Photobiomodulation for Prevention of Chemotherapy-induced Peripheral Neuropathy in Women With Breast Cancer

Double-blind Superiority Randomized Controlled Clinical Trial. Objective of the study: To evaluate the effectiveness of photobiomodulation using the LED board in the prevention of peripheral neuropathy in the lower limbs in women with breast cancer undergoing chemotherapy at the Cancer Hospital III of the National Cancer Institute (HCIII/INCA).

Study Overview

• Status: Completed
• Conditions: Peripheral Nervous System Diseases AND Breast Neoplasms
• Intervention / Treatment: Device: Intervention group with the IV and V LED board; Device: Intervention group with the IV, V and Violet LED board; Device: Control group with LED board without emitting light

Detailed Description

Materials and methods: This is a single-blind superiority randomized controlled clinical trial. Women aged over 18 years, with breast cancer in stages I to IIIC and who have an indication for curative treatment with neoadjuvant or adjuvant chemotherapy at HCIII/INCA will be eligible. Patients with a previous diagnosis of another primary cancer will be excluded; patients undergoing surgery and/or chemotherapy at another institution; patients who previously had altered sensitivity in the feet; patients who are unable to answer the questionnaires and patients unable to receive photobiomodulation due to acute infections in the lower limbs. After recruitment, the women will be allocated into three groups: two Intervention groups (use of the IV and V LED board; and IV, V and Violet) and a Control group (use of the LED board without light emission). Peripheral neuropathy, pain, global muscle strength, body balance, sensitivity, health-related quality of life and related independent variables will be evaluated, such as the characteristics of the patient, the tumor and the oncological treatment performed. Data analysis: Statistical analysis will be conducted following intention-to-treat principles. Data normality will be tested using the Kolmogorov Smirnov test, considering as normal distribution those with p > 0.05.

• Study Type: Interventional
• Enrollment (Actual): 186
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • Rio de Janeiro, Brazil, 20530-003
    • Erica Alves Nogueira Fabro

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Women aged over 18 years, with breast cancer in stages I to IIIC and who have an indication for curative treatment with neoadjuvant or adjuvant chemotherapy in HCIII/INCA.

Exclusion Criteria:

• Patients with a previous diagnosis of another primary cancer
• Patients undergoing surgery and/or chemotherapy at another Institution
• Patients who previously had altered sensitivity in the feet
• Patients who are unable to respond to questionnaires
• Patients unable to receive photobiomodulation due to acute lower limb infections

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Intervention group with the IV and V LED board; Time of Applications will for 20 minutes on each extremity (foot soles), until the last day of chemotherapy treatment. The sequential LED treatments will be administered by the Sportllux Ultra model (Cosmedical) in a predefined cycle, with the combination of light emitters in two wavelengths: 42 red (660nm) and 42 infrared (850nm); LED blanket in the size of 10x12 cm; average power of each LED: 5mW; operating mode: continuous; polarization: random; irradiance at the opening of each LED: 25mW/cm2; opening diameter of each LED: 10mm; application time: 1 session of 20 minutes; power per LED: 30mW; radiant exposure: 36J/cm2 during 20 minutes of application. Tissue from the lower limb extremities will come into contact with the LED panel during treatment to ensure even delivery of photobiomodulation. The panels are large enough to more than cover the entire edge area at one time during application.	Device: Intervention group with the IV and V LED board; Applications of the LED board will be performed daily for 20 minutes on each extremity (foot soles), until the last day of chemotherapy treatment. The sequential LED treatments will be administered by the Sportllux Ultra model (Cosmedical) in a predefined cycle, with the combination of light emitters in two wavelengths: 42 red (660nm) and 42 infrared (850nm); LED blanket in the size of 10x12 cm; average power of each LED: 5mW; operating mode: continuous; polarization: random; irradiance at the opening of each LED: 25mW/cm2; opening diameter of each LED: 10mm; application time: 1 session of 20 minutes; power per LED: 30mW; radiant exposure: 36J/cm2 during 20 minutes of application. Tissue from the lower limb extremities will come into contact with the LED panel during treatment to ensure even delivery of photobiomodulation. The panels are large enough to more than cover the entire edge area at one time during application.
Active Comparator: Intervention group with the IV, V and Violet LED board; Time of Applications will be for 20 minutes on each extremity (foot soles), until the last day of chemotherapy treatment. The sequential LED treatments will be administered by the Sportllux Ultra model (Cosmedical) in a predefined cycle, with the combination of light emitters in three wavelengths: 18 red (660nm), 18 infrared (850nm) and 36 violet (420nm). ); LED blanket in the size of 10x12 cm; average power of each LED: 5mW; operating mode: continuous; polarization: random; irradiance at the opening of each LED: 25mW/cm2; opening diameter of each LED: 10mm; application time: 1 session of 20 minutes; power per LED: 30mW; radiant exposure: 36J/cm2 during 20 minutes of application. Tissue from the lower limb extremities will come into contact with the LED panel during treatment to ensure even delivery of photobiomodulation. The panels are large enough to more than cover the entire edge area at one time during application.	Device: Intervention group with the IV, V and Violet LED board; Applications of the LED board will be performed daily for 20 minutes on each extremity (foot soles), until the last day of chemotherapy treatment. The sequential LED treatments will be administered by the Sportllux Ultra model (Cosmedical) in a predefined cycle, with the combination of light emitters in three wavelengths: 18 red (660nm), 18 infrared (850nm) and 36 violet (420nm). ); LED blanket in the size of 10x12 cm; average power of each LED: 5mW; operating mode: continuous; polarization: random; irradiance at the opening of each LED: 25mW/cm2; opening diameter of each LED: 10mm; application time: 1 session of 20 minutes; power per LED: 30mW; radiant exposure: 36J/cm2 during 20 minutes of application. Tissue from the lower limb extremities will come into contact with the LED panel during treatment to ensure even delivery of photobiomodulation. The panels are large enough to more than cover the entire edge area at one time during application.
Placebo Comparator: Control group with LED board without emitting light; Applications of the LED board will be performed daily for 20 minutes on each extremity (foot soles), until the last day of chemotherapy treatment. The sequential LED treatments will be administered by the Sportllux Ultra (Cosmedical) model without the light emitting combination. LED blanket in the size of 10x12 cm and application time: 1 session of 20 minutes. Tissue from the lower limb extremities will come into contact with the LED panel during treatment to ensure even delivery of photobiomodulation. The panels are large enough to more than cover the entire edge area at one time during application. Women will receive a booklet with guidelines for the correct use of the LED board and will be instructed to continue their usual physical activities and mark the daily frequency of application of the LED board	Device: Control group with LED board without emitting light; Applications of the LED board will be performed daily for 20 minutes on each extremity (foot soles), until the last day of chemotherapy treatment. The sequential LED treatments will be administered by the Sportllux Ultra (Cosmedical) model without the light emitting combination. LED blanket in the size of 10x12 cm and application time: 1 session of 20 minutes. Tissue from the lower limb extremities will come into contact with the LED panel during treatment to ensure even delivery of photobiomodulation. The panels are large enough to more than cover the entire edge area at one time during application.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peripheral neuropathy	Chemotherapy Induced Peripheral Neuropathy Assessment Tool (FANPIQ), which is validated and translated from the Chemotherapy Induced Peripheral Neuropathy Assessment Tool - (CIPNAT).	Until the conclusion of the study, on average 14 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lower limb pain	Short Form McGill Questionnaire, which is the McGill questionnaire in its shortened form	Until the conclusion of the study, on average 14 months
Overall Muscle Strength	Hydraulic Jamar Dynamometer (Sammons Preston Rolyan, 4, Sammons Court, Bolingbrook, IL, 60440)	Until the conclusion of the study, on average 14 months
Body Balance	Timed Up and Go Test (TUG)	Until the conclusion of the study, on average 14 months
Lower limb sensitivity	Esthesiometer (monofilaments)	until the conclusion of the study, on average 14 months
Health-related quality of life	Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group - Neurotoxicity Questionnaire (FACT/GOG-NTX), Portuguese version FACT/GOG-NTX (Portuguese version)	Until the conclusion of the study, on average 14 months
Satisfaction with the use of photobiomodulation	Questions will be asked about overall satisfaction with the management of peripheral neuropathy	Until the conclusion of the study, on average 14 months
Assessment of Adherence to Treatment	The LED board application diary will be used in which patients in intervention group A and B and control will be instructed to fill it in daily during the intervention period. In this diary, patients must inform the date of application of the LED board, if it was performed on both feet and if the duration time was 20 minutes on each limb. The LED board application diary must be delivered by the patient or family member to a physiotherapist who will be responsible for receiving it, on the last day of the chemotherapy treatment.	Until the conclusion of the study, on average 14 months
Impact of Peripheral Neuropathy on Activities of Daily Living	Chemotherapy Induced Peripheral Neuropathy Assessment Tool (FANPIQ)	Until the conclusion of the study, on average 14 months

Collaborators and Investigators

• Sponsor: Erica Alves Nogueira Fabro
• Collaborators: COSMEDICAL; BLED MED COMERCIO E DISTRIBUIÇÃO LTDA

Publications and helpful links

General Publications

• Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987 Aug;30(2):191-197. doi: 10.1016/0304-3959(87)91074-8.
• Zecha JA, Raber-Durlacher JE, Nair RG, Epstein JB, Elad S, Hamblin MR, Barasch A, Migliorati CA, Milstein DM, Genot MT, Lansaat L, van der Brink R, Arnabat-Dominguez J, van der Molen L, Jacobi I, van Diessen J, de Lange J, Smeele LE, Schubert MM, Bensadoun RJ. 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. Support Care Cancer. 2016 Jun;24(6):2793-805. doi: 10.1007/s00520-016-3153-y. Epub 2016 Mar 17.
• Andrade, L.C.A; Costa G.L.A. and other Timed Up and Go test in assessing the risk of falls in the elderly: a literature review. Research, Society and Development. 2021, 10(13):1-7.
• Alberto, Talita; Corbo, B.F.B; e outros Efeitos do emissor de luz (LED) vermelho na estimulação de fibroblastos: ansiedade na emoção tecidual. Revista Intellectus. Vol 1, n. 33 de 2016.
• Andreo L, Soldera CB, Ribeiro BG, de Matos PRV, Bussadori SK, Fernandes KPS, Mesquita-Ferrari RA. Effects of photobiomodulation on experimental models of peripheral nerve injury. Lasers Med Sci. 2017 Dec;32(9):2155-2165. doi: 10.1007/s10103-017-2359-7. Epub 2017 Oct 23.
• Argenta PA, Ballman KV, Geller MA, Carson LF, Ghebre R, Mullany SA, Teoh DG, Winterhoff BJ, Rivard CL, Erickson BK. The effect of photobiomodulation on chemotherapy-induced peripheral neuropathy: A randomized, sham-controlled clinical trial. Gynecol Oncol. 2017 Jan;144(1):159-166. doi: 10.1016/j.ygyno.2016.11.013. Epub 2016 Nov 22.
• Rafael Inácio Barbosa, R.I; Marcolino A.M; Guirro R.R.J; Nilton Mazzer, Nilton; et al. Efeito do laser de baixa intensidade (660 nm) na regeneração do nervo isquiático lesado em ratos. Fisioterapia e Pesquisa, São Paulo, v.17, n.4, p. 294-9, out/dez. 2010.
• Bensadoun RJ, Bollet MA, Liem X, Cao K, Magne N. New photobiomodulation device for prevention and cure of radiotherapy-induced oral mucositis and dermatitis: results of the prospective Safe PBM study. Support Care Cancer. 2022 Feb;30(2):1569-1577. doi: 10.1007/s00520-021-06574-2. Epub 2021 Sep 19.
• Bethesda, MD: National Cancer Institute. PDQ® Adult Treatment Editorial Board. PDQ Breast Cancer Treatment (Adult). Available at: https://www.cancer.gov/types/breast/hp/breast-treatment-pdq. Accessed August 10th, 2022.
• Brasil. Ministério da Saúde; Instituto Nacional de Câncer José Alencar Gomes da Silva. Ações de enfermagem para o controle do câncer: uma proposta de integração ensino-serviço. Rio de Janeiro: INCA; 2008. Bases do tratamento; p. 369-556.
• Beliche T.W.O; Hamu T.C.D.S. et al. Diferenças de aplicação do teste timed up and go em crianças típicas. Revista Temas em Saúde, v. 20, n°1, p. 95-103. João Pessoa,2020.
• Bretan O, Silva Junior JE, Ribeiro OR, Corrente JE. Risk of falling among elderly persons living in the community: assessment by the Timed up and go test. Braz J Otorhinolaryngol. 2013 Jan-Feb;79(1):18-21. doi: 10.5935/1808-8694.20130004.
• Calhoun EA, Welshman EE, Chang CH, Lurain JR, Fishman DA, Hunt TL, Cella D. Psychometric evaluation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (Fact/GOG-Ntx) questionnaire for patients receiving systemic chemotherapy. Int J Gynecol Cancer. 2003 Nov-Dec;13(6):741-8. doi: 10.1111/j.1525-1438.2003.13603.x.
• Costa TC, Lopes M, Anjos AC, Zago MM. [Chemotherapy-induced peripheral neuropathies: an integrative review of the literature]. Rev Esc Enferm USP. 2015 Apr;49(2):335-45. doi: 10.1590/S0080-623420150000200020. Portuguese.
• DUTRA M. C; CABRAL A. L. L, CARVALHO G. A. Tradução para o português e validação do teste timed up and go. Revista Interfaces. Saúde, Humanas e Tecnologia. Vol. 3(9), pp. 81-88, 22 de Abril, 2016
• Fisusi FA, Akala EO. Drug Combinations in Breast Cancer Therapy. Pharm Nanotechnol. 2019;7(1):3-23. doi: 10.2174/2211738507666190122111224.
• Fernandes A.A; Marins J.C.B. Teste de força de preensão manual: análise metodológica e dados normativos em atletas. Fisioter. mov. 24 (3). Set 2011.
• Hsieh YL, Fan YC, Yang CC. Low-level laser therapy alleviates mechanical and cold allodynia induced by oxaliplatin administration in rats. Support Care Cancer. 2016 Jan;24(1):233-242. doi: 10.1007/s00520-015-2773-y. Epub 2015 May 26.
• Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2020: incidência de câncer de mama no Brasil. Rio de Janeiro: INCA; 2021. [acesso em agosto 2021]. Disponível: http://www.inca.gov.br.
• LEHMAN, L. F. et al. Avaliação neurológica simplificada. Belo Horizonte: ALM International, 1997. 104 p.
• Joy L, Jolien R, Marithe C, Stijn E, Laura S, Hilde L, Sandra B, Wendy N, Ruth H, Liesbeth R, Sylvana S, Sylvia H, Jeroen M. The use of photobiomodulation therapy for the prevention of chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled pilot trial (NEUROLASER trial). Support Care Cancer. 2022 Jun;30(6):5509-5517. doi: 10.1007/s00520-022-06975-x. Epub 2022 Mar 21.
• Lodewijckx J, Robijns J, Bensadoun RJ, Mebis J. Photobiomodulation Therapy for the Management of Chemotherapy-Induced Peripheral Neuropathy: An Overview. Photobiomodul Photomed Laser Surg. 2020 Jun;38(6):348-354. doi: 10.1089/photob.2019.4771. Epub 2020 May 28.
• Malta CEN, Carlos ACAM, de Alencar MCM, Alves E Silva EF, Nogueira VBC, Alves APNN, Chaves FF, de Moura JFB, de Barros Silva PG. Photobiomodulation therapy prevents dysgeusia chemotherapy induced in breast cancer women treated with doxorubicin plus cyclophosphamide: a triple-blinded, randomized, placebo-controlled clinical trial. Support Care Cancer. 2022 Mar;30(3):2569-2580. doi: 10.1007/s00520-021-06642-7. Epub 2021 Nov 19.
• Martin LG, Silva MD. Chemotherapy-induced peripheral neuropathy: a literature review. Einstein (Sao Paulo). 2011 Dec;9(4):538-44. doi: 10.1590/S1679-45082011RW2220. English, Portuguese.
• Martinez B.P; Santos M. R; et al. SEGURANÇA E REPRODUTIBILIDADE DO TESTE TIMED UP AND GO EM IDOSOS HOSPITALIZADOS. Rev Bras Med Esporte - Vol. 22, No 5 - Set/Out, 2016.
• Pereira, Esdras Edgar Batista; SANTOS, Nadia Barreto dos; SARGES, Edilene do Socorro Nascimento Falcão. Avaliação da capacidade funcional do paciente oncogeriátrico hospitalizado. Revista Pan-Amazônica de Saúde, v. 5, n. 4, p. 37-44, 2014.
• Reis, Mariana Xavier. Escalas de Avaliação de Neuropatia Periférica Induzida por Quimioterapia - Uma revisão. São Luiz,2016.
• Rezende,L; Campanholi, LL; Tessaro, A. Manual de Condutas e Práticas Fisioterapêuticas no Câncer de Mama da ABFO. 1 ed. Rio de Janeiro; Thieme Revinter Publicações, 2018.
• Sene GA, Sousa FF, Fazan VS, Barbieri CH. Effects of laser therapy in peripheral nerve regeneration. Acta Ortop Bras. 2013;21(5):266-70. doi: 10.1590/S1413-78522013000500005.
• Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol. 2020 Mar 9;50(3):225-229. doi: 10.1093/jjco/hyz213.
• Simão, DAS. Estudo da neuropatia periférica induzida por quimioterapia: possíveis preditores clínicos e validação de instrumento de avaliação, 2015.
• Simão, D.A.S.; Murad, M.; et al. Neuropatia periférica induzida por quimioterapia: revisão para a prática clínica. Rev Dor. São Paulo, 2015 jul-set;16(3):215-20.
• Simão, D.A.S; Abreu, M.N.S; Gomez, R.S; et al. Evolução Clínica e Preditores da Neuropatia Periférica Induzida por Quimioterapia. Revista Brasileira de Cancerologia 2019; 65(2): e-04392.
• da Silva Simao DA, Teixeira AL, Souza RS, de Paula Lima ED. Evaluation of the Semmes-Weinstein filaments and a questionnaire to assess chemotherapy-induced peripheral neuropathy. Support Care Cancer. 2014 Oct;22(10):2767-73. doi: 10.1007/s00520-014-2275-3. Epub 2014 May 9.
• Souza, FN. Avaliação da dor em pacientes oncológicos em um hospital escola da cidade de Florianópolis/SC. Florianópolis, SC, 2020.
• Zandonai, AP. Adaptação transcultural e validação do instrument Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) para o Brasil. Tese de Doutorado, apresentada à Escola de Enfermagem de Ribeirão Preto/USP. Área de concentração: Enfermagem Fundamental. Ribeirão Preto,2015.
• Wamser E.L, Valderramas S.R, Paula J.Á. Et al. Melhor Desempenho no teste Timed Up And Go está associado a melhor desempenho funcional em idosas da comunidade. Geriatr Gerontol Aging. 2015; 9(4):138-43.
• Wang Y, Ge Y, Xing W, Liu J, Wu J, Lin H, Lu Y. The effectiveness and safety of low-level laser therapy on breast cancer-related lymphedema: An overview and update of systematic reviews. Lasers Med Sci. 2022 Apr;37(3):1389-1413. doi: 10.1007/s10103-021-03446-3. Epub 2021 Nov 15.
• Heiskanen V, Hamblin MR. Photobiomodulation: lasers vs. light emitting diodes? Photochem Photobiol Sci. 2018 Aug 8;17(8):1003-1017. doi: 10.1039/c8pp90049c.

Study record dates

Study Major Dates

• Study Start (Actual): March 8, 2023
• Primary Completion (Actual): June 4, 2024
• Study Completion (Actual): June 4, 2024

Study Registration Dates

• First Submitted: November 30, 2022
• First Submitted That Met QC Criteria: December 15, 2022
• First Posted (Actual): December 23, 2022

Study Record Updates

• Last Update Posted (Actual): June 26, 2025
• Last Update Submitted That Met QC Criteria: June 21, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Breast cancer; Chemotherapy; Photobiomodulation; Peripheral neuropathy
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Neuromuscular Diseases; Skin Diseases; Breast Diseases; Breast Neoplasms; Peripheral Nervous System Diseases; Nervous System Diseases
• Other Study ID Numbers: Prevention of neuropathy

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No