patients with mucositis grade 3 or greater were more likely to have undergone an allogeneic transplantation, receive TPN, have documented positive blood or oral cultures, and have longer hospitalizations than those with low-grade mucositis. IMPLICATIONS FOR NURSING Nurses are in a unique position to propose and administer interventions to prevent and alleviate symptoms of mucositis.
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Comparison of photobiomodulation using either an intraoral or an extraoral laser on oral mucositis induced by chemotherapy in rats. Support Care Cancer 2019; 28:867-876. [PMID: 31165336 DOI: 10.1007/s00520-019-04889-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the present study was to compare the effect of intraoral (IO) and extraoral (EO) diode laser irradiation on oral mucositis (OM) induced by 5-fluorouracil (5-FU) in rats. METHODS Animals (n = 78) were divided into the following groups: negative control (NC), positive control (PC), IO 6 J/cm2, EO with 6 J/cm2 (EO 6 J/cm2), and 12 J/cm2 (EO 12 J/cm2). OM was induced with an intraperitoneal injection of 5-FU and scarification of the buccal mucosa. Over the following 14 days, animals received photobiomodulation (PBM) daily. Clinical and histological evaluation was done by scores at days 8, 10, and 14. The redox state was evaluated by reactive species levels, antioxidant network, and immunohistochemistry analysis. RESULTS Clinically, on day 8, PBM groups showed lower scores of OM with EO 6 J/cm2 presenting a significantly lower degree compared to PC (p < 0.05). On days 10 and 14, all PBM groups exhibited improvement of OM compared to PC (p < 0.01). On day 8, all PBM groups exhibited an accelerated healing process compared to PC (p < 0.01) and reduction of reactive species (p < 0.001). Also, all PBM groups demonstrated higher levels of antioxidant GPx compared to PC (p < 0.001). Analysis of nitrotyrosine revealed that on day 14, this protein damage marker was significantly reduced in the EO 6 J/cm2 group (p > 0.05). CONCLUSIONS An EO diode laser protocol promoted positive effects in the clinical, histopathological, and redox state in OM induced by 5-FU in rats. Among the EO protocols, EO 6 J/cm2 showed the most encouraging results.
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19
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de Pauli Paglioni M, Araújo ALD, Arboleda LPA, Palmier NR, Fonsêca JM, Gomes-Silva W, Madrid-Troconis CC, Silveira FM, Martins MD, Faria KM, Ribeiro ACP, Brandão TB, Lopes MA, Leme AFP, Migliorati CA, Santos-Silva AR. Tumor safety and side effects of photobiomodulation therapy used for prevention and management of cancer treatment toxicities. A systematic review. Oral Oncol 2019; 93:21-28. [PMID: 31109692 DOI: 10.1016/j.oraloncology.2019.04.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/15/2022]
Abstract
Photobiomodulation therapy (PBMT), also known as low-level laser therapy (LLLT), has been increasingly used for the treatment of toxicities related to cancer treatment. One of the challenges for the universal acceptance of PBMT use in cancer patients is whether or not there is a potential for the light to stimulate the growth of residual malignant cells that evaded oncologic treatment, increasing the risk for tumor recurrences and development of a second primary tumor. Current science suggests promising effects of PBMT in the prevention and treatment of breast cancer-related lymphedema and oral mucositis, among other cancer treatment toxicities. Nevertheless, this seems to be the first systematic review to analyze the safety of the use of PBMT for the management of cancer-related toxicities. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 27 articles met the search criteria. Selected studies included the use of PBMT for prevention and treatment of oral mucositis, lymphedema, radiodermatitis, and peripheral neuropathy. Most studies showed that no side effects were observed with the use of PBMT. The results of this systematic review, based on current literature, suggest that the use of PBMT in the prevention and management of cancer treatment toxicities does not lead to the development of tumor safety issues.
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Affiliation(s)
- Mariana de Pauli Paglioni
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Anna Luíza Damaceno Araújo
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Natalia Rangel Palmier
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Jéssica Montenegro Fonsêca
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Wagner Gomes-Silva
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), Brazil; Medical School, Nove de Julho University, São Paulo, Brazil
| | - Cristhian Camilo Madrid-Troconis
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dentistry Program, Corporación Universitaria Rafael Nuñez, Cartagena, Colombia
| | - Felipe Martins Silveira
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Manoela Domingues Martins
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Karina Morais Faria
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), Brazil
| | | | | | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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Ribeiro da Silva VC, da Motta Silveira FM, Barbosa Monteiro MG, da Cruz MMD, Caldas Júnior ADF, Pina Godoy G. Photodynamic therapy for treatment of oral mucositis: Pilot study with pediatric patients undergoing chemotherapy. Photodiagnosis Photodyn Ther 2018; 21:115-120. [DOI: 10.1016/j.pdpdt.2017.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/26/2022]
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He M, Zhang B, Shen N, Wu N, Sun J. A systematic review and meta-analysis of the effect of low-level laser therapy (LLLT) on chemotherapy-induced oral mucositis in pediatric and young patients. Eur J Pediatr 2018; 177:7-17. [PMID: 29128883 DOI: 10.1007/s00431-017-3043-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/03/2023]
Abstract
UNLABELLED Oral mucositis is one of the most frequent complications after chemotherapy, occurring in approximately 52 to 80% of children receiving treatment for cancer. Recently, it has been suggested that the use of low-energy laser could reduce the grade of oral mucositis and alleviate the symptoms. In 2014, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology has recommended low-level laser therapy in prevention of mucositis for hematopoietic stem cell transplantation patients because of its beneficial effects in majority of recent studies. However, the recommendation was made for adult patients, not pediatric patients. Data about the effect of low-level laser therapy in pediatric patients is limited. This study aims to synthesize the available clinical evidences on the effects of low-level laser therapy (LLLT) in the prevention and treatment of chemotherapy-induced oral mucositis (OM). A meta-analysis was performed using trials identified through the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Web of Science, China Biology Medicine (CBM), Wanfang Database, and China National Knowledge Infrastructure (CNKI). Data on occurrence, duration, and severity of oral mucositis were collected. All randomized controlled studies and clinical controlled studies comparing LLLT to routine qualified prevention or treatment during or after chemotherapy were critically appraised and analyzed. We found 8 qualified clinical trials with a total of 373 pediatric patients; the methodological quality was acceptable. After prophylactic LLLT, the odds ratio for developing OM was significantly lower compared with placebo(OR = 0.50, 95% CI 0.29 to 0.87, P = 0.01), the odds ratio for developing grade III OM or worse was statistically significantly lower compared with placebo (OR = 0.30, 95% CI (0.10, 0.90), P = 0.03), and the OM severity was statistically significantly lower compared with placebo (SMD = - 0.56, 95% CI (- 0.98, - 0.14), P = 0.009). For therapeutic LLLT, the OM severity was significantly reduced compared to routine care (SMD = - 1.18, 95% CI (- 1.52, - 0.84), P < 0.00001). Oral pain was also reduced after LLLT over routine care (MD = - 0.73, 95% CI (- 1.36, - 0.11), P = 0.02). CONCLUSION Prophylactic LLLT reduces mucositis and severe mucositis and decreases the average severity of oral mucositis in pediatric and young patients with cancer. Therapeutic LLLT also reduces the average severity of oral mucositis and oral pain. Further research should investigate the optimal parameter of LLLT in pediatric and young patients, and studies with higher methodological quality should be performed. What is known: • Low-level laser therapy (LLLT) was recommended by Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology; however, evidences about LLLT on oral mucositis in pediatric and young patients were insufficient and lack supportive synthesized data. • Recently, there have been several new RCTs or CCTs for pediatric patients or young adults. What is new: • Prophylactic LLLT reduces the occurrence of mucositis and severe mucositis and decreases the average severity of oral mucositis in pediatric and young patients. • Therapeutic LLLT reduces the average severity of oral mucositis and oral pain.
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Affiliation(s)
- Mengxue He
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binghua Zhang
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Nanping Shen
- Department of Nursing,, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Wu
- Labor Room, Shanghai First Maternity and Infant Hospital, Shanghai, China
| | - Jiwen Sun
- Department of Nursing,, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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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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23
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Comparison of laser and ozone treatments on oral mucositis in an experimental model. Lasers Med Sci 2017; 32:673-677. [DOI: 10.1007/s10103-017-2166-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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