Variation of Energy in Photobiomodulation for the Control of Radiotherapy-Induced Oral Mucositis: A Clinical Study in Head and Neck Cancer Patients

Cizelene do Carmo Faleiros Veloso Guedes, Silas Antonio Juvencio de Freitas Filho, Paulo Rogério de Faria, Adriano Mota Loyola, Robinson Sabino-Silva, Sérgio Vitorino Cardoso, Cizelene do Carmo Faleiros Veloso Guedes, Silas Antonio Juvencio de Freitas Filho, Paulo Rogério de Faria, Adriano Mota Loyola, Robinson Sabino-Silva, Sérgio Vitorino Cardoso

Abstract

Oral mucositis (OM) is a frequent and severe adverse effect of therapy against head and neck cancer. Photobiomodulation with the low-power laser is known to be effective against OM, but the diversity of protocols and the possibility of stimulating residual tumor cells are still obstacles. The present study aimed to compare two doses of laser energy delivered to the oral mucosa of patients under oncologic treatment for head and neck cancer, looking for differences in the control of mucositis, as well as in the frequency of tumoral recurrences. Fifty-eight patients undergoing radiotherapy were randomized into two groups, distinguished according to the energy delivered by laser irradiation, namely, 0.25 J and 1.0 J. The groups were compared according to frequency, severity, or duration of OM, as well as the frequency of tumoral recurrences. OM was significantly less frequent in patients receiving 1.0 J of energy, but the groups did not differ regarding severity or duration of OM. Tumoral recurrence also did not vary significantly between the groups. Photobiomodulation with a higher dose of energy (1.0 J versus 0.25 J) is associated with better control of radiotherapy-induced OM and does not significantly increase the risk of neoplastic recurrence.

Figures

Figure 1
Figure 1
Patient with oral mucositis depicting a large ulcer covered by fibrin pseudomembrane on the left side of the tongue. The lesion was painful, and the patient was unable to eat solid foods (grade 3 on WHO scale [17]).

References

    1. Maria O. M., Eliopoulos N., Muanza T. Radiation-induced oral mucositis. Frontiers in Oncology. 2017;7:p. 89. doi: 10.3389/fonc.2017.00089.
    1. Trotti A., Bellm L. A., Epstein J. B., et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiotherapy and Oncology. 2003;66(3):253–262. doi: 10.1016/s0167-8140(02)00404-8.
    1. Franco P., Martini S., Di Muzio J., et al. Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer. Medical Oncology. 2017;34(5):p. 81. doi: 10.1007/s12032-017-0950-1.
    1. Russo G., Haddad R., Posner M., Machtay M. Radiation treatment breaks and ulcerative mucositis in head and neck cancer. Oncologist. 2008;13(8):886–898. doi: 10.1634/theoncologist.2008-0024.
    1. Sonis S. T. Mucositis: the impact, biology and therapeutic opportunities of oral mucositis. Oral Oncology. 2009;45(12):1015–2010. doi: 10.1016/j.oraloncology.2009.08.006.
    1. Eriksson D., Stigbrand T. Radiation-induced cell death mechanisms. Tumour Biology. 2010;31(4):363–372. doi: 10.1007/s13277-010-0042-8.
    1. Al-Dasooqi N., Sonis S. T., Bowen J. M., et al. Emerging evidence on the pathobiology of mucositis. Supportive Care in Cancer. 2013;21(7):2075–2083. doi: 10.1007/s00520-013-1810-y.
    1. De Sanctis V., Bossi P., Sanguineti G., et al. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus statements. Critical Reviews in Oncology/Hematology. 2016;100:147–166. doi: 10.1016/j.critrevonc.2016.01.010.
    1. Bensadoun R. J., Franquin J. C., Ciais G., et al. 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. Supportive Care in Cancer. 1999;7(4):244–252. doi: 10.1007/s005200050256.
    1. Bensadoun R. J., Nair R. G. 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. Current Opinion in Oncology. 2012;24(4):363–370. doi: 10.1097/cco.0b013e328352eaa3.
    1. Zecha J. A., Raber-Durlacher J. E., Nair R. G., et al. Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety considerations. Supportive Care in Cancer. 2016;24(6):2781–2792. doi: 10.1007/s00520-016-3152-z.
    1. Oton-Leite A. F., Silva G. B., Morais M. O., et al. Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer patients. Lasers in Surgery and Medicine. 2015;47(4):296–305. doi: 10.1002/lsm.22349.
    1. Carroll J. D., Milward M. R., Cooper P. R., Hadis M., Palin W. M. Developments in low level light therapy (LLLT) for dentistry. Dental Materials. 2014;30(5):465–475. doi: 10.1016/j.dental.2014.02.006.
    1. Fekrazad R., Chiniforush N. Oral mucositis prevention and management by therapeutic laser in head and neck cancers. Journal of Lasers in Medical Science. 2014;5(1):1–7.
    1. Migliorati C., Hewson I., Lalla R. V., et al. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Supportive Care in Cancer. 2013;21(1):333–341.
    1. Bjordal J. M., Bensadoun R. J., Tunèr J., Frigo L., Gjerde K., Lopes-Martins R. A. A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis. Supportive Care in Cancer. 2011;19(8):1069–1077. doi: 10.1007/s00520-011-1202-0.
    1. World Health Organization. WHO Handbook for Reporting Results of Cancer Treatment. WHO Offset Publication no. 48. Geneva, Switzerland: World Health Organization; 1979.
    1. Chen J., Liu P., Wang Q., Wu L., Zhang X. Influence of intensity-modulated radiation therapy on the life quality of patients with nasopharyngeal carcinoma. Cell Biochemistry and Biophysics. 2015;73(3):731–736. doi: 10.1007/s12013-015-0638-0.
    1. Tolentino E. S., Centurion B. S., Ferreira L. H., Souza A. P., Damante J. H., Rubira-Bullen I. R. Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients. Journal of Applied Oral Science. 2011;19(5):448–454. doi: 10.1590/s1678-77572011000500003.
    1. Antunes H. S., Herchenhorn D., Small I. A., et al. Phase III trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation. Radiotherapy and Oncology. 2013;109(2):297–302. doi: 10.1016/j.radonc.2013.08.010.
    1. Gautam A. P., Fernandes D. J., Vidyasagar M. S., Maiya A. G., Vadhiraja B. M. Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients–a triple blinded randomized controlled trial. Radiotherapy and Oncology. 2012;104(3):349–354. doi: 10.1016/j.radonc.2012.06.011.
    1. Carvalho P. A., Jaguar G. C., Pellizzon A. C., Prado J. D., Lopes R. N., Alves F. A. 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. Oral Oncology. 2011;47(12):1176–1181. doi: 10.1016/j.oraloncology.2011.08.021.
    1. Arun Maiya G., Sagar M. S., Fernandes D. Effect of low level helium-neon (He-Ne) laser therapy in the prevention & treatment of radiation induced mucositis in head & neck cancer patients. Indian Journal of Medical Research. 2006;124(4):399–402.
    1. Chung H., Dai T., Sharma S. K., et al. The nuts and bolts of low-level laser (light) therapy. Annals of Biomedical Engineering. 2012;40(2):516–533. doi: 10.1007/s10439-011-0454-7.
    1. Basso F. G., Pansani T. N., Turrioni A. P., Bagnato V. S., Hebling J., de Souza Costa C. A. In vitro wound healing improvement by low-level laser therapy application in cultured gingival fibroblasts. International Journal of Dentistry. 2012;2012:6. doi: 10.1155/2012/719452.719452
    1. Moshkovska T., Mayberry J. It is time to test low level laser therapy in Great Britain. Postgraduate Medical Journal. 2005;81(957):436–441. doi: 10.1136/pgmj.2004.027755.
    1. Ciais G., Namer M., Schneider M., et al. Laser therapy in the prevention and treatment of mucositis caused by anticancer chemotherapy. Bulletin du Cancer. 1992;79(2):183–191.
    1. Barasch A., Peterson D. E., Tanzer J. M., et al. Helium-neon laser effects on conditioning-induced oral mucositis in bone marrow transplantation patients. Cancer. 1995;76(12):2550–2556. doi: 10.1002/1097-0142(19951215)76:12<2550::aid-cncr2820761222>;2-x.
    1. Genot-Klastersky M. T., Klastersky J., Awada F., et al. 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. Supportive Care in Cancer. 2008;16(12):1381–1387. doi: 10.1007/s00520-008-0439-8.
    1. Schubert M. M., Eduardo F. P., Guthrie K. A., et al. A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Supportive Care in Cancer. 2007;15(10):1145–1154. doi: 10.1007/s00520-007-0238-7.
    1. Oberoi S., Zamperlini-Netto G., Beyene J., Treister N. S., Sung L. Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis. PLoS One. 2014;9(9) doi: 10.1371/journal.pone.0107418.e107418
    1. Khouri V. Y., Stracieri A. B., Rodrigues M. C., et al. Use of therapeutic laser for prevention and treatment of oral mucositis. Brazilian Dental Journal. 2009;20(3):215–220. doi: 10.1590/s0103-64402009000300008.
    1. Simões A., Eduardo F. P., Luiz A. C., et al. Laser phototherapy as topical prophylaxis against head and neck cancer radiotherapy-induced oral mucositis: comparison between low and high/low power lasers. Lasers in Surgery and Medicine. 2009;41(4):164–270. doi: 10.1002/lsm.20758.
    1. Gomes Henriques Á. C., Ginani F., Oliveira R. M., et al. Low-level laser therapy promotes proliferation and invasion of oral squamous cell carcinoma cells. Lasers in Medical Science. 2014;29(4):1385–1395. doi: 10.1007/s10103-014-1535-2.
    1. Khan I., Tang E., Arany P. Molecular pathway of near-infrared laser phototoxicity involves ATF-4 orchestrated ER stress. Scientific Reports. 2015;5:p. 10581. doi: 10.1038/srep10581.
    1. Antunes H. S., Herchenhorn D., Small I. A., et al. Long-term survival of a randomized phase III trial of head and neck cancer patients receiving concurrent chemoradiation therapy with or without low-level laser therapy (LLLT) to prevent oral mucositis. Oral Oncology. 2017;71:11–15. doi: 10.1016/j.oraloncology.2017.05.018.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera