Clinical use of photobiomodulation as a supportive care during radiation therapy

From molecular mechanisms to clinical applications: A comprehensive review of photobiomodulation in cancer treatment

Photobiomodulation (PBM) is a non-invasive therapeutic technique that regulates biological processes using primarily low-power lasers or light-emitting diodes (LEDs) to achieve therapeutic effects. Its application has expanded significantly, particularly in the field of cancer therapy. This review provides a comprehensive overview of PBM, elucidating its underlying mechanisms of action and its potential applications in cancer therapy. It highlights the benefits of PBM in reducing side effects of cancer treatments such as acute oral mucositis, radiation dermatitis, lymphedema, neuropathic pain, and radiation enteropathy. Furthermore, the ability of PBM to inhibit cancer cell proliferation and induce apoptosis, and discusses safety concerns of PBM in clinical applications, presenting existing research that emphasizes its significant potential in cancer therapy was summarized. PBM therapy may offer promising new clinical options for managing cancer and mitigating the side effects associated with conventional cancer therapies.

Plasma cell gingivitis: A systematic review and guideline to diagnosis

OBJECTIVE

Plasma cell gingivitis is a rare non-dental plaque-induced gingival disease often associated with hypersensitivity reactions. Due to its rarity many questions present around its presentation, etiology, and treatment. Moreover, its histopathology has many similarities with other periodontal condition such as periodontitis. The present systematic review aimed to assess the cases of plasma cell gingivitis focusing on its clinical features, possible etiologic factors, and treatment modalities.

METHODS

The search was done in The MEDLINE database, Scopus, and Web of Science from January 1999 until August 2024 for English publications using the following terms: (plasma cell gingivitis OR atypical gingivostomatitis OR allergic gingivostomatitis) AND (etiology OR clinical feature OR clinical manifestation OR treatment OR management). Any presented cases with clinical manifestation of plasma cell gingivitis confirmed with histopathologic assessment were included. Studies with unclear data, periodontitis or gingivitis cases which was not first treated for periodontal disease or not allowed for proper check-ups were excluded.

RESULTS

Sixteen articles comprise 19 cases included in this review from them 13 were female (68.420 %) and 6 were male (31.57 %) with wide age range from 9 to 64 years. Anterior of the maxilla were affected in all cases. Erythematous gingiva are presented in all cases which were mostly diffuse involvement. Bleeding on slight provocation and lip swelling were another clinical signs. Treatment modalities were different from discontinuing possible etiologic factors, topical drugs, to removing the lesion, and photobiomodulation.

CONCLUSION

In cases of gingival inflammation, it is important to first rule out other diseases such as gingivitis, periodontitis, and inflammatory gingival enlargement. The diagnosis of plasma cell gingivitis should be based on a detailed past medical history, accurate clinical evaluation, laboratory, microscopic, and immunohistochemical assessment.

Efficacy of photobiomodulation therapy combined with mobile health education in patients with head and neck cancer suffering from chronic xerostomia after radiotherapy: protocol for a three-arm, randomised, placebo-controlled, double-blinded study

INTRODUCTION

The role of photobiomodulation (PBM) therapy for oral tissue damage induced by cancer treatment is currently unclear, and there is low-quality to moderate-quality evidence supporting the use of this approach for treating xerostomia and/or hyposalivation. Consequently, patients with head and neck cancer increasingly turn to basic oral hygiene to alleviate salivary gland dysfunction, and their adherence can be improved by mobile health (mHealth) education. The primary objective of this study will be to analyse the effects of different doses of PBM therapy (7.5 J/cm2 vs 3 J/cm2) plus mHealth education on quality of life (QoL), oral health, salivary secretion and salivary gland ultrasound assessment at postintervention and at the 6-month follow-up in patients with head and neck cancer after radiotherapy compared with those in control group.

METHODS AND ANALYSIS

A prospective, three-arm, randomised, placebo-controlled, double-blinded study will be conducted among patients with head and neck cancer suffering from chronic xerostomia. A total of 20 patients per arm will be included and randomly assigned to receive 7.5 J/cm2 of PBM, 3 J/cm2 of PBM or placebo therapy. PBM therapy will be applied during 24 sessions at 22 points extra and intraorally two times per week for 3 months, combined with a mobile application (https://www.laxer.es). The assessments will be recorded at the beginning of the study, at postintervention and at the 6-month follow-up. The primary outcomes will be QoL, oral health, salivary secretion and salivary gland ultrasound. The pain pressure threshold, functional performance, mood and sleep quality will be secondary indicators.

ETHICS AND DISSEMINATION

This study received ethics approval from the Andalusian Biomedical Research Ethics Portal (2402-N-21 CEIM/CEI Provincial de Granada) according to the Declaration of Helsinki for Biomedical Research. The results of this study will be presented at national and international conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT05106608.

Management of Cancer Therapy-Induced Oral Mucositis Using Photobiomodulation Therapy: An Overview of Systematic Reviews

Objective: To systematically summarize the evidence for photobiomodulation therapy (PBMT) in the prevention and treatment of oral mucositis (OM) in patients undergoing cancer treatment. An electronic search was conducted in 8 databases and grey literature. Background: PBMT is recommended for the management of OM resulting from cancer treatment, with several systematic reviews (SRs) being published in recent years on this topic. Methods: Only SRs with outcomes from clinical trials were included, with no language or year restriction. The AMSTAR 2 tool was used to assess the methodological quality of the SRs. Results: Five thousand eight hundred fifty-six references were found, and 16 were selected for this review. OM prevention and treatment were favorable for PBMT in most studies, with a significant reduction in OM severity. Most studies obtained moderate confidence. Conclusions: PBMT represents an effective strategy in the management of OM, and this evidence is supported by studies with acceptable methodological quality.

Evaluating laser photobiomodulation for chemotherapy-induced peripheral neuropathy: a randomised phase II trial

PURPOSE

This study aims to evaluate the efficacy and safety of laser photobiomodulation (PBM) for treatment of established chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors.

METHODS

We conducted a randomised phase II, non-comparative, sham-controlled, single-blinded clinical trial in 44 cancer survivors reporting CIPN symptoms at least 3 months following completion of neurotoxic chemotherapy. Participants were randomised 2:1 to either PBM laser or sham control delivered twice weekly for 12 sessions. Assessments were conducted at baseline, the end of intervention (6 weeks), and 6 weeks post intervention (12 weeks). Participants completed neuropathy, quality of life and function questionnaires, and a clinical neurological assessment. The primary outcome was proportion of participants with CIPN response, defined as either symptom resolution or reduction of minimally clinically important difference.

RESULTS

In the laser and control groups, CIPN response rates were - 48% and 53% at 6 weeks and 45% and 33% at 12 weeks, respectively. The null hypothesis that the true response rate is 5% in the laser arm was rejected at both 6 and 12 weeks (p < 0.001 for both). Compared to baseline, patient-reported CIPN improved in both laser and control groups after the intervention. At 12 weeks, improvement was sustained in the laser group and approaching baseline in the control group. Clinical signs, quality of life, and function remained stable in both groups. Low-grade "side-effects" were observed in both arms.

CONCLUSION

PBM may offer clinically meaningful symptom benefit in cancer survivors with established CIPN with improvement potentially continuing beyond completion of the intervention. A larger study is warranted to evaluate this further.

Duodenal Dual-Wavelength Photobiomodulation Improves Hyperglycemia and Hepatic Parameters with Alteration of Gut Microbiome in Type 2 Diabetes Animal Model

BACKGROUND

Recently, the duodenum has garnered interest for its role in treating metabolic diseases, including type 2 diabetes (T2DM). Multiple sessions of external photobiomodulation (PBM) in previous animal studies suggested it resulted in improved hyperglycemia, glucose intolerance, and insulin resistance with a multifactorial mechanism of action, despite the target organ of PBM not being clearly proven. This study aimed to determine whether a single session of a duodenal light-emitting diode (LED) PBM may impact the T2DM treatment in an animal model.

METHODS

Goto-Kakizaki rats as T2DM models were subjected to PBM through duodenal lumen irradiation, sham procedure, or control in 1-week pilot (630 nm, 850 nm, or 630/850 nm) and 4-week follow-up (630 nm or 630/850 nm) studies. Oral glucose tolerance tests; serum glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide, and insulin levels; liver chemistry and histology; and gut microbiome in the PBM, sham control, and control groups were evaluated.

RESULTS

In the 1-week study, duodenal dual-wavelength (D, 630/850 nm) LED PBM showed improved glucose intolerance, alkaline phosphatase and cholesterol levels, and weight gain than other groups. The D-LED PBM group in the 4-week study also showed improved hyperglycemia and liver enzyme levels, with relatively preserved pancreatic islets and increased serum insulin and GLP-1 levels. Five genera (Bacteroides, Escherichia, Parabacteroides, Allobaculum, and Faecalibaculum) were significantly enriched 1 week after the D-LED PBM. Bacteroides acidifaciens significantly increased, while Lachnospiraceae significantly decreased after 1 week.

CONCLUSION

A single session of D-LED PBM improved hyperglycemia and hepatic parameters through the change of serum insulin, insulin resistance, insulin expression in the pancreatic β-cells, and gut microbiome in T2DM animal models.