Low-Level Laser Therapy for the Treatment of Oral Mucositis Induced by Hematopoietic Stem Cell Transplantation: A Systematic Review with Meta-Analysis

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.

Near-infrared photobiomodulation therapy on HD10.6 human sensory neurons cell culture

PURPOSE

We investigated the molecular effects of near-infrared photobiomodulation therapy (PBMT) on HD10.6 human sensory neuron cell cultures. This study explores the utility of PBMT in modulating the functionality of sensory neurons in vitro with a potential translational effect on analgesia, a significant concern in clinical settings, particularly in pediatrics where non-invasive treatments are crucial.

METHODS

HD10.6 human sensory neuron cell model was employed in the study. The 800 and 970 PBMT was tested on the cells and mitochondria related parameters and TRP channel functionality were evaluated after irradiation.

RESULTS

We found that PBMT affects mitochondrial dynamics and reduces oxidative stress, influenced calcium ion flow, pivotal in nociception signaling, and modified the expression of TRPV1 and TRPA1 receptors post-irradiation.

CONCLUSIONS

This study observed a potential impact of PBMT on sensory neurons through various cellular mechanisms. These findings may contribute to the understanding of PBMT's mechanistic effects on human sensory neurons, not yet explored in in-vitro model, pointing to its potential utility as a supportive treatment for non-invasive pain management in pediatric care.

Photobiomodulation preconditioning for oral mucositis prevention and quality of life improvement in chemotherapy patients: a randomized clinical trial

BACKGROUND

Given the suffering experienced by cancer patients, effective solutions must be found to prevent painful and debilitating side effects of anti-cancer treatment. This trial aims to study the effect of preconditioning with photobiomodulation in preventing oral mucositis and xerostomia in cancer patients undergoing chemotherapy alone for the first time, and to examine its role in improving patients' quality of life.

MATERIALS AND METHODS

This is a prospective, randomized, double-blind clinical trial including 45 patients divided into three age- and sex-matched groups. Group 1 received basic oral care instructions before undergoing chemotherapy. Group 2 received basic oral care instructions plus photobiomodulation using an intraoral 650 nm diode laser. Group 3 received basic oral care instructions plus photobiomodulation using a 650 nm diode laser intraorally and a 980 nm diode laser extraorally.

RESULTS

After one week of follow-up, 73.3% of patients in Group 2 and 80% in Group 3 did not develop oral mucositis. The remaining patients in both groups experienced only mild erythema. In contrast, all patients in Group 1 developed oral mucositis, ranging from mild erythema to ulceration greater than 3 cm². After two weeks of follow-up, 80% of patients in Group 2 and 86.7% in Group 3 remained free of oral mucositis. The remaining patients in both groups experienced only mild erythema. In contrast, 93.3% of patients in Group 1 developed oral mucositis, with cases ranging from mild erythema to ulcers larger than 3 cm². There were statistically significant differences between the three groups in oral mucositis assessment scale after one week and after two weeks (p < 0.001). Specifically, ulcerative mucositis was not observed in both laser groups, while it was observed in 13.3% of patients in Group 1. However, these differences were not statistically significant (p = 0.129). Regarding Late Effects in Normal Tissue (LENT-SOMA) scale, there was a statistically significant difference between the three groups studied (p = 0.037). There was also a statistically significant difference in the Oral Health Impact Profile (OHIP-14) between the three groups studied (p = 0.003 after one week, p = 0.023 after two weeks).

CONCLUSION

Preconditioning before starting chemotherapy, whether with the intraoral red laser alone or in combination with the extraoral infrared laser, has shown significant results in preventing oral mucositis and dry mouth, and it has also played a major role in improving patients' quality of life.

TRIAL REGISTRATION

This trial was registered in ISRCTN registry under no ISRCTN70634383 ( https://doi.org/10.1186/ISRCTN70634383 ) on 24/07/2023.

Efficacy of photobiomodulation therapy in the management of oral mucositis in patients with head and neck cancer: A systematic review and meta-analysis of randomized controlled trials

Numerous studies have examined the effectiveness of photobiomodulation therapy (PBMT) in reducing chemoradiotherapy (CRT)-induced oral mucositis (OM) in patients with head and neck cancer (HNC). Despite this, there is an urgent need to update the meta-analyses on this topic. This meta-analysis aims to explore the impact of PBMT on CRT-induced OM in these patients. We conducted a systematic search in PubMed, Embase, Cochrane, LILACS, and Web of Science from January 2000 to October 2023. This search focused on randomized controlled trials (RCTs) that assessed the effects of PBMT on CRT-induced OM. The study included a total of 14 RCTs encompassing 869 patients with HNC. The incidence of OM in the PBMT group was significantly lower from the second week onwards compared to the control group (RR = 0.49, CI = 0.25-0.97, I2  = 71%, p = 0.04), and this was present until the seventh week (RR = 0.77, CI = 0.61-0.99, I2  = 89%, p = 0.04). Furthermore, the occurrence of severe mucositis in the PBMT group decreased from the third week (RR = 0.51, CI = 0.29-0.90, I2  = 12%, p = 0.02) until the conclusion of the intervention (RR = 0.45, CI = 0.24-0.85, I2  = 80%, p = 0.01). Additionally, PBMT showed beneficial effects in alleviating OM-related pain (WMD = -1.09, 95% CI = -1.38 to -0.880, I2  = 13%, p < 0.00001). The use of He-Ne or InGaAlP lasers with a power range of 10-25 mW demonstrated the most favorable outcomes in preventing and treating OM. PBMT has shown considerable efficacy in reducing the incidence, severity, and pain associated with OM in patients with HNC. Future studies are encouraged to further investigate the most effective parameters for PBMT in the management of OM.

Optimizing high dose melphalan

Melphalan, has been a major component of myeloma therapy since the 1950s. In the context of hematopoietic cell transplantation (HCT), high dose melphalan (HDM) is the most common conditioning regimen used due to its potent anti-myeloma effects and manageable toxicities. Common toxicities associated with HDM include myelosuppression, gastrointestinal issues, and mucositis. Established approaches to reduce these toxicities encompass dose modification, nausea prophylaxis with 5HT3 receptor antagonists, cryotherapy, amifostine use, and growth factors. Optimization of melphalan exposure through personalized dosing and its combination with other agents like busulfan, or bendamustine show promise. Propylene glycol-free melphalan (Evomela) represents a novel formulation aiming to enhance drug stability and reduce adverse effects. This review explores strategies to enhance the efficacy and mitigate the toxicity of HDM in multiple myeloma. Future directions involve exploring these strategies in clinical trials to improve the safety and efficacy of HDM, thereby enhancing outcomes for multiple myeloma patients undergoing autologous HCT.

Efficacy of Low-Level Laser Therapy for Oral Mucositis in Hematologic Patients Undergoing Transplantation: A Single-Arm Prospective Study

Oral mucositis significantly affects the quality of life in hematologic cancer patients undergoing hematopoietic stem cell transplantation. Despite global evidence supporting the efficacy of low-level laser therapy (LLLT) for mucositis prevention, its clinical adoption in Japan is limited. This study aimed to fill this gap by evaluating the safety and efficacy of LLLT in a Japanese patient population. In a single-group, non-blinded, exploratory trial, we compared 21 LLLT-treated patients against a historical control of 96 patients. The primary endpoint was the incidence of Grade ≥ 2 mucositis, based on NCI-CTCAE ver. 4.0. The LLLT group showed a significantly lower incidence of Grade ≥ 2 mucositis (23.8%) compared to the control group (64.6%) (p = 0.0006). Furthermore, Grade ≥ 2 mucositis correlated with increased oral dryness and longer hospital stays. Our study confirms the efficacy of LLLT in reducing the onset of severe oral mucositis among Japanese hematologic cancer patients, advocating for its clinical introduction as a preventive measure in Japan.