The Path to an Evidence-Based Treatment Protocol for Extraoral Photobiomodulation Therapy for the Prevention of Oral Mucositis

Ather Adnan, Anna N Yaroslavsky, James D Carroll, Wayne Selting, Amy F Juliano, Wendy B London, Stephen T Sonis, Christine N Duncan, Nathaniel S Treister, Ather Adnan, Anna N Yaroslavsky, James D Carroll, Wayne Selting, Amy F Juliano, Wendy B London, Stephen T Sonis, Christine N Duncan, Nathaniel S Treister

Abstract

Oral mucositis is a painful complication of hematopoietic stem cell transplantation for which photobiomodulation therapy (PBMT) is a safe and effective intervention. Extraoral delivery of PBMT has clinical advantages over intraoral delivery but requires additional dosimetric considerations due to the external tissue layers through which the light must propagate before reaching the oral mucosa. Additionally, to date there has been no dose modeling study, a task essential to developing a justified treatment protocol. We review here some of the complexities surrounding extraoral photobiomodulation therapy and offer that may help guide researchers toward an evidence-based treatment protocol for the prevention of oral mucositis.

Keywords: hematopoietic stem cell transplant; low level light therapy; monte carlo; oral mucositis; photobiomodulation therapy.

Conflict of interest statement

JC is CEO of THOR Photomedicine. WL receives payment for service on Data and Safety Monitoring Boards for Merck and Jubilant Draximage. SS reports personal fees from Biomodels, LLC, personal fees from Primary Endpoint Solutions, LLC, outside of the submitted work. As an employee of Biomodels and PES, he is involved in assisting industry, government and academics in the study and enablement of drugs, biologicals and devices to treat patients for a broad range of indications including cancer and oral toxicities of cancer therapy. He does not have equity or receive payment from any of the companies' clients. NT serves as a consultant for MuReva Phototherapy Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Adnan, Yaroslavsky, Carroll, Selting, Juliano, London, Sonis, Duncan and Treister.

Figures

Figure 1
Figure 1
Artistic representation of (A) intraoral and (B) extraoral photobiomodulation therapy.
Figure 2
Figure 2
Layer model diagram of facial tissues. Adapted with permission from Mendelson et al.

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