Phototherapy 660 nm for the prevention of radiodermatitis in breast cancer patients receiving radiation therapy: study protocol for a randomized controlled trial

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.

Assessment of Integrative Therapeutic Methods for Improving the Quality of Life and Functioning in Cancer Patients-A Systematic Review

Background: Cancer rehabilitation represents a series of measures adopted for the recovery of psychological, emotional, social, and financial functioning in the case of cancer patients. The purpose of this study is to identify the main elements of therapeutic management in the field of medical rehabilitation, as well as integrative, complementary medicine and holistic approaches that can be performed on the oncological patient. Methods: This systematic literature review follows the methodology outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" ("PRISMA") statement, which is an internationally recognized and widely accepted standard. Results: Active rehabilitative therapies offer therapeutic options for improving the functioning and quality of life of oncological patients; these therapies comprehensively address both the physical and psychological aspects of the disease. This review also includes the latest novelties and nanotechnologies applied in oncological rehabilitation, for example, drugs (or supplements) inspired by nature. Conclusions: Physical and rehabilitation medicine, mostly using stimulating therapeutic methods, was recently added to the list of contraindications in the management of oncological patients, both as an approach to the pathological concept itself and as an approach to the main clinical consequences and functional aspects of oncological therapies. Integrative, complementary medicine presents an important therapeutic resource in the case of oncological patients. Advanced studies are needed in the future to further ascertain the role of these therapies.

Comment on "Photobiomodulation therapy for the prevention of acute radiation dermatitis (RD) in head and neck cancer patients (DERMISHEAD trial)"

Our aim was to report some methodological shortcomings in the recently published article "Photobiomodulation therapy for the prevention of acute radiation dermatitis (RD) in head and neck cancer patients (DERMISHEAD trial)" by Robjins et al. There are some issues regarding the incomplete photobiomodulation (PBM) parameters and application.

Development of porphyrin and titanium dioxide sonosensitizers for sonodynamic cancer therapy

Sonodynamic therapy for malignant tumours has gained much attention for its deep penetration effect and efficient tumour killing ability. The design, modification, and utilization of sonosensitizers are important aspects of sonodynamic therapy. As an essential factor in this process, highly effective sonosensitizers should be developed to facilitate the clinical applications of sonodynamic therapy. This review takes porphyrin- and titanium dioxide (TiO₂)-based systems as representative organic and inorganic sonosensitizers respectively, and summarizes their characteristics and biological effects as sonodynamic therapy. Upon discovery of novel sonosensitizers, sonodynamic therapy becomes an efficient means of adjuvant therapy for the treatment of malignant tumours.

Investigation of neutron and gamma radiation protective characteristics of synthesized quinoline derivatives

PURPOSE

Quinoline is formed by various natural compounds, such as alkaloids from the cinchona plant, which exhibit various biological activities, and is an important building material for the development of new drugs. Quinoline can be used in anti-radiation drug development but radiation interaction properties must be determined.

MATERIAL AND METHODS

In this study, six types of synthesized quinoline derivatives were used. Fast neutron removal cross-section, mean free path, half value layer and transmission number were theoretically determined by using GEometry ANd Tracking 4 and FLUktuierende KAskade simulation codes for neutron shielding. Neutron dose absorption rates were determined using the ²⁴¹Am-Be fast neutron source and the Canberra NP series portable BF₃ gas proportional neutron detector. Gamma radiation shielding parameters were determined by using WinXCom and PSY-X/PSD software. Additionally, the genotoxic potentials of the derivatives were assessed by using the Ames/Salmonella bacterial reversion assay.

RESULTS AND CONCLUSIONS

Neutron shielding parameters such as removal cross-section, mean free path, half value layer and transmission number were theoretically determined for fast neutrons. To determine neutron absorption capacity of quinoline derivatives, neutron absorption, experiments were conducted. In addition, gamma radiation shielding parameters were calculated such as the mean free path (MFP), mass attenuation coefficient (µt), half value thickness layer (HVL) and effective atomic number (Zeff) in the energy range of 0.015-15 MeV. The results of the all quinoline derivatives have excellent fast neutron shielding power compared to ordinary concrete. In addition, all quinoline derivatives have been found to have the capacity to attenuate gamma radiation. Moreover, they absorb well in both types of radiation, do not cause secondary radiation, and they are genotoxically safe at the tested concentrations. This study has demonstrated that these products can be used as active ingredients for a drug to be developed against radiation.

Effect of photobiomodulation therapy on radiodermatitis in a mouse model: an experimental animal study

This study aimed to evaluate the effect of photobiomodulation (PBM) for prevention of radiodermatitis in an irradiated mouse model and compare the efficacy of PBM using 633- or 830-nm wavelengths. Irradiated mice were randomly distributed into three groups: A (633 nm), B (830 nm), and C (without PBM). On post-irradiation days 7 and 21, we compared acute damage and recovery in treated skin samples to non-irradiated skin using H&E, Masson's trichrome, anti-CD45 and PCNA immunohistochemistry, and a TUNEL assay. Grade 3 radiodermatitis was evident only in group C. Compared with that in group C, the skin in groups A and B had significantly less epidermal hyperplasia, inflammatory cell infiltration, and thinner dermis on day 7 and less inflammatory cell infiltration, fewer apoptotic cells, and thinner dermis on day 21. However, there was no significant difference between groups A and B. This study indicates PBM could prevent severe radiodermatitis by reducing epidermal and dermal damage, inflammation, and apoptosis. There was no difference in PBM efficacy between the 633- and 830-nm wavelengths.

Modulatory effect of photobiomodulation on stem cell epigenetic memory: a highlight on differentiation capacity

Differentiation potential of stem cells into various lineages makes these cells as promising sources to treat multiple diseases. In this regard, the use of different strategies and protocols to increase differentiation capacity is highly demanded. Low-level laser therapy, a relatively noninvasive technique, has the capacity to accelerate the healing of numerous injuries and a portion of restorative capacity could be correlated with the stem cell activation and differentiation. Several mechanisms have been diagnosed to participate in orientation of stem cells to functional mature cells. Among them, the status of DNA methylation orchestrates the maintenance of tissue-specific gene expression during the differentiation procedure. DNA methylation is a momentous event in embryogenesis and functional maturation. This review article highlighted the potency of laser irradiation (low-level intensities) in the differentiation of stem cells by modulation of methylation. The analysis of these modalities could help us to understand the underlying mechanisms participating in the therapeutic effects of photobiomodulation.

Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols

PURPOSE

There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed.

METHODS

Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.

RESULTS

PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations.

CONCLUSION

PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.

A pilot study using the Chinese herbal paste Liu-He-Dan to manage radiodermatitis associated with breast cancer radiotherapy

BACKGROUND

During radiotherapy for breast cancer, patients are greatly affected by pain, infection, and delayed healing of wounds caused by radiodermatitis. In the present study, we aimed to determine the efficacy of Liu-He-Dan in treating radiodermatitis.

METHODS

In 26 breast cancer patients who experienced moist decrustation while receiving radiotherapy, 5 g Liu-He-Dan was applied externally once daily after the wound surface had been cleaned and dried. The healing time was recorded, and a Kaplan-Meier survival curve was applied to analyze the treatment course. Meanwhile, a pain assessment using the Numeric Rating Scale (nrs) recorded the pain level experienced by patients after application of the Liu-He-Dan.

RESULTS

After application of Liu-He-Dan, the average healing time for the surface of the moist decrustation wounds was 14.17 ± 2.03 days (range: 5-22 days). Inflammatory seepage decreased significantly and exudation almost disappeared in 3 days. The pain trend line indicated that the average nrs score declined with treatment in all patients. The average nrs scores at days 1, 4, and 7 were 6.13, 3.62, and 2.58 respectively. After 3 days of treatment, pain was remarkably alleviated in 80.76% of patients. After treatment for 1 week, the pain remission rate was 96.15%, without any obvious adverse reactions.

CONCLUSIONS

Liu-He-Dan was efficacious in treating radiation skin injury with little toxicity and few side effects; the economic efficiency of the treatment was also favourable. The Liu-He-Dan was generally well tolerated by patients. In future, randomized control trials will be established for further observation of the value of Liu-He-Dan in treating radiodermatitis in breast cancer.