Articles and Abstracts on Oral Mucositis Research
Low-level laser therapy in the prevention and treatment of cancer therapy-induced mucositis: 2012 state of the art based on literature review and meta-analysis
René-Jean Bensadouna and Raj G. Nairb
Purpose of Review
To discuss the promising state of the art low-level laser therapy (LLLT) for preventive and therapeutic usage in oral mucositis due to cancer therapy.
Photomedicine using LLLT is very effective with intraoral and extraoral devices in the management of oral mucositis, based on several studies including randomized control studies. A systematic review identified 33 relevant articles that were subjected to meta-analysis based on which laser parameters in routine practice are being defined. Meta-analysis showed that LLLT reduced risk of oral mucositis with relative risk (RR) 2.45 [confidence interval (CI) 1.85–3.18], reduced duration, severity of oral mucositis and reduced number of days with oral mucositis (4.38 days, P.0.0009). RR was similar between the red (630–670 nm) and infrared (780–830 nm) LLLT. Pain-relieving effect based on the Cohen scale was at 1.22 (CI 0.19–2.25).
No adverse side effects of LLLT were reported; hence, we recommend red or infrared LLLT with diode output between 10–100mW, dose of 2–3 J/cm2/cm2 for prophylaxis and 4 J/cm2 (maximum limit) for therapeutic effect, application on single spot rather than scanning motion. Lesions must be evaluated by a trained clinician and therapy should be repeated daily or every other day or a minimum of three times per week until resolution. There is moderate-to-strong evidence in favor of LLLT at optimal doses as a well tolerated, relatively inexpensive intervention for cancer therapy-induced oral mucositis. It is envisaged that LLLT will soon become part of routine oral supportive care in cancer.
CURR OPIN 1040-8746 _ 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: A double-blind randomized study in head and neck cancer patients.
Carvalho PA, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA Stomatology Department - Hospital A.C. Camargo, Sao Paulo, Brazil.
The purpose of this prospective study was to determine the effect of the low-level laser in the prevention and treatment of mucositis in head and neck cancer patients. A total of 70 patients with malignant neoplasms in the oral cavity or oropharynx were evaluated. The patients were randomized into two low-level laser therapy groups: Group 1 (660nm/15mW/3.8J/cm(2)/spot size 4mm(2)) or Group 2 (660nm/5mW/1.3J/cm(2)/spot size 4mm(2)) starting on the first day of radiotherapy. Oral mucositis was assessed daily and weekly using the NCI and WHO scales. Oral pain was scored daily with a visual analogue scale before laser application. The patients in Group 1 had a mean time of 13.5days (range 6-26days) to present mucositis grade II, while the patients in Group 2 had a mean time of 9.8days (range 4-14days) (both WHO and NCI p=0.005). In addition, Group 2 also presented a higher mucositis grade than Group 1 with significant differences found in weeks 2 (p=0.019), 3 (p=0.005) and 4 (p=0.003) for WHO scale and weeks 2 (p=0.009) and 4 (p=0.013) for NCI scale. The patients in Group 1 reported lower pain levels (p=0.004). Low-level laser therapy during radiotherapy was found to be effective in controlling the intensity of mucositis and pain.
Oral Oncol 2011 Sep 10
Evaluation of the effect of low level laser on prevention of chemotherapy-induced mucositis.
Arbabi-Kalati F, Arbabi-Kalati F, Moridi T
Radiotherapy in the head and neck region and chemotherapy might give rise to oral mucositis which is a severe and painful inflammation. There is no known definite cure for mucositis. A number of studies have attempted to evaluate the effect of low-power laser on radiotherapy- and chemotherapy-induced mucositis. The present study was undertaken to evaluate the effect of low-power laser on the prevention of mucositis, xerostomia and pain as a result of chemotherapy. The subjects in this double-blind randomized controlled study were 24 adult patients who underwent chemotherapy during 2009-2010. The results showed that low-power laser was able to decrease the effect of chemotherapy on oral mucositis, xerostomia and pain in a variety of malignancies (P<0.05). It can be concluded that low-power laser might decrease the intensity of mucositis.
Acta Med Iran 2013 51(3) 157-62
Effect of low-level laser therapy on patient reported measures of oral mucositis and quality of life in head and neck cancer patients receiving chemoradiotherapy-a randomized controlled trial.
Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Nigudgi S
Chemoradiotherapy (CRT)-induced oral mucositis (OM) adversely affects a patient’s oral functions and quality of life (QOL). Low-level laser therapy (LLLT) showed some preventive and curative effects against clinically reported objective measures of OM in few trials including our recently published study. There is dearth of evidence regarding the effects of LLLT on patient’s subjective experience of OM and QOL. Hence, we did this study to evaluate the effects of LLLT on a patient’s reported measures of OM and QOL in head and neck cancer (HNC) patients receiving CRT.
This triple blinded study randomized 220 HNC patients scheduled for CRT (three weekly Cisplatin + RT = 66 Gray (2 Gy/session), five fractions/week for 6.5 weeks, total 33 fractions) into laser (110) and placebo (110) groups. The laser group received LLLT (Technomed Electronics Advanced Laser Therapy 1000, He-Ne, lambda = 632.8 nm, power density = 24 mW/cm(2), dosage = 3.0 J at each point, total dose/session = 36-40 J, spot size 1 cm(2), irradiation time/point 125 s) before each radiation session, while the placebo group did not receive laser therapy. Methodology was similar to our recently published study (Gautam et al. Radiother Oncol 104:349-354, 2012). In this part of our study, a blinded assessor collected subjective outcomes of the patient’s reported measures of OM using Oral Mucositis Weekly Questionnaire-Head and Neck (OMWQ-HN) and QOL using Functional Assessment of Cancer Treatment-Head and Neck (FACT-HN) Questionnaire. Data were analyzed using repeated measure ANOVA through general linear model. Statistical significance was kept at p < 0.05. RESULTS: Results analysis revealed that OMWQ-HN (F = 12.199, df = 6,1314, p < 0.001) and FACT-HN (p < 0.05) scores were significantly lower in LLLT than placebo group patients. Also, a significant reduction (p < 0.001) in incidence of severe OM, need for opioid analgesics, and total parenteral nutrition was observed.
LLLT was effective in improving the patient’s subjective experience of OM and QOL in HNC patients receiving CRT.
Support Care Cancer 2012 Dec 8
Amelioration of oral mucositis pain by NASA near-infrared light- emitting diodes in bone marrow transplant patients.
Hodgson BD, Margolis DM, Salzman DE, Eastwood D, Tarima S, Williams LD, Sande JE, Vaughan WP, Whelan HTPediatric Dentistry, Marquette University School of Dentistry, 1801 W. Wisconsin Ave., Rm. 326, Milwaukee, WI, 53233, USA, email@example.com.
This study seeks to investigate the use of extra-orally applied near-infrared phototherapy for the reduction of oral pain secondary to chemotherapy- and radiation therapy-induced mucositis in adult and pediatric hematopoietic stem cell transplant (HSCT) patients.
Eighty HSCT patients were divided into regular (R) and low (L) risk groups, then to experimental (E) and placebo (P) groups, resulting in four groups (ER, EL, PR, PL). Experimental subjects received 670 (+/-10) nm gallium-aluminum-arsinide light-emitting diode device for 80 s at approximately 50 mW/cm(2) energy density and power exposure of 4 J/cm(2). Placebo patients received the same procedures, but with a placebo phototherapy (identical device but <5 mW/cm(2) energy density). Patients received their respective light therapy once per day starting on the day of the HSCT (day 0) and continued through day +14. Blinded evaluators examined the patients three times per week and scored their oral tissues and patient-reported pain assessments at each evaluation utilizing the WHO, NCI- CTCAE, and OMAS scales.
Analysis of the mean scores at each observation demonstrate that the extra-oral application of phototherapy resulted in a significant reduction in patient-reported pain between the ER and PR patients (p < 0.05) at day +14 when graded via the WHO criteria. The ER and EL patients were improved in almost all other categories and assessment scales, but the differences were not statistically significant.
Phototherapy demonstrated a significant reduction in patient-reported pain as measured by the WHO criteria in this patient population included in this study. Improvement trends were noted in most other assessment measurements.
Support Care Cancer 2011 Jul 3
A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis.
Bjordal JM, Bensadoun RJ, Tuner J, Frigo L, Gjerde K, Lopes-Martins RA?Centre for Evidence-Based Practice, Bergen University College-HiB, Moellendalsvn. 6, 5009, Bergen, Norway, firstname.lastname@example.org.
The purpose of this study is to review the effects of low-level laser therapy (LLLT) in the prevention and treatment of cancer therapy-induced oral mucositis (OM).
A systematic review and meta-analysis of randomised placebo-controlled trials of LLLT performed during chemotherapy or radiation therapy in head and neck cancer patients.
We found 11 randomised placebo-controlled trials with a total of 415 patients; methodological quality was acceptable at 4.10 (SD +/- 0.74) on the 5-point Jadad scale. The relative risk (RR) for developing OM was significantly (p = 0.02) reduced after LLLT compared with placebo LLLT (RR = 2.03 (95% CI, 1.11 to 3.69)). This preventive effect of LLLT improved to RR = 2.72 (95% CI, 1.98 to 3.74) when only trials with adequate doses above 1 J were included. For treatment of OM ulcers, the number of days with OM grade 2 or worse was significantly reduced after LLLT to 4.38 (95% CI, 3.35 to 5.40) days less than placebo LLLT. Oral mucositis severity was also reduced after LLLT with a standardised mean difference of 1.33 (95% CI, 0.68 to 1.98) over placebo LLLT. All studies registered possible side-effects, but they were not significantly different from placebo LLLT.
There is consistent evidence from small high-quality studies that red and infrared LLLT can partly prevent development of cancer therapy-induced OM. LLLT also significantly reduced pain, severity and duration of symptoms in patients with cancer therapy-induced OM.
Support Care Cancer 2011 Aug 19(8) 1069-77
Laser phototherapy as a treatment for radiotherapy-induced oral mucositis.
Lino MD, Carvalho FB, Oliveira LR, Magalhaes EB, Pinheiro AL, Ramalho LM
Oral mucositis is a harmful side effect of radiotherapy (RT) on the head and neck region. There are encouraging reports on the beneficial aspects of the use of laser light on the treatment of oral mucositis. This paper reports the efficacy of laser phototherapy (LPT) on the treatment of oral mucositis in a patient undergoing RT after surgical removal of a squamous cell carcinoma with osseous invasion of the maxilla. Palatal and commissural lesions were treated with lambda660 nm, 40 mW, slashed circle=4 mm(2), in contact mode, 5 x 2.4 J/ cm(2) per point, 14.4 J/cm(2) per session. For treating the lesion on the patient's nasal mucosa, LPT (slashed circle=4 mm(2), lambda780 nm, 70 mW, 3 x 2.1 J/cm(2) per point, 6.3 J/cm(2) per session, contact mode) was used on the external area of the nose. A single dose (2.4 J/cm(2)) with the lambda660 nm laser, as described before, was applied on the entrance of each nostril. LPT was used 3 times/week during 4 weeks. Treatment results indicate that the use of LPT on oral mucositis was effective and allowed the patient to carry on the RT without interruption. However, long-term and controlled clinical trials are necessary to establish both preventive and curative protocols using LPT.
Braz Dent J 2011 22(2) 162-5
Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: A double-blind randomized study in head and neck cancer patients.
Carvalho PA, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA. Stomatology Department - Hospital A.C. Camargo, São Paulo, Brazil.
The purpose of this prospective study was to determine the effect of the low-level laser in the prevention and treatment of mucositis in head and neck cancer patients. A total of 70 patients with malignant neoplasms in the oral cavity or oropharynx were evaluated. The patients were randomized into two low-level laser therapy groups: Group 1 (660nm/15mW/ 3.8J/cm(2)/spot size 4mm(2)) or Group 2 (660nm/5mW/1.3J/cm(2)/spot size 4mm(2)) starting on the first day of radiotherapy. Oral mucositis was assessed daily and weekly using the NCI and WHO scales. Oral pain was scored daily with a visual analogue scale before laser application. The patients in Group 1 had a mean time of 13.5days (range 6-26days) to present mucositis grade II, while the patients in Group 2 had a mean time of 9.8days (range 4-14days) (both WHO and NCI p=0.005). In addition, Group 2 also presented a higher mucositis grade than Group 1 with significant differences found in weeks 2 (p=0.019), 3 (p=0.005) and 4 (p=0.003) for WHO scale and weeks 2 (p=0.009) and 4 (p=0.013) for NCI scale. The patients in Group 1 reported lower pain levels (p=0.004). Low-level laser therapy during radiotherapy was found to be effective in controlling the intensity of mucositis and pain.
Oral Oncol. 2011 Sep 10. [Epub ahead of print]
The Prevention of Induced Oral Mucositis with Low-Level Laser Therapy in Bone Marrow Transplantation Patients: A Randomized Clinical Trial.
Silva GB, Mendonca EF, Bariani C, Antunes HS, Silva MA1 Hematopoietic Stem Cell Transplant Unit, Araujo Jorge Hospital, Goias Fight Cancer Association , Goiania, Goias, Brazil .
Abstract Background Data and Objective
Patients who have received high doses of chemotherapy, either alone or in combination with total body irradiation often cite oral mucositis (OM) as the most debilitating side effect. The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) on the prevention of conditioning- induced OM in hematopoietic stem cell transplantation (HSCT).
We randomized 42 patients who underwent autologous or allogeneic HSCT. A low-level InGaAlP diode laser was used, emitting light at 660 nm, 40 mW, and 4 J/cm(2). An evaluation of OM was carried out using the World Health Organization scale.
Results and Conclusion
In the LLLT group, 57.1% of patients had an OM grade 0, 9.6% had grade 1, and 33.3% had grade 2, whereas in the control group, only 4.8% of patients were free of OM (grade 0). Our results indicate that the preventive use of LLLT in patients who have undergone HSCT is a powerful instrument in reducing OM incidence.
Photomed Laser Surg 2010 Oct 22
A randomized controlled trial of visible-light therapy for the prevention of oral mucositis.
Elad S, Luboshitz-Shon N, Cohen T, Wainchwaig E, Shapira MY, Resnick IB, Radiano R, Lubart R, Or R
The objective of this study was to assess the efficacy of a novel visible-light therapy (VLT) device for the prevention of oral mucositis in hematopoietic stem cell transplantation (HSCT) patients. A VLT-device suitable for intra-oral use was applied to 20 patients undergoing HSCT. The study design was placebo-controlled, randomized and double-blind. Oral mucositis was assessed using the OMAS and WHO scales. Oral pain and acceptance levels were scored by the patient using a 10-step scale. Patients were evaluated once a week until day 21 post- HSCT. Mucositis rate, severity and pain score were compared. At the third visit, 1week post- HSCT, mucositis rates were significantly lower in the treatment group (for both WHO and OMAS p=0.02). Mucositis was also less severe in the treatment group (for WHO p=0.01; for OMAS p=0.01). Furthermore, the patients in the treatment group reported lower pain levels (p=0.04). The treatment was well tolerated and highly accepted, with no reports of adverse events related to the device. These findings suggest that the VLT-device is safe and effective for the prevention of oral mucositis in patients undergoing HSCT.
Oral Oncol 2010 Dec 15
The use of low-energy laser (LEL) for the prevention of chemotherapy- and/or radiotherapy-induced oral mucositis in cancer patients: results from two prospective studies
Genot-Klastersky MT, Klastersky J, Awada F, Awada A, Crombez P, Martinez MD, Jaivenois MF, Delmelle M, Vogt G, Meuleman N, Paesmans M
Low-energy laser (LEL) treatment has been suggested as an effective and safe method to prevent and/or treat oral mucositis induced by chemotherapy and/or radiotherapy; however, it has not gained wide acceptance so far.
Materials and Methods
We conducted two clinical trials testing the LEL technique: firstly, as a secondary prevention in patients with various solid tumors treated with chemotherapy who all developed severe mucositis after a previous identical chemotherapy and, secondly, as therapeutic intervention (compared to sham illumination in a randomized way) in patients with hematological tumors receiving intensive chemotherapy and having developed low-grade oral mucositis.
We entered 26 eligible patients in the first study and 36 were randomized in the second study. The success rate was 81% (95%CI = 61-93%) when LEL was given as a preventive treatment. In the second study, in patients with existing lesions, the therapeutic success rate was 83% (95%CI = 59-96%), which was significantly different from the success rate reached in the sham-treated patients (11%; 95%CI = 1-35%); the time to development of grade 3 mucositis was also significantly shorter in the sham-treated patients (p < 0.001).
Our results strongly support the already available literature, suggesting that LEL is an effective and safe approach to prevent or treat oral mucositis resulting from cancer chemotherapy.
Support Care Cancer 2008 Dec 16(12) 1381-7
Light-emitting diode therapy in chemotherapy-induced mucositis.
Sacono NT, Costa CA, Bagnato VS, Abreu-e-Lima FC Department of Orthodontics and Pediatric Dentistry, Sao Paulo State University, Araraquara School of Dentistry, Araraquara, SP, Brazil.
Background and Objective
Mucositis is the most common oral complication of cancer chemotherapy, which causes pain on mastication and swallowing, impairs patients' ability to eat and take oral drugs and may determine interruption of the treatment. The aim of this study was to evaluate the effect of light-emitting diode (LED) therapy on chemotherapy-induced mucositis in hamsters.
Study Design / Materials & Methods
Animals of both experimental (Group I; n = 32) and positive control (Group II; n = 32) groups received intraperitoneal injections of 5-fluorouracil on days 0 and 2. All animals had their right and left cheek pouch irritated by superficial scratching on days 3 and 4. In Group I, LED irradiation (630 nm+/-10 nm, 160 mW, 12 J/cm2) was applied during 37.5 seconds at days 3, 4, 6, 8, 10, 12, and 14. In Group II, mucositis was induced, but LED therapy was not performed. The oral mucosa was photographed from day 4 to 14 at 2-day intervals. Photographs were randomly scored according to the severity of induced mucositis (0 to 5). In the negative control group (Group III; n = 6), no mucositis was induced. Biopsies of the cheek pouches of 8 animals (Group I and Group II) were surgically obtained on days 5, 9, 13 and 15 and processed for histological examination.
The statistical analysis showed significant differences between irradiated and non-irradiated groups (P<0.05). However, muscular degeneration was observed in 18% of the samples of Group I.
It may be concluded that the LED therapy protocol established for this in vivo study was effective in reducing the severity of oral mucositis, although the oral lesions were not completely prevented.
Lasers Surg Med 2008 Nov 40(9) 625-33
Severity of Oral Mucositis in Patients Undergoing Hematopoietic Cell Transplantation and an Oral Laser Phototherapy Protocol: A Survey of 30 Patients.
Eduardo FD, Bezinelli L, Luiz AC, Correa L, Vogel C, Eduardo CDHospital Israelita Albert Einstein, Unit of Bone Marrow Transplantation, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil.
Abstract Background Data and Objective
Oral mucositis (OM) is one of the worst cytotoxic effects of chemotherapy and radiotherapy in patients undergoing hematopoietic cell transplantation (HCT), and it causes severe morbidity. Laser phototherapy has been considered as an alternative therapy for prevention and treatment of OM. The aim of this study was to describe the incidence and severity of OM in HCT patients subjected to laser phototherapy, and to discuss its effect on the oral mucosa.
Patients and Methods
Information concerning patient age and gender, type of basic disease, conditioning regimen, type of transplant, absence or presence of pain related to the oral cavity, OM grade, and adverse reactions or unusual events were collected from 30 patients undergoing HCT (allogeneic or autologous). These patients were given oral laser phototherapy with a InGaAIP laser (660 nm and 40 mW) daily. The data were tabulated and their frequency expressed as percentages.
In the analysis of those with OM, it was observed that 33.4% exhibited grade I, 40% grade II, 23.3% grade III, and 3.3% grade IV disease. On the most critical post-HCT days (D+5 and D+8), it was observed that 63.3% of patients had grade I and 33.3% had grade II disease; no patients had grade III or IV disease in this period. This severity of OM was similar to that seen in other studies of laser phototherapy and OM.
The low grades of OM observed in this survey show the beneficial effects of laser phototherapy, but randomized clinical trials are necessary to confirm these findings.
Photomed Laser Surg 2008 Aug 12
Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial.
Antunes HS, de Azevedo AM, da Silva Bouzas LF, Adao CA, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, D'Aiuto de Matos V, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG. Section of Dentistry, Instituto Nacional de Cancer (INCA), Rio de Janeiro. Brazil
We investigated the clinical effects of low-power laser therapy (LPLT) on prevention and reduction of severity of conditioning-induced oral mucositis (OM) for hematopoietic stem cell transplantation (HSCT). We randomized 38 patients who underwent autologous (AT) or allogeneic (AL) HSCT. A diode InGaAlP was used, emitting light at 660 nm, 50 mW, and 4 J/cm2, measured at the fiberoptic end with 0.196 cm2 of section area. The evaluation of OM was done using the Oral Mucositis Assessment Scale (OMAS) and the World Health Organization (WHO) scale. In the LPLT group, 94.7% of patients had an OM grade (WHO) lower than or equal to grade 2, including 63.2% with grade 0 and 1, whereas in the controls group, 31.5% of patients had an OM grade lower than or equal to grade 2 (P < .001). Remarkably, the hazard ratio (HR) for grades 2, 3, and 4 OM was 0.41 (range, 0.22-0.75; P = .002) and for grades 3 and 4 it was 0.07 (range, 0.11-0.53; P < . 001). Using OMAS by the calculation of ulcerous area, 5.3% of the laser group presented with ulcers of 9.1 cm2 to 18 cm2, whereas 73.6% of the control group presented with ulcers from 9.1 cm2 to 18 cm2 (P = .003). Our results indicate that the use of upfront LPLT in patients who have undergone HSCT is a powerful instrument in reducing the incidence of OM and is now standard in our center.
Blood 2007 Mar 109 (5) 2250-55
Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation
Jaguar GC, Prado JD, Nishimoto IN, Pinheiro MC, de Castro DO Jr, da Cruz Perez DE, Alves FA Department of Stomatology, Cancer Hospital A.C. Camargo, Sao Paulo, Brazil.
To evaluate the clinical effects of laser therapy on the prevention and reduction of oral mucositis in patients who underwent hematopoietic stem cell transplantation (HSCT).
Patients and Methods
From January 2003 to September 2004, 24 patients received prophylactic laser therapy (L + group). The applications started from the beginning of the conditioning regimen up to day +2. The oral assessment was performed daily until day +30. This group was compared with historical controls, namely 25 patients, who did not receive laser therapy (L- group).
All patients developed some grade of mucositis. However, the L- group presented initial mucositis by 4.36 days, whereas the L+ group presented it in 6.12 days (P = 0.01). The maximum mucositis occurred between day +2 and day +6 with healing by day +25 in the L- group and between day +2 and day +7 with healing by day +14 for the L+ group (P = 0.84). Laser therapy also reduced the time of oral pain from 5.64 to 2.45 days (P = 0.04), and decreased the consumption of morphine (P = 0.07).
This study suggests that laser therapy can be useful in oral mucositis to HSCT patients and improve the patient's quality of life. However, controlled randomized trials should be performed to confirm the real efficacy of laser therapy.
Oral Dis 2007 Nov 13(6) 538-43
Low-level laser for prevention and therapy of oral mucositis induced by chemotherapy or radiotherapy.
Genot MT, Klastersky J Laboratoire d'Investigation Clinique H.J. Tagnon, Institut Jules Bordet, Centre des Tumeurs, Universite Libre de Bruxelles, Bruxelles, Belgium.
Purpose of Review
Oral mucositis is a common morbid condition associated with chemotherapy or radiotherapy for which there is no standard prophylaxis or treatment. There is increasing evidence that the use of low-level laser can reduced the severity of mucositis associated with chemotherapy or radiation therapy. The purpose of this review is to examine the available evidence for it.
For most approaches commonly used to prevent or treat chemotherapy-associated or radiotherapy-associated oral mucositis, a recent panel of experts could not find sufficient levels of evidence to recommend or suggest their use. As for low-level laser therapy, the results are difficult to assess and compare because of interoperator variability and because clinical trials are difficult to conduct in that field. Nevertheless, there is accumulating evidence in support of low-level laser therapy.
On the basis of literature data, it is reasonable to conclude that the evidence that low-level laser therapy may be useful in decreasing the severity of chemotherapy-associated or radiotherapy-associated mucositis is substantial, even though there have been few controlled studies in the field of prevention.
Curr Opin Oncol 2005 May 17(3) 236-40
Patients with moderate chemotherapy-induced mucositis: pain therapy using low intensity lasers
Nes AG, Posso MB Buskerud University, Drammen, Norway. email@example.com
Intensive cancer therapy normally affects malignant and normal cells with high replication rates. Cells in the gastrointestinal tract are therefore commonly affected by cytotoxins. This often results in the development of chemotherapy-induced oral mucositis (COM). COM is the inflammatory response of the oral mucous membrane to the chemotherapy drugs. Low level laser therapy (LLLT) has proved to be effective in treating and repairing biologically damaged tissue and to reduce pain. LLLT has also proven to be an efficient method for the prevention of oral mucositis.
To investigate the effect of LLLT on pain relief among patients who have developed COM.
The study was performed as a clinical test with a sample consisting of 13 adult patients receiving oncology treatment. The patients were treated during a 5-day period, and the pain was measured before and after each laser application. The laser used was an AsGaAl, with a wavelength of 830 nm and a potency of 250 mW. The energy given was 35 J cm(-2).
The results were analysed using the Wilcoxon test.
There was a significant (P = 0.007) 67% decrease in the daily average experience of pain felt before and after each treatment, confirming that LLLT can relieve pain among patients who have developed COM.
The low number of COM patients at the hospital did not allow a control group to be included in the study, and therefore the results contain a potential placebo effect.
Implications for Nursing Care
The most important benefit the authors consider to be the value for the patients of better and quicker treatment with a drastic reduction in painful mucositis.
Int Nurs Rev 2005 Mar 52(1) 68-72
Pilot study of laser effects on oral mucositis in patients receiving chemotherapy.
Wong SF, Wilder-Smith P
Western University of Health Sciences, College of Pharmacy, Division of Hematology/Oncology, Pomona, California 91766, USA.
The purpose of this study was to examine the effectiveness of laser therapy in the prevention and/or healing of chemotherapy-induced oral mucositis lesions. This study also evaluated the ease and feasibility of the laser therapy and the impact of the treatment on improving the patient's quality of life.
Patients and Methods
Fifteen patients with an episode of prior chemotherapy-induced grade 3 or 4 mucositis with 5-fluorouracil continuous infusion consented to participate in this study. All patients were provided with standardized mouth care instructions at the initiation of chemotherapy treatments. Enrolled patients received laser therapy treatments 24 hours before the chemotherapy and then recommenced weekly with evenly distributed exposure to the standardized designated areas by one operator during the entire cycle of chemotherapy at the same doses until the mucositis resolved or the chemotherapy cycle was completed. lntraoral perfusion was measured by laser Doppler technology. Patients were assessed for response to laser therapy according to standardized mucositis grading criteria by evaluating development of lesions, extent and duration of lesions, and time to healing. The effect of laser therapy on ability to continue planned chemotherapy, the reduction in dose, delays, and ability to maintain planned dose intensity were assessed. The impact of laser therapy on pain control was evaluated using the visual analogue score. A quality-of-life survey was completed by each patient at the initiation of chemotherapy and then weekly throughout the chemotherapy.
Eleven of 15 patients experienced grade 0 mucositis, three patients experienced grade 1 to 2 mucositis, and one patient experienced grade 3 to 4 mucositis. Fourteen patients completed the lasertherapy as planned, and none of the patients withdrew from the laser therapy treatments because of noncompliance. One patient continued to experience grade 4 mucositis that necessitated an interruption in the planned chemotherapy regimen and, consequently, the laser treatment. Patients tolerated the laser therapy very well and did not report any increased discomfort. No significant changes in perfusion were observed as a result of laser therapy.
In this pilot study, laser therapy significantly reduced the incidence and the severity of mucositis in chemotherapy patients. The laser therapy does not appear to promote wound healing by affecting the intraoral perfusion, as assessed by Doppler measurements. The mechanisms involved in the mediating of the observed effects remain unknown at this time. Continued research is warranted to determine the optimal laser wavelength and parameters.
Cancer J 2002 May-Jun 8(3) 247-54
NASA light-emitting diodes for the prevention of oral mucositis in pediatric bone marrow transplant patients.
Whelan HT, Connelly JF, Hodgson BD, Barbeau L, Post AC, Bullard G, Buchmann EV, Kane M, Whelan NT, Warwick A, Margolis D Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. firstname.lastname@example.org
The purpose of this study was to determine the effects of prophylactic near-infrared light therapy from light-emitting diodes (LEDs) in pediatric bone marrow transplant (BMT) recipients.
Oral mucositis (OM) is a frequent side effect of chemotherapy that leads to increased morbidity. Near-infrared light has been shown to produce biostimulatory effects in tissues, and previous results using near-infrared lasers have shown improvement in OM indices. However, LEDs may hold greater potential for clinical applications.
Materials and Methods
We recruited 32 consecutive pediatric patients undergoing myeloablative therapy in preparation for BMT. Patients were examined by two of three pediatric dentists trained in assessing the Schubert oral mucositis index (OMI) for left and right buccal and lateral tongue mucosal surfaces, while the patients were asked to rate their current left and right mouth pain, left and right xerostomia, and throat pain. LED therapy consisted of daily treatment at a fluence of 4 J/cm(2) using a 670-nm LED array held to the left extraoral epithelium starting on the day of transplant, with a concurrent sham treatment on the right. Patients were assessed before BMT and every 2-3 days through posttransplant day 14. Outcomes included the percentage of patients with ulcerative oral mucositis (UOM) compared to historical epidemiological controls, the comparison of left and right buccal pain to throat pain, and the comparison between sides of the buccal and lateral tongue OMI and buccal pain.
The incidence of UOM was 53%, compared to an expected rate of 70-90%. There was also a 48% and 39% reduction of treated left and right buccal pain, respectively, compared to untreated throat pain at about posttransplant day 7 (p < 0.05). There were no significant differences between sides in OMI or pain. CONCLUSION: Although more studies are needed, LED therapy appears useful in the prevention of OM in pediatric BMT patients.
J Clin Laser Med Surg 2002 Dec 20(6) 319-24
Effects of Low Level Laser Therapy on Oral Mucositis Caused by Anticancer Chemotherapy in Pediatric Patients
Hae Ja Kim, M.D., Shi Youn Rho, M.D., and Yong Sup Shin, M.D.?Depratment of Anesthesiology, Chungnam National University, College of Medicine, Daejeon, Korea
Oral mucositis is a common complication of anticancer chemotherapy. The sequelae of this consist of an increased risk of infection, moderate to severe pain, compromised oral function, and bleeding. This study was performed to evaluated the effects of the He-Ne laser and the Ga-Al- As laser on oral mucositis caused by anticancer chemotherapy in pediatric patients.?Methods: There were 3 cases of osteosarcoma and 6 cases of leukemia. All patients received He-Ne laser (632.8 nm wavelength, power 60 mW) application on 400# 600 Hz scanning for 5# 20 minutes and Ga-Al-As laser (904 nm wavelength, power 40 mW) application by fiberoptic hand piece placed in immediate proximity to the tissue without direct contact with it for 30 seconds per point for 5 days per week. During the application patients wore wavelength-specific dark glasses and were instructed to keep their eyes closed. Results: The mean number of treatments with oral intake was 4.89 ? 0.64. The mean number of total treatments was 9.44 ? 2.59. There were no significant side effects during and after the laser btreatments. Conclusions: He-Ne laser and Ga-Al-As (IR) laser treatment were well tolerated and reduced the severity and duration of chemotherapy-induced oral mucositis in pediatric oncologic patients.
The Journal of The Korean Pain Society 2001 Jun; 14(01) 51-55
Low-energy He/Ne laser in the prevention of radiation-induced mucositis. A multicenter phase III randomized study in patients with head and neck cancer.
Bensadoun RJ, Franquin JC, Ciais G, Darcourt V, Schubert MM, Viot M, Dejou J, Tardieu C, Benezery K, Nguyen TD, Laudoyer Y, Dassonville O, Poissonnet G, Vallicioni J, Thyss A, Hamdi M, Chauvel P, Demard FExternal Radiotherapy Unit, Centre Antoine-Lacassagne, Nice, France. email@example.com
Use of the low-energy helium-neon laser (LEL) appears to be a simple atraumatic technique for the prevention and treatment of mucositis of various origins. Preliminary findings, and significant results obtained for chemotherapy-induced mucositis in a previous phase III study, prompted a randomized multicenter double-blind trial to evaluate LEL in the prevention of acute radiation- induced stomatitis. Irradiation by LEL corresponds to local application of a high-photon-density monochromatic light source. Activation of epithelial healing for LEL-treated surfaces, the most commonly recognized effect, has been confirmed by numerous in vitro studies. The mechanism of action at a molecular and enzymatic level is presently being studied. From September 1994 to March 1998, 30 patients were randomized. Technical specification: 60 mW (25 mW at Reims, 1 patient), He-Ne, wavelength 632.8 nm. The trial was open to patients with carcinoma of the oropharynx, hypopharynx and oral cavity, treated by radiotherapy alone (65 Gy at a rate of 2 Gy/ fraction, 5 fractions per week) without prior surgery or concomitant chemotherapy. The malignant tumor had to be located outside the tested laser application areas (9 points): posterior third of the internal surfaces of the cheeks, soft palate and anterior tonsillar pillars. Patients were randomized to LEL or placebo light treatment, starting on the first day of radiotherapy and before each session. The treatment time (t) for each application point was given by the equation : t(s)= energy (J/cm2) x surface (cm2)/Power (W). Objective assessment of the degree of mucositis was recorded weekly by a physician blinded to the type of treatment, using the WHO scale for grading of mucositis and a segmented visual analogue scale for pain evaluation. Protocol feasibility and compliance were excellent. Grade 3 mucositis occured with a frequency of 35.2% without LEL and of 7.6% with LEL (P<0.01). The frequency of "severe pain" (grade 3) was 23.8% without LEL, falling to 1.9% with LEL (P<0.05). Pain relief was significantly reduced throughout the treatment period (weeks 2-7). LEL therapy is capable of reducing the severity and duration of oral mucositis associated with radiation therapy. In addition, there is a tremendous potential for using LEL in combined treatment protocols utilizing concomitant chemotherapy and radiotherapy.
Support Care Cancer 1999 Jul 7(4) 244-52
Laser therapy in the prevention and treatment of mucositis caused by anticancer chemotherapy
Ciais G, Namer M, Schneider M, Demard F, Pourreau-Schneider N, Martin PM, Soudry M, Franquin JC, Zattara H Centre de lutte contre le cancer Antoine-Lacassagne, Nice, France.
The appearance of mucositis is a frequent and painful secondary effect of anticancer chemotherapy. Patients who develop oral toxicity during the first course of treatment will almost assuredly show identical side effects during each subsequent course unless the drugs are changed or the doses are lowered. In the absence of an efficacious antidote or preventive prophylaxis for such lesions to date, this report presents the results of a preliminary retrospective non-randomized study of the effect of soft-laser treatments on mucositis in cancer patients receiving combination chemotherapy, including 5-fluorouracil. Iatrogenic mucositis was observed during 43% of 53 chemotherapy cycles in the case control population. Curative laser therapy reduced the time to repair lesions and the rate of therapeutic modifications. For patients who received soft-laser therapy as a preventive measure, the incidence of oral complications was reduced to 6% during 101 cycles of chemotherapy. All of these patients, even those who have encountered mucositis before receiving preventive laser therapy, terminated their cancer therapy as originally scheduled. Well designed and carefully controlled trials will be necessary to define the place of helium-neon laser therapy in the repair and prevention of oral complications due to cancer chemotherapy.
Bull Cancer 1992 79(2) 183-91
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