Clinical Evaluation of Intravascular Blood Irradiation with Laser, Photobiomodulation, and Photodynamic Therapy in Cancer Patients with Mucositis

Systemic photobiomodulation: an integrative review of evidence for intravascular laser irradiation of blood and vascular photobiomodulation

Currently, clinical practice has demonstrated various applications for systemic laser photobiomodulation (PBM). In recent years, an increasing number of studies have been highlighted in the literature; however, they differ in their application methods, which can be intravenous, referred to as ILIB (intravascular laser irradiation of blood), or transdermally, recently termed VPBM (vascular photobiomodulation). This review aimed to compile all findings on these techniques and critically discuss their results. A search for articles was conducted in the PubMed, Scopus, and Web of Science databases using Medical Subject Headings (MeSH) to select descriptors with the boolean operators "AND/OR." After applying inclusion and exclusion criteria, 37 articles were selected. Of these, 19 studies discussed the use of systemic PBM with intravenous application, and 7 studies reported transcutaneous application. Regarding clinical studies, 28 studies addressed the application of the techniques in respiratory, cardiovascular, metabolic, neurological, and musculoskeletal conditions. For preclinical studies, 9 articles primarily discussed the application of systemic PBM in pulmonary and musculoskeletal conditions. Despite the promising results, methodological limitations, and variabilities in studies on systemic laser PBM prevent the categorical assertion of its efficacy. It is essential to conduct rigorous new studies to elucidate the mechanisms of action and determine the technique's efficacy.

Effect of modified intravascular laser irradiation of blood in the oral and systemic conditions during dental treatment-A systematic review

The aim of this study was to investigate the scientific evidence regarding the effectiveness of modified-ILIB (intravascular laser irradiation of blood) in the control of systemic conditions and/or oral changes during dental care. This systematic literature review study aimed to answer the question, "Is modified-ILIB an effective adjuvant therapy in the control of systemic conditions and/or oral changes in children and adults during dental treatment?". The protocol for this systematic review was registered in the PROSPERO database under number CRD42023493800. The search was carried out in the PubMed, Web of Science, LILACS, SCOPUS and EMBASE databases on June 10, 2024. Google Scholar was used as a search source for gray literature. Randomized clinical trials were included, without restrictions on language or year of publication. The RoB 2.0 tool was used to assess the risk of bias and GRADE was used to check the quality of the evidence. A total of 750 articles were retrieved and five studies were selected for this review. All studies were in English and were carried out in Brazil. The outcomes were periodontal parameters and glycemic control in patients with periodontitis and type II diabetes, anxiety control in pediatric dentistry, postoperative pain after third molar extraction and improving taste in post-COVID-19 patients. The majority of studies had a low risk of bias, while only one study was considered to have some concerns. The quality of evidence from the studies was considered very low. The current evidence does not overwhelmingly support the effectiveness of modified-ILIB in controlling oral and/or systemic conditions in dentistry.

Analysis of the Ultrasensitive C-Reactive Protein and Homocysteine Biomarkers after Photobiomodulation Therapy in Hormone Blocker-Treated Mastectomized Women: A Randomized, Blind, and Controlled Clinical Study

Main: The pharmacological treatment of cancer can lead to undesirable hemodynamic adverse effects. Laser therapy may promote hemodynamic balance in these patients. This study aimed to analyze the values of the biomarkers ultrasensitive C-reactive protein (PCR_us) and Homocysteine (HCy) after the use of intravascular laser irradiation of blood (ILIB) in mastectomized patients using hormonal blockers Tamoxifen and Aromatase Inhibitors. Methods: This was an experimental, placebo-controlled, randomized clinical trial with experimental (G1) and control (G2) groups. In G1, patients were irradiated with ILIB using a red laser at 660 nm on the carotid artery, while G2 received a placebo treatment. Blood collection for HCy and us-CRP biomarker evaluation was conducted monthly for 4 months. Statistical analysis was performed using R Studio 4.4.2 and JAMOVI, with a significance level of 5%. Results: A total of 21 patients participated in the study, with 12 in G1 and 9 in G2. There were no differences in age, systolic, diastolic blood pressure, and heart rate between the groups. The initial and final mean PCR_us levels for G1 were 6.8 and 3.8 mg/dL, and for HCy were 14.2 and 12.1 µmol/L, respectively. While for G2 initial and final mean PCR_us levels were 9.40 and 7.60 mg/dL, and for HCy were 14.33 and 16.69 µmol/L. There was no statistical difference for PCR_us. However, a significant difference between the groups (p < 0.05) for HCy in the 3rd and 4th months. Conclusion: During ILIB Therapy, there was a reduction in HCy, which may favor the improvement of cardiovascular function in these patients undergoing anticancer therapies.

The Remodulation of Actin Bundles during the Stimulation of Mitochondria in Adult Human Fibroblasts in Response to Light

β-actin belongs to cytoskeletal structures that change dynamically in cells according to various stimuli. Human skin can be considered as an organ that is very frequently exposed to various stress factors, of which light plays an important role. The present study focuses on adult human fibroblasts exposed to two types of light stress. Orange light with a wavelength of 590 nm was used here to stimulate the photosensitizer localized in the cells as a residual dose of photodynamic therapy (PDT). On the other hand, near-infrared light with a wavelength of 808 nm was considered for photobiomodulation (PBM), which is often used in healing processes. Confocal fluorescence microscopy was used to observe changes in intercellular communication, mitochondrial structures, and cytoskeletal dynamics defined by the remodulation of β-actin of fibroblasts. The number of β-actin bundles forming spherical structures was detected after light exposure. These structures as β-actin oligomers were confirmed with super-resolution microscopy. While PDT led to the disintegration of actin oligomers, PBM increased their number. The interaction of β-actin with mitochondria was observed. The combination of PDT and PBM treatments is important to minimize the side effects of cancer treatment with PDT on healthy cells, as shown by the cell metabolism assay in this work. In this work, β-actin is presented as an important parameter that changes and is involved in the response of cells to PDT and PBM.

Photodynamic therapy (PDT) for oral leukoplakia: a systematic review and meta-analysis of single-arm studies examining efficacy and subgroup analyses

OBJECTIVE

This study aims to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of oral leukoplakia and explore the subgroup factors that may influence its effectiveness.

METHODS

A systematic search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science databases to identify relevant studies. Meta-analysis was performed using Stata15.0 software. Cochran's Q test and I2 statistics were used to evaluate heterogeneity, egger's test was used to evaluate publication bias.

RESULTS

The analysis of 17 studies included in this study suggests that PDT may be effective in achieving complete response (CR) [ES = 0.50, 95%CI: (0.33,0.66)], partial response (PR) [ES = 0.42, 95%CI: (0.27,0.56)], no response (NR) [ES = 0.19, 95%CI: (0.11,0.27)]in patients with oral leukoplakia. The recurrence rate was also evaluated [ES = 0.13, 95%CI: (0.08,0.18)]. Subgroup analysis showed that various factors such as light source, wavelength, medium, duration of application, clinical and pathological diagnosis classification influenced efficacy of PDT. The lesion areas of the leukoplakia after treatment were reduced by 1.97cm2 compared with those before treatment.

CONCLUSION

Our findings show that PDT is a viable treatment for oral leukoplakia. However, the effectiveness of the therapy may depend on several factors, as suggested by our subgroup analyses. (Registration no. CRD42023399848 in Prospero, 26/02/2023).

Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review

OBJECTIVE

Our objective was to review the first 20 years of photobiomodulation (PBM) clinical studies for oral mucositis (OM) mitigation.

STUDY DESIGN

A scoping review screened controlled clinical studies. The PBM devices, protocols, and clinical outcomes were analyzed.

RESULTS

Seventy-five studies met the inclusion criteria. The first study dated from 1992, and the term "PBM" was first published in 2017. Public services, placebo-controlled randomized trials, and patients with head and neck chemoradiation were predominant among included studies. Prophylactic red intraoral laser protocols were mostly used. Comparing the outcomes of all protocols was unfeasible due to missing treatment parameters and nonhomogeneous measurements.

CONCLUSIONS

The main barrier to optimizing clinical protocols of PBM for OM was the lack of standardization in clinical studies. Although PBM use is now globally present in oncology settings and generally marked by good outcomes reported, additional randomized clinical trials with well-described methods are necessary.

Photobiomodulation for the management of xerostomia and oral mucositis in patients with cancer: a randomized clinical trial

To evaluate the applicability of photobiomodulation therapy (PBM-T) in the management of xerostomia and OM. Fifty-three patients with head and neck squamous cell carcinoma were randomized into two groups: Sham and PBM-T. The Sham group received artificial saliva and laser simulation, while the PBM-T group received artificial saliva and PBM-T. Xerostomia-related quality of life (QoL), the presence or absence of OM lesions, the decayed-missing-filled teeth (DMFT) index, and periodontal charts were evaluated. The results of the QoL questionnaire, DMFT index, and periodontal chart were analyzed with the Kruskal-Wallis test, followed by the Student-Newman-Keuls test, while OM findings were compared using the Mann-Whitney test. QoL scores significantly increased in the Sham group (p < 0.0001), denoting more severe xerostomia symptoms (p = 0.0074), and decreased in the PBM-T group, indicating no or very mild xerostomia. Higher grades of OM were found in the Sham group than the PBM-T group (p = 0.0001). There was no significant difference in DMFT index or periodontal charts between the groups (p > 0.05). PBM-T improved QoL in patients with head and neck cancer treated with radiotherapy, whether as radiation alone or as an adjunct to chemotherapy and surgery.

Disinfection Potential of 980 nm Diode Laser and Hydrogen Peroxide (3%) in "Critical Probing Depths" Periodontal Pockets: Retrospective Study

A successful treatment of periodontitis depends largely on the successful elimination of the periodontopathogens during non-surgical and surgical mechanical debridement. In this retrospective study, data collection was conducted from 2017 to 2021. The retrospective study included 128 patients with 128 sites of localized periodontitis with pocket depths > 5 mm. The included data were based on sites that received conventional mechanical debridement followed by different adjunctive approaches. In total, 30 patients did not receive any additional treatment (SRP group), 30 patients received SRP + 980 nm diode laser irradiation only (SRP + laser), 30 patients received SRP + 3% hydrogen peroxide irrigation (SRP + H2O2) only and 30 patients received a combined treatment of 3% hydrogen peroxide and 980 nm diode laser irradiation (SRP + H2O2 + laser). Total bacterial counts (TBC) in the periodontal pocket collected for all participants before treatment, immediately after treatment, 6 weeks after treatment, 12 weeks after treatment and 6 months after treatment were statistically analyzed and compared. When the laser was used, irradiation parameters were 10 μsec/pulse duration, 10 kHz, pick power of 10 W, average power of 1 W, irradiation time of one minute with inward and outward movements, and fiber diameter of 320 μm. The irradiation was repeated 3 times/pocket. When hydrogen peroxide was used, the irrigation was conducted for one minute and repeated 3 times. The maximum reduction in TBC was obtained when SRP was coupled with 3% H2O2 irrigation followed by 980 nm diode laser irradiation. After six months of follow-up, a significant reduction in TBC was obtained for the group of SRP + H2O2 + laser when compared to all the other groups, from 7.27 × 107 before intervention to 3.21 × 107 after six months. All three approaches to SRP showed a significant reduction in TBC immediately after treatment. Values were 3.52 × 107, 4.01 × 106, 9.58 × 106, 1.98 × 106 for SRP alone, SRP + diode, SRP + H2O2 and SRP + H2O2 + diode laser, respectively. At 6 months, we saw no significant difference between SRP + laser and SRP + H2O2 with 4.01 × 107 and 4.32 × 107, respectively. This retrospective study reveals that after SRP, irrigation with 3% hydrogen peroxide and irradiation with a 980 nm diode laser within specific treatment protocol can be used as an additional approach to conventional SRP to increase the disinfection of the periodontal pockets > 5 mm.