Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022

Jolien Robijns, Raj G Nair, Joy Lodewijckx, Praveen Arany, Andrei Barasch, Jan M Bjordal, Paolo Bossi, Anne Chilles, Patricia M Corby, Joel B Epstein, Sharon Elad, Reza Fekrazad, Eduardo Rodrigues Fregnani, Marie-Thérèse Genot, Ana M C Ibarra, Michael R Hamblin, Vladimir Heiskanen, Ken Hu, Jean Klastersky, Rajesh Lalla, Sofia Latifian, Arun Maiya, Jeroen Mebis, Cesar A Migliorati, Dan M J Milstein, Barbara Murphy, Judith E Raber-Durlacher, Hendrik J Roseboom, Stephen Sonis, Nathaniel Treister, Yehuda Zadik, René-Jean Bensadoun, Jolien Robijns, Raj G Nair, Joy Lodewijckx, Praveen Arany, Andrei Barasch, Jan M Bjordal, Paolo Bossi, Anne Chilles, Patricia M Corby, Joel B Epstein, Sharon Elad, Reza Fekrazad, Eduardo Rodrigues Fregnani, Marie-Thérèse Genot, Ana M C Ibarra, Michael R Hamblin, Vladimir Heiskanen, Ken Hu, Jean Klastersky, Rajesh Lalla, Sofia Latifian, Arun Maiya, Jeroen Mebis, Cesar A Migliorati, Dan M J Milstein, Barbara Murphy, Judith E Raber-Durlacher, Hendrik J Roseboom, Stephen Sonis, Nathaniel Treister, Yehuda Zadik, René-Jean Bensadoun

Abstract

Disclaimer: This article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.

Objective: This position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).

Background: There is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients' quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.

Methods: A literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.

Results: There is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.

Conclusions: There is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.

Keywords: cancer supportive care; cancer-treatment side effects; dermatitis; guidelines; mucositis; photobiomodulation (PBM); recommendations.

Conflict of interest statement

MRH declares the following potential conflicts of interest. Scientific Advisory Boards: Transdermal Cap Inc, Cleveland, OH; BeWell Global Inc, Wan Chai, Hong Kong; Hologenix Inc. Santa Monica, CA; LumiThera Inc, Poulsbo, WA; Vielight, Toronto, Canada; Bright Photomedicine, Sao Paulo, Brazil; Quantum Dynamics LLC, Cambridge, MA; Global Photon Inc, Bee Cave, TX; Medical Coherence, Boston MA; NeuroThera, Newark DE; JOOVV Inc, Minneapolis-St. Paul MN; AIRx Medical, Pleasanton CA; FIR Industries, Inc. Ramsey, NJ; UVLRx Therapeutics, Oldsmar, FL; Ultralux UV Inc, Lansing MI; Illumiheal & Petthera, Shoreline, WA; MB Lasertherapy, Houston, TX; ARRC LED, San Clemente, CA; Varuna Biomedical Corp. Incline Village, NV; Niraxx Light Therapeutics, Inc, Boston, MA. Consulting; Lexington Int, Boca Raton, FL; USHIO Corp, Japan; Merck KGaA, Darmstadt, Germany; Philips Electronics Nederland B.V. Eindhoven, Netherlands; Johnson & Johnson Inc, Philadelphia, PA; Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany. Stockholdings: Global Photon Inc, Bee Cave, TX; Mitonix, Newark, DE, JR, JL and JM are part of the Limburg Clinical Research Center (LCRC) and were supported by the foundation Limburg Sterk Merk, the province of Limburg, the Flemish government, Hasselt University, Ziekenhuis Oost-Limburg, Jessa Hospital, Kom op Tegen Kanker, Limburgs Kankerfonds, Limburgse Kankersamenwerking, and ASA Srl. SE discloses conflicts of interest related to treatment for cGVHD consulting Falk Pharma GmbH. PRA has been supported by travel or serves as a consultant for Mureva, Vielight, Thor Photomedicine, Kerber Applied Research, Lumithera, Jooov, and NST consulting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest.

Copyright © 2022 Robijns, Nair, Lodewijckx, Arany, Barasch, Bjordal, Bossi, Chilles, Corby, Epstein, Elad, Fekrazad, Fregnani, Genot, Ibarra, Hamblin, Heiskanen, Hu, Klastersky, Lalla, Latifian, Maiya, Mebis, Migliorati, Milstein, Murphy, Raber-Durlacher, Roseboom, Sonis, Treister, Zadik, Bensadoun and “Cancer Supportive Care” WALT Working Group.

Figures

Figure 1
Figure 1
Timeline of advances in the application of PBM therapy for oral mucositis. The grey font represents basic science advances. *current WALT position paper. Abbreviations used SR&MA – Systematic review and meta-analysis; OM –Oral Mucositis; PBM - Photobiomodulation; MASCC – Multinational Association for Supportive Care in Cancer; ISOO – International Society for Oral oncology; WALT – World Association for Photobiomodulation Therapy; CCO – Cytochrome C Oxidase; TGF-β – Transforming Growth Factor beta 1; TRPV1 - Transient Receptor Potential-V1 .

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