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Cruz AR, Minicucci EM, Betini M, Almeida-Lopes L, Tieghi Neto V, Cataneo AJM. Efficacy of photobiomodulation in the treatment of oral mucositis in patients undergoing antineoplastic therapy: systematic review and meta-analysis. Support Care Cancer 2023; 31:645. [PMID: 37853254 DOI: 10.1007/s00520-023-08105-7] [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: 06/18/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To evaluate the effectiveness of photobiomodulation in the treatment of oral mucositis. METHODS Systematic review and meta-analysis encompassing in the electronic databases: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, and CINAHL and in http://clinicaltrials.gov . Eligibility criteria were randomized, non-randomized, and observational studies that used photobiomodulation for the treatment of oral mucositis. The endpoints were reduction in the severity of oral mucositis, duration of lesions, and pain reduction. For data analysis, the Review Manager 5.4 program was used. RESULTS A total of 316 studies were identified, 297 in the electronic databases and 19 in http://clinicaltrials.gov . After removing duplicates, 260 studies were selected for title and abstract reading, of which 223 were excluded. A total of 37 studies were chosen for full reading, of which 6 were included in the review, totaling 299 patients. The treatment used was photobiomodulation. The patients were divided into two groups: the laser group used only photobiomodulation or associated with other therapies, and the control group did not use photobiomodulation. For the endpoint reduction in the severity of oral mucositis (OM), the chance of reduction of the OM was greater in the laser group as compared to the control group. For the endpoints duration of OM lesions and pain reduction, it was not possible to carry out a meta-analysis due to the high heterogeneity between studies. In the interpretation of the meta-analysis, the reduction in the severity of oral mucositis was greater in the group that received photobiomodulation. CONCLUSION Photobiomodulation was effective in the treatment of oral mucositis.
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Affiliation(s)
- Adriana Regina Cruz
- Program of Surgery and Translational Medicine, University Unesp, Medical School, Botucatu, São Paulo, Brazil.
| | - Eliana Maria Minicucci
- Clinical Hospital of São Paulo State University Unesp, Medical School, Botucatu, São Paulo, Brazil
| | - Marluci Betini
- Reference Technical Section, University Unesp, Medical School, Botucatu, São Paulo, Brazil
| | - Luciana Almeida-Lopes
- Institute of Research and Learning in the Area of Health - NUPEN, São Carlos, São Paulo, Brazil
| | - Victor Tieghi Neto
- Department of Dentistry, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Photobiomodulation for Chemotherapy-Induced Oral Mucositis in Pediatric Patients. Biomolecules 2023; 13:biom13030418. [PMID: 36979353 PMCID: PMC10046229 DOI: 10.3390/biom13030418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Oral mucositis (OM) is a common side effect in patients undergoing chemotherapy (CT), especially in children due to their rapid epithelial mitotic rate. It has been associated with a significant reduction in life quality since it leads to pain, an inadequate intake of nutrients, an increased risk of opportunistic infections, and interruptions of CT. Photobiomodulation (PMB) with low-level laser therapy (LLLT) has shown faster healing, reduction in pain, and the reduced use of analgesic compared to placebo groups. The purpose of this review is to analyze and compare the existing clinical trials and identify their shortcomings in hope to make future research easier. Using MeSH terms and keywords, the Embase, Medline, and PubMed databases we searched for the period of the last 5 years. We identified a total of 15 clinical trials, with a total of 929 pediatric patients analyzed in this review. We compared different light sources and other laser technique characteristics used in clinical trials such as wavelength, energy and power density, spot size, irradiation time, PBM protocol, and OM evaluation. The main findings show inconsistent laser parameter quotations, differences in the PBM protocol along with a laser application technique, and a lack of clinical trials. Based on that, more studies with a high methodological quality should be conducted in order to provide a unified PBM protocol suitable for the pediatric population.
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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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Guimarães JR, Carvalho LG, Damascena LC, Sampaio ME, Ribeiro IL, Sousa SA, Valença AM. The incidence of severe oral mucositis and its occurrence sites in pediatric oncologic patients. Med Oral Patol Oral Cir Bucal 2021; 26:e299-e303. [PMID: 33247566 PMCID: PMC8141319 DOI: 10.4317/medoral.24185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Childhood cancer is one of the main causes of child mortality and its treatment has debilitating effects on the oral cavity. Several oral mucositis (SOM) is one of the most common and may cause undesirable symptoms such as pain and risk of systemic infection. Material and Methods This was a longitudinal, retrospective, and observational study determining the incidence of severe oral mucositis (SOM) and its occurrence sites in pediatric oncologic patients, in João Pessoa, Brazil, between 2013 and 2018. Data from 56 patients aged 1 to 18 years were collected from their medical records and through an oral mucosa examination, from the 1st to 5th week of chemotherapy treatment (CT) using the modified Oral Assessment Guide, by previously calibrated examiners (Kappa index > 0.7). The data were analyzed by the Chi-square test, and Odds Ratios were calculated. Results Most patients were females (54.5%), aged 8.8 years (± 4.8), with hematologic tumors (73.2%), predominantly Acute Lymphoid Leukemia (50.0%). An increase in the occurrence of SOM was observed throughout the CT (P = 0.05), ranging from 12.5% in the 1st to 35.7% in the 5th CT week. In the 1st CT week, there was a predominance of alterations in the lips (5.5%) and saliva (5.5%), while in the 5th, the jugal / palate mucosa (21.4%) remained the most affected site by SOM. Differences in the severity of SOM in the jugal / palate mucosa (P = 0.01) and labial mucosa (P = 0.04) were observed over time. In the 5th CT week, the likelihood of developing SOM was 13.3-fold higher (95% CI: 1.5 - 105.6) in patients with hematologic tumors. Conclusions The incidence of SOM was higher in the 5th CT week, most commonly affecting the jugal / palate mucosa, and patients with hematologic tumors were more prone to develop SOM. Key words:Mucositis, oncology, pediatric dentistry.
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Affiliation(s)
- J-R Guimarães
- Manuel Satyro, 350/2301, Cabo Branco 58045-110, João Pessoa, Paraíba, Brazil
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Tomé RFF, Silva DFB, Dos Santos CAO, de Vasconcelos Neves G, Rolim AKA, de Castro Gomes DQ. ILIB (intravascular laser irradiation of blood) as an adjuvant therapy in the treatment of patients with chronic systemic diseases-an integrative literature review. Lasers Med Sci 2020; 35:1899-1907. [PMID: 32656732 DOI: 10.1007/s10103-020-03100-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/07/2020] [Indexed: 12/22/2022]
Abstract
To perform an integrative review of the literature on the effectiveness of intravascular laser irradiation of blood (ILIB) as an adjunct therapy in the treatment of chronic systemic diseases. This is an integrative literature review that included non-randomized and randomized controlled clinical trials that specifically evaluated the therapeutic effect of ILIB on chronic systemic diseases, without restriction of time, and written in English. The Medical Publications (PubMed)/MEDLINE database was used. MeSH (Medical Subject Headings) was used to select search descriptors with the Boolean operators "AND/OR." After applying the inclusion and exclusion criteria, 13 articles were selected. Coronary diseases were the most prevalent, followed by type 2 diabetes mellitus, with the coronary artery being the most widely used access route for ILIB application. Despite the varied parameters and protocols for using this kind of therapy, all studies have shown satisfactory results in the patients' clinical condition. ILIB proved to be effective in all organic systems, showing some positive result. However, studies on the effect of this therapy on various diseases are still scarce in the literature, and there is a need for more well-designed clinical trials to better understand the role of ILIB in various systemic diseases.
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Affiliation(s)
| | - Diego Filipe Bezerra Silva
- Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351 - Bairro Universitário, Campina Grande, PB, 58429-500, Brazil.
- Departament of Dentistry, State University of Paraíba, R. Baraúnas, 351 - Bairro Universitário, Campina Grande, PB, Brazil.
| | - Carlus Alberto Oliveira Dos Santos
- Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351 - Bairro Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Gabriella de Vasconcelos Neves
- Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351 - Bairro Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Ana Karina Almeida Rolim
- Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351 - Bairro Universitário, Campina Grande, PB, 58429-500, Brazil
| | - Daliana Queiroga de Castro Gomes
- Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351 - Bairro Universitário, Campina Grande, PB, 58429-500, Brazil
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Morais-Faria K, Palmier NR, de Lima Correia J, de Castro Júnior G, Dias RB, da Graça Pinto H, Lopes MA, Ribeiro ACP, Brandão TB, Santos-Silva AR. Young head and neck cancer patients are at increased risk of developing oral mucositis and trismus. Support Care Cancer 2020; 28:4345-4352. [PMID: 31912359 DOI: 10.1007/s00520-019-05241-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate cancer treatment-related toxicities in young head and neck cancer (HNC) patients. MATERIAL AND METHODS A total of 44 patients were included in the present retrospective cohort study, which was designed to access oral toxicities of cancer treatment in young (< 45 years of age, Group I, n = 22) and old (> 58 years of age, Group II, n = 22) HNC patients with similar tumor stage and treatment protocols. Oral mucositis (OM), xerostomia, dysphagia, dysgeusia, trismus, and radiodermatitis were assessed during days 7th, 21st, and 35th of head and neck radiotherapy (HNRT) according to previously validated scales (World Health Organization criteria and the National Cancer Institute and Common Terminology Criteria for Adverse Events version 4.0). RESULTS Patients from both groups showed high incidence and severity of oral toxicities by the end of the HNRT with OM (81.9% (Group I); 63.6% (Group II)) and xerostomia (72.6% (Group I); 77.2% (Group II)) being the most prevalent toxicities. No differences regarding xerostomia, dysphagia, dysgeusia, and radiodermatitis incidences or severity could be observed between groups. However, higher incidences and severity of OM at 21st and 35th fractions (odds ratio = 2.22 and 5.71, respectively) and trismus at 21st and 35th fractions (odds ratio = 6.17 and 14.5, respectively) were observed throughout the treatment in young patients when compared to older patients (p < 0.01 and p < 0.05, respectively). CONCLUSION Young HNC patients are more affected by cancer treatment-related OM and trismus despite the similarities in clinical staging and treatment protocols with elderly patients.
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Affiliation(s)
- Karina Morais-Faria
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil
| | - Natalia Rangel Palmier
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil
| | - Jaqueline de Lima Correia
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil
| | - Gilberto de Castro Júnior
- Clinical Oncology Service, São Paulo State Cancer Institute (ICESP), School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Reinaldo Brito Dias
- Department of Maxillofacial Surgery, Prosthesis and Traumatology, USP, São Paulo, Brazil
| | | | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil
| | | | - Thaís Bianca Brandão
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil. .,Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil.
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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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