Skip to main content

Advertisement

SpringerLink
Log in

Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2

  • Review
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To investigate the role of photobiomodulation (PBM) in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as quality of life (QoL), analgesia, functional impairment, and nutritional status, as well as on the impact on survival/ recurrences, radiotherapy (RT) interruption, adherence, cost-effectiveness, safety, feasibility, and tolerability.

Methods

An electronic search in PubMed and Scopus databases was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel.

Results

A total of 22 papers were included. Overall, a beneficial effect of PBM was evidenced in the amelioration of QoL, nutritional status, the reduction of pain, and functional impairment. Preventive PBM may reduce the incidence and duration of RT interruptions, potentially contributing to improved cancer treatment outcomes. PBM treatments are safe and recommended for routine use, with the caveat of avoiding direct tumor exposures where feasible. However, it does not appear to impact cancer survivorship/recurrences directly. Despite additional clinical efforts involving routine PBM use, the individual and public health benefits will positively impact oncology care.

Conclusions

Quality of life, pain and functional impairment, nutritional status, and survival may be effectively improved with PBM. Given its established efficacy also in reducing RT interruptions and its safety, feasibility, and tolerability, PBM should be included in the field of supportive cancer care in HNC patients. Improved understanding of PBM mechanisms and precise dose parameters is enabling the generation of more robust, safe, and reproducible protocols; thus, it is imperative to support further clinical implementation as well as both applied and basic science research in this novel field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gobbo M, Merigo E, Arany PR et al (2022) Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 1. Front Oral Health 3:945718. https://doi.org/10.3389/froh.2022.945718

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bellm LA, Epstein JB, Rose-Ped A et al (2000) Patient reports of complications of bone marrow transplantation. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 8:33–39. https://doi.org/10.1007/s005209900095

    Article  CAS  Google Scholar 

  3. Adelstein DJ, Li Y, Adams GL et al (2003) An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol Off J Am Soc Clin Oncol 21:92–98. https://doi.org/10.1200/JCO.2003.01.008

    Article  Google Scholar 

  4. Epstein JB, Beaumont JL, Gwede CK et al (2007) Longitudinal evaluation of the oral mucositis weekly questionnaire-head and neck cancer, a patient-reported outcomes questionnaire. Cancer 109:1914–1922. https://doi.org/10.1002/cncr.22620

    Article  PubMed  Google Scholar 

  5. Kelly C, Paleri V, Downs C, Shah R (2007) Deterioration in quality of life and depressive symptoms during radiation therapy for head and neck cancer. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 136:108–111. https://doi.org/10.1016/j.otohns.2006.06.1278

    Article  Google Scholar 

  6. Ventafridda V, Tamburini M, Caraceni A et al (1987) A validation study of the WHO method for cancer pain relief. Cancer 59:850–856. https://doi.org/10.1002/1097-0142(19870215)59:4<850::aid-cncr2820590432>3.0.co;2-1

    Article  CAS  PubMed  Google Scholar 

  7. Ehrsson YT, Langius-Eklöf A, Laurell G (2012) Nutritional surveillance and weight loss in head and neck cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 20:757–765. https://doi.org/10.1007/s00520-011-1146-4

    Article  Google Scholar 

  8. Vartanian JG, Carvalho AL, Yueh B et al (2006) Brazilian-Portuguese validation of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Head Neck 28:1115–1121. https://doi.org/10.1002/hed.20464

    Article  PubMed  Google Scholar 

  9. Nugent B, Lewis S, O’Sullivan JM (2010) Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev CD007904. https://doi.org/10.1002/14651858.CD007904.pub2

  10. Koom WS, Ahn SD, Song SY et al (2012) Nutritional status of patients treated with radiotherapy as determined by subjective global assessment. Radiat Oncol J 30:132–139. https://doi.org/10.3857/roj.2012.30.3.132

    Article  PubMed  PubMed Central  Google Scholar 

  11. Antunes HS, Herchenhorn D, Small IA et al (2017) 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 Oncol 71:11–15. https://doi.org/10.1016/j.oraloncology.2017.05.018

    Article  PubMed  Google Scholar 

  12. Arora H, Pai KM, Maiya A et al (2008) Efficacy of He-Ne laser in the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105(180–186):186.e1. https://doi.org/10.1016/j.tripleo.2007.07.043

    Article  PubMed  Google Scholar 

  13. Bensadoun RJ, Franquin JC, Ciais G et al (1999) 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. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 7:244–252. https://doi.org/10.1007/s005200050256

    Article  CAS  Google Scholar 

  14. Bensadoun R-J, Bollet MA, Liem X et al (2022) New photobiomodulation device for prevention and cure of radiotherapy-induced oral mucositis and dermatitis: results of the prospective Safe PBM study. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 30:1569–1577. https://doi.org/10.1007/s00520-021-06574-2

    Article  Google Scholar 

  15. Bourbonne V, Otz J, Bensadoun R-J et al (2019) Radiotherapy mucositis in head and neck cancer: prevention by low-energy surface laser. BMJ Support Palliat Care. https://doi.org/10.1136/bmjspcare-2019-001851

  16. da Costa JDR, de Lima Dantas JB, Martins GB et al (2021) Adherence of head and neck cancer patients to laser photobiomodulation in a public health service: pilot study. Complement Ther Med 58:102687. https://doi.org/10.1016/j.ctim.2021.102687

    Article  PubMed  Google Scholar 

  17. de Pauli Paglioni M, Faria KM, Palmier NR et al (2021) Patterns of oral mucositis in advanced oral squamous cell carcinoma patients managed with prophylactic photobiomodulation therapy-insights for future protocol development. Lasers Med Sci 36:429–436. https://doi.org/10.1007/s10103-020-03091-2

    Article  PubMed  Google Scholar 

  18. Elgohary HM, Eladl HM, Soliman AH, Soliman ES (2018) Effects of ultrasound, laser and exercises on temporomandibular joint pain and trismus following head and neck cancer. Ann Rehabil Med 42:846–853. https://doi.org/10.5535/arm.2018.42.6.846

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fischlechner R, Kofler B, Schartinger VH et al (2021) Does low-level laser therapy affect the survival of patients with head and neck cancer? Lasers Med Sci 36:599–604. https://doi.org/10.1007/s10103-020-03073-4

    Article  PubMed  Google Scholar 

  20. Gautam AP, Fernandes DJ, Vidyasagar MS et al (2012) Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients - a triple blinded randomized controlled trial. Radiother Oncol J Eur Soc Ther Radiol Oncol 104:349–354. https://doi.org/10.1016/j.radonc.2012.06.011

    Article  Google Scholar 

  21. Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya GA (2012) Low level helium neon laser therapy for chemoradiotherapy induced oral mucositis in oral cancer patients - a randomized controlled trial. Oral Oncol 48:893–897. https://doi.org/10.1016/j.oraloncology.2012.03.008

    Article  PubMed  Google Scholar 

  22. Gautam AP, Fernandes DJ, Vidyasagar MS et al (2013) Effect of low-level laser therapy on patient reported measures of oral mucositis and quality of life in head and neck cancer patients receiving chemoradiotherapy--a randomized controlled trial. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 21:1421–1428. https://doi.org/10.1007/s00520-012-1684-4

    Article  Google Scholar 

  23. Gautam AP, Fernandes DJ, Vidyasagar MS et al (2015) Low level laser therapy against radiation induced oral mucositis in elderly head and neck cancer patients-a randomized placebo controlled trial. J Photochem Photobiol B 144:51–56. https://doi.org/10.1016/j.jphotobiol.2015.01.011

    Article  CAS  PubMed  Google Scholar 

  24. Genot-Klastersky MT, Paesmans M, Ameye L et al (2020) Retrospective evaluation of the safety of low-level laser therapy/photobiomodulation in patients with head/neck cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 28:3015–3022. https://doi.org/10.1007/s00520-019-05041-3

    Article  CAS  Google Scholar 

  25. Gobbo M, Ottaviani G, Perinetti G et al (2014) Evaluation of nutritional status in head and neck radio-treated patients affected by oral mucositis: efficacy of class IV laser therapy. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 22:1851–1856. https://doi.org/10.1007/s00520-014-2155-x

    Article  CAS  Google Scholar 

  26. González-Arriagada WA, Ramos LMA, Andrade MAC, Lopes MA (2018) Efficacy of low-level laser therapy as an auxiliary tool for management of acute side effects of head and neck radiotherapy. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol 20:117–122. https://doi.org/10.1080/14764172.2017.1376097

    Article  Google Scholar 

  27. Gouvêa de Lima A, Villar RC, de Castro G et al (2012) Oral mucositis prevention by low-level laser therapy in head-and-neck cancer patients undergoing concurrent chemoradiotherapy: a phase III randomized study. Int J Radiat Oncol Biol Phys 82:270–275. https://doi.org/10.1016/j.ijrobp.2010.10.012

    Article  PubMed  Google Scholar 

  28. Guedes CDCFV, de Freitas Filho SAJ, de Faria PR, Loyola AM, Sabino-Silva R, Cardoso SV (2018) Variation of energy in photobiomodulation for the control of radiotherapy-induced oral mucositis: a clinical study in head and neck cancer patients. Int J Dent 2018:4579279. https://doi.org/10.1155/2018/4579279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Legouté F, Bensadoun R-J, Seegers V et al (2019) Low-level laser therapy in treatment of chemoradiotherapy-induced mucositis in head and neck cancer: results of a randomised, triple blind, multicentre phase III trial. Radiat Oncol Lond Engl 14:83. https://doi.org/10.1186/s13014-019-1292-2

    Article  Google Scholar 

  30. Lima AG, Antequera R, Peres MP et al (2010) Efficacy of low-level laser therapy and aluminum hydroxide in patients with chemotherapy and radiotherapy-induced oral mucositis. Braz Dent J 21:186–192. https://doi.org/10.1590/s0103-64402010000300002

    Article  PubMed  Google Scholar 

  31. Martins AFL, Morais MO, de Sousa-Neto SS et al (2021) Photobiomodulation reduces the impact of radiotherapy on oral health-related quality of life due to mucositis-related symptoms in head and neck cancer patients. Lasers Med Sci 36:903–912. https://doi.org/10.1007/s10103-020-03167-z

    Article  PubMed  Google Scholar 

  32. Morais MO, Martins AFL, de Jesus APG et al (2020) A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 28:4263–4273. https://doi.org/10.1007/s00520-019-05283-1

    Article  Google Scholar 

  33. Oton-Leite AF, Corrêa de Castro AC, Morais MO et al (2012) Effect of intraoral low-level laser therapy on quality of life of patients with head and neck cancer undergoing radiotherapy. Head Neck 34:398–404. https://doi.org/10.1002/hed.21737

    Article  PubMed  Google Scholar 

  34. Kanatas AN, Rogers SN (2004) A national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl 86:6–10. https://doi.org/10.1308/003588404772614605

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Rogers SN, Lowe D (2009) Screening for dysfunction to promote multidisciplinary intervention by using the University of Washington Quality of Life Questionnaire. Arch Otolaryngol Head Neck Surg 135:369–375. https://doi.org/10.1001/archoto.2009.7

    Article  PubMed  Google Scholar 

  36. Bjordal JM, Johnson MI, Iversen V et al (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg 24:158–168. https://doi.org/10.1089/pho.2006.24.158

    Article  CAS  PubMed  Google Scholar 

  37. Walsh LJ (1997) The current status of low level laser therapy in dentistry. Part 1. Soft tissue applications. Aust Dent J 42:247–254. https://doi.org/10.1111/j.1834-7819.1997.tb00129.x

    Article  CAS  PubMed  Google Scholar 

  38. Konopka-Filippow M, Zabrocka E, Wójtowicz A et al (2015) Pain management during radiotherapy and radiochemotherapy in oropharyngeal cancer patients: single-institution experience. Int Dent J 65:242–248. https://doi.org/10.1111/idj.12181

    Article  PubMed  Google Scholar 

  39. He Y, Guo T, Guan H et al (2018) Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy: a meta-analysis. Cancer Manag Res 10:1419–1428. https://doi.org/10.2147/CMAR.S160469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Buffa FM, Bentzen SM, Daley FM et al (2004) Molecular marker profiles predict locoregional control of head and neck squamous cell carcinoma in a randomized trial of continuous hyperfractionated accelerated radiotherapy. Clin Cancer Res Off J Am Assoc Cancer Res 10:3745–3754. https://doi.org/10.1158/1078-0432.CCR-03-0248

    Article  CAS  Google Scholar 

  41. Vera-Llonch M, Oster G, Hagiwara M, Sonis S (2006) Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 106:329–336. https://doi.org/10.1002/cncr.21622

    Article  PubMed  Google Scholar 

  42. Maciá I, Garau M, Solé Monné J, Cambra Serés MJ et al (2009) Compliance to the prescribed overall treatment time (OTT) of curative radiotherapy in normal clinical practice and impact on treatment duration of counteracting short interruptions by treating patients on Saturdays. Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mex 11:302–311. https://doi.org/10.1007/s12094-009-0358-2

    Article  Google Scholar 

  43. Bensadoun R-J, Epstein JB, Nair RG et al (2020) Safety and efficacy of photobiomodulation therapy in oncology: a systematic review. Cancer Med 9:8279–8300. https://doi.org/10.1002/cam4.3582

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kreisler M, Christoffers AB, Willershausen B, d’Hoedt B (2003) Low-level 809 nm GaAlAs laser irradiation increases the proliferation rate of human laryngeal carcinoma cells in vitro. Lasers Med Sci 18:100–103. https://doi.org/10.1007/s10103-003-0265-7

    Article  CAS  PubMed  Google Scholar 

  45. Sonis ST, Hashemi S, Epstein JB et al (2016) Could the biological robustness of low level laser therapy (photobiomodulation) impact its use in the management of mucositis in head and neck cancer patients. Oral Oncol 54:7–14. https://doi.org/10.1016/j.oraloncology.2016.01.005

    Article  PubMed  Google Scholar 

  46. Zecha JAEM, Raber-Durlacher JE, Nair RG et al (2016) 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. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 24:2781–2792. https://doi.org/10.1007/s00520-016-3152-z

    Article  Google Scholar 

  47. Barasch A, Raber-Durlacher J, Epstein JB, Carroll J (2016) Effects of pre-radiation exposure to LLLT of normal and malignant cells. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 24:2497–2501. https://doi.org/10.1007/s00520-015-3051-8

    Article  Google Scholar 

  48. Bjordal JM, Bensadoun R-J, Tunèr J et al (2011) A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 19:1069–1077. https://doi.org/10.1007/s00520-011-1202-0

    Article  Google Scholar 

  49. Elting LS, Cooksley CD, Chambers MS, Garden AS (2007) Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 68:1110–1120. https://doi.org/10.1016/j.ijrobp.2007.01.053

    Article  PubMed  Google Scholar 

  50. Nonzee NJ, Dandade NA, Patel U et al (2008) Evaluating the supportive care costs of severe radiochemotherapy-induced mucositis and pharyngitis : results from a Northwestern University Costs of Cancer Program pilot study with head and neck and nonsmall cell lung cancer patients who received care at a county hospital, a Veterans Administration Hospital, or a comprehensive cancer care center. Cancer 113:1446–1452. https://doi.org/10.1002/cncr.23714

    Article  PubMed  Google Scholar 

  51. Murphy BA, Beaumont JL, Isitt J et al (2009) Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manage 38:522–532. https://doi.org/10.1016/j.jpainsymman.2008.12.004

    Article  PubMed  Google Scholar 

  52. Migliorati C, Hewson I, Lalla RV et al (2013) Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 21:333–341. https://doi.org/10.1007/s00520-012-1605-6

    Article  Google Scholar 

  53. Robijns J, Nair RG, Lodewijckx J et al (2022) Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol 12:927685. https://doi.org/10.3389/fonc.2022.927685

    Article  PubMed  PubMed Central  Google Scholar 

  54. Khan I, Arany PR (2016) Dosimetry for photobiomodulation therapy: response to Sommers et al. Ann Transl Med 4:208. https://doi.org/10.21037/atm.2016.05.34

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Khan I, Tang E, Arany P (2015) Molecular pathway of near-infrared laser phototoxicity involves ATF-4 orchestrated ER stress. Sci Rep 5:10581. https://doi.org/10.1038/srep10581

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Young NC, Maximiano V, Arany PR (2022) Thermodynamic basis for comparative photobiomodulation dosing with multiple wavelengths to direct odontoblast differentiation. J Biophotonics 15(6):e202100398. https://doi.org/10.1002/jbio.202100398

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Oral and Maxillofacial Surgery, Ca’ Foncello Hospital, Treviso, Italy

    Margherita Gobbo

  2. Oral Biology, Surgery and Biomedical Engineering, University at Buffalo, Buffalo, NY, USA

    Praveen R. Arany

  3. Faculty of Dentistry, Côte d’Azur University, Nice, France

    Elisabetta Merigo

  4. Department of Radiation Oncology, Centre de Haute Energie, Nice, France

    René-Jean Bensadoun

  5. Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, São Paulo, Brazil

    Alan Roger Santos-Silva

  6. Department of Clinic and Preventive Dentistry, Federal University of Pernambuco, Pernambuco, Brazil

    Luiz Alcino Gueiros

  7. Department of Surgical, Medical and Health Sciences, University of Trieste, Trieste, Italy

    Giulia Ottaviani

Authors
  1. Margherita Gobbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Praveen R. Arany
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabetta Merigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. René-Jean Bensadoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alan Roger Santos-Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luiz Alcino Gueiros
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giulia Ottaviani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Margherita Gobbo and Giulia Ottaviani had the idea for the article and performed the literature search. Margherita Gobbo, Praveen R. Arany, Elisabetta Merigo, René-Jean Bensadoun, Alan Roger Santos-Silva, and Luiz Alcino Gueiros performed the literature analysis, revision, and data analysis. Margherita Gobbo drafted the article, Giulia Ottaviani checked and reviewed the work. All the authors critically revised the work.

Corresponding author

Correspondence to Giulia Ottaviani.

Ethics declarations

Ethical approval

Not applicable

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gobbo, M., Arany, P.R., Merigo, E. et al. Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2. Support Care Cancer 31, 306 (2023). https://doi.org/10.1007/s00520-023-07749-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07749-9

Keywords

Search

Navigation