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Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

To systematically review the literature and update the evidence-based clinical practice guidelines for the use of photobiomodulation (PBM), such as laser and other light therapies, for the prevention and/or treatment of oral mucositis (OM).

Methods

A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) using PubMed and Web of Science. We followed the MASCC methods for systematic review and guidelines development. The rigorously evaluated evidence for each intervention, in each cancer treatment setting, was assigned a level-of-evidence (LoE). Based on the LoE, one of the following guidelines was determined: Recommendation, Suggestion, or No Guideline Possible.

Results

Recommendations are made for the prevention of OM and related pain with PBM therapy in cancer patients treated with one of the following modalities: hematopoietic stem cell transplantation, head and neck (H&N) radiotherapy (without chemotherapy), and H&N radiotherapy with chemotherapy. For each of these modalities, we recommend 1–2 clinically effective protocols; the clinician should adhere to all parameters of the protocol selected. Due to inadequate evidence, currently, No Guideline Possible for treatment of established OM or for management of chemotherapy-related OM. The reported clinical settings were extremely variable, limiting data integration.

Conclusions

The evidence supports the use of specific settings of PBM therapy for the prevention of OM in specific patient populations. Under these circumstances, PBM is recommended for the prevention of OM. The guidelines are subject to continuous update based on new published data.

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Abbreviations

CT:

Chemotherapy

GaAlAs:

Gallium-aluminum-arsenide

H&N:

Head and neck

HeNe:

Helium-Neon

HSCT:

Hematopoietic stem cell transplantation

InGaAlP:

Indium-Gallium-Aluminum-Phosphorus

InGaAs:

Indium-Gallium-Arsenide

LED:

Light-emitting diode

LLLT:

Low-level laser therapy

LoE:

Level of evidence

OM:

Oral mucositis

MASCC/ISOO:

Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology

PBM:

Photobiomodulation

PTP:

Photobiomodulation therapy parameters

RCT:

Randomized controlled trial

RT:

Radiotherapy

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Acknowledgments

The authors would like to thank the medical librarians, Lorraine Porcello, MSLIS, MSIM, from the Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA, and to Daniel A. Castillo, MLIS from the Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA, for their valuable assistance during the literature search phase.

Author information

Authors and Affiliations

  1. Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel

    Yehuda Zadik

  2. Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, P.O.Box 12272, Jerusalem, 9112102, Israel

    Yehuda Zadik

  3. Department of Oral Biology and Biomedical Engineering, School of Dental Medicine, Engineering and Applied Sciences, University at Buffalo, 3435 Main Street, B36A Foster Hall, Buffalo, NY, 14214, USA

    Praveen R. Arany

  4. Oral Medicine Service, Hospital Sírio-Libanês São Paulo, São Paulo, Brazil

    Eduardo Rodrigues Fregnani

  5. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy

    Paolo Bossi

  6. Clinical Research Division, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil

    Héliton Spindola Antunes

  7. Gérant, Responsable de Service, Centre de Haute Energie, Nice, France

    René-Jean Bensadoun

  8. Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, PE, Brazil

    Luiz Alcino Gueiros

  9. University of Bresciam, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental Clinic Oral Medicine, Brescia, Italy

    Alessandra Majorana

  10. Griffith University and Gold Coast University Hospital, Southport, Australia

    Raj G. Nair

  11. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA

    Vinisha Ranna

  12. Division of Pediatric Oncology/Hematology/Immunology, Beatrix Childrens Hospital, University Medical Center Groningen, Groningen, The Netherlands

    Wim J. E. Tissing

  13. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Anusha Vaddi & Sharon Elad

  14. Departments of Physics and Chemistry, Bar-Ilan University, Ramat-Gan, Israel

    Rachel Lubart

  15. College of Dentistry, University of Florida, Gainesville, FL, USA

    Cesar Augusto Migliorati

  16. Section of Oral Medicine, University of Connecticut Health, Farmington, CT, USA

    Rajesh V. Lalla

  17. Yong Loo Lin School of Medicine, Clinical Research Centre, National University of Singapore, Level 2, Singapore, Singapore

    Karis Kin Fong Cheng

Authors
  1. Yehuda Zadik
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  2. Praveen R. Arany
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  3. Eduardo Rodrigues Fregnani
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  4. Paolo Bossi
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  5. Héliton Spindola Antunes
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  6. René-Jean Bensadoun
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  7. Luiz Alcino Gueiros
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  8. Alessandra Majorana
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  9. Raj G. Nair
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  10. Vinisha Ranna
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  11. Wim J. E. Tissing
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  12. Anusha Vaddi
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  13. Rachel Lubart
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  14. Cesar Augusto Migliorati
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  15. Rajesh V. Lalla
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  16. Karis Kin Fong Cheng
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  17. Sharon Elad
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Consortia

On behalf of The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

Corresponding authors

Correspondence to Yehuda Zadik or Praveen R. Arany.

Ethics declarations

Conflict of interest

Per the MASCC Guidelines policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel. The following authors disclose no conflict of interest: YZ, ERF, HSA, RJB, LAG, AM, RGN, VR, WJET, AV, RL, CAM, KKFC and SE. The following authors disclose a potential conflict of interest as detailed in the ICMJE form for disclosure of potential conflicts of interest: PRA, PB and RVL.

PRA has received grants and personal fees from Lumitex and NIDCR/NIH , personal fees from NeomedLight, grants from NST Consulting, grants from Phillips Research, grants from American Society of Lasers in Surgery and Medicine, grants from American Dental Education Association, non-financial support from Thor Photomedicine, non-financial support from Weber Medical; In addition, PRA has a patent Laser systems for dental therapy issued and serve in the honorary positions of President of World Association for Photobiomodulation Therapy,

Immediate Past-President of North American Association for Photobiomodulation Therapy, Chair of Society for Photonics and Engineers, Mechanisms for Photobiomodulation Therapy, Technical Group member of Photobiomodulation therapy, Optical Society of America, Program Chair of Society for Advanced Wound Care, Wound Healing Society.

PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche.

RVL has served as a consultant for Colgate Oral Pharmaceuticals, Galera Therapeutics, Ingalfarma SA, Monopar Therapeutics, Mundipharma, and Sucampo Pharma; has received research support to his institution from Galera Therapeutics, Novartis, Oragenics, and Sucampo Pharma; and has received stock in Logic Biosciences.

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Zadik, Y., Arany, P.R., Fregnani, E.R. et al. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 27, 3969–3983 (2019). https://doi.org/10.1007/s00520-019-04890-2

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