Supportive Care in Cancer

, Volume 24, Issue 6, pp 2781–2792 | Cite as

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

  • Judith A. E. M. Zecha
  • Judith E. Raber-Durlacher
  • Raj G. Nair
  • Joel B. Epstein
  • Stephen T. Sonis
  • Sharon Elad
  • Michael R. Hamblin
  • Andrei Barasch
  • Cesar A. Migliorati
  • Dan M. J. Milstein
  • Marie-Thérèse Genot
  • Liset Lansaat
  • Ron van der Brink
  • Josep Arnabat-Dominguez
  • Lisette van der Molen
  • Irene Jacobi
  • Judi van Diessen
  • Jan de Lange
  • Ludi E. Smeele
  • Mark M. Schubert
  • René-Jean BensadounEmail author
Review Article



There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters.


This study is a narrative non-systematic review.


We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority.


Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.


Low level laser therapy Low level light therapy Photobiomodulation Mucositis Orofacial complications Chemotherapy Radiation therapy Head and neck cancer Safety LLLT and PBM 


Conflict of interest

Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, Ron van der Brink, Josep Arnabat Dominguez, and Rene-Jean Bensadoun have received travel expenses and hotel accommodation from THOR Photomedicine Ltd. UK. Raj Nair has received an honorarium from THOR, UK. Michael R Hamblin was supported by US NIH grant R01AI050875. All the other authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Judith A. E. M. Zecha
    • 1
  • Judith E. Raber-Durlacher
    • 1
    • 2
  • Raj G. Nair
    • 3
  • Joel B. Epstein
    • 4
    • 5
  • Stephen T. Sonis
    • 6
  • Sharon Elad
    • 7
  • Michael R. Hamblin
    • 8
    • 9
    • 10
  • Andrei Barasch
    • 11
  • Cesar A. Migliorati
    • 12
  • Dan M. J. Milstein
    • 1
  • Marie-Thérèse Genot
    • 13
  • Liset Lansaat
    • 14
  • Ron van der Brink
    • 15
  • Josep Arnabat-Dominguez
    • 16
  • Lisette van der Molen
    • 14
  • Irene Jacobi
    • 14
  • Judi van Diessen
    • 17
  • Jan de Lange
    • 1
  • Ludi E. Smeele
    • 1
    • 14
  • Mark M. Schubert
    • 18
  • René-Jean Bensadoun
    • 19
    Email author
  1. 1.Department of Oral and Maxillofacial Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and VU UniversityAmsterdamThe Netherlands
  3. 3.Department of Haematology and Oncology/Cancer ServicesGold Coast University Hospital, Queensland HealthGold CoastAustralia
  4. 4.Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesUSA
  5. 5.Division of Otolaryngology and Head and Neck SurgeryCity of HopeDuarteUSA
  6. 6.Division of Oral MedicineBrigham and Women’s Hospital and the Dana-Farber Cancer Institute and Biomodels LLCBostonUSA
  7. 7.Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer CenterUniversity of Rochester Medical CenterRochesterUSA
  8. 8.Wellman Center for PhotomedicineMassachusetts General HospitalBostonUSA
  9. 9.Department of DermatologyHarvard Medical SchoolBostonUSA
  10. 10.Harvard-MIT Division of Health Science and TechnologyCambridgeUSA
  11. 11.Weill Cornell Medical CenterDivision of OncologyNew YorkUSA
  12. 12.Department of Diagnostic Sciences and Oral MedicineUniversity of Tennessee Health Science Center, College of DentistryMemphisUSA
  13. 13.Laser Therapy Unit, Institut Jules BordetCentre des Tumeurs de l’Université Libre de BruxellesBrusselsBelgium
  14. 14.Antoni van Leeuwenhoek Department of Head and Neck Oncology and SurgeryNetherlands Cancer InstituteAmsterdamThe Netherlands
  15. 15.City of HopeDuarteUSA
  16. 16.Department of Oral Surgery, Faculty of DentistryUniversity of BarcelonaBarcelonaSpain
  17. 17.Antoni van Leeuwenhoek Department Radiation Oncology AmsterdamNetherlands Cancer InstituteAmsterdamThe Netherlands
  18. 18.Seattle Cancer Care Alliance (SCCA)SeattleUSA
  19. 19.World Association for Laser Therapy (WALT) Scientific SecretaryCentre de Haute Energie (CHE)NiceFrance

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