Skip to main content
SpringerLink
Log in

Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial

Supportive Care in Cancer volume 24, pages 1035–1042 (2016)Cite this article

Abstract

Purpose

The purpose of this study is to evaluate the effectiveness of low-level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic stem cell transplantation.

Methods

This is a randomized, parallel, superiority trial including 35 patients divided into the following: laser (n = 17) and sham (n = 18). The variables assessed were oral mucositis (grade 2 of the World Health Organization oral toxicity scale), severe oral mucositis (grade 3 or 4), and pain (according to a visual analogue scale). In the laser group, a InGaAlP laser, wavelength of 650 nm, power 100 mW, energy per point of 2 J, time 20 s by point, extremity fiber optic 0.028 cm2, and energy density 70 J/cm2, was used, applied the first day of conditioning until D + 5, while the sham group received simulated laser over the same period.

Results

No statistically significant difference was found in the incidence of oral mucositis (p = 0.146). Severe mucositis was found in 40 % of the patients (14/35), 3 in the intervention group (17.65 %) and 11 in the sham group (61.11 %) (p = 0.015). The cumulative probability of survival with respect to the development of severe oral mucositis was >0.6 for the intervention group and 0 for the control group (p = 0.0397). On the day on which pain was considered the worst, patients in the sham group were more likely to classify their pain as severe compared to those in the laser group (p = 0.041).

Conclusion

Low-level laser therapy proved effective for the prevention of severe oral mucositis and intense oral pain in patients submitted to hematopoietic stem cell transplantation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

References

  1. Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan R, Potting CJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB (2014) Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 23(1):223–236

    Article  PubMed Central  PubMed  Google Scholar 

  2. Djavid GE, Emami A, Ataie-Fashtami L, Safaeinodehi SR, Merikh-Baiat F, Fateh M, Zand N (2011) Low level laser therapy in management of chemotherapy- induced oral mucositis: prophylaxis or treatment? J Lasers Med Sci 2(1):12–17

    Google Scholar 

  3. Freitas ACC, Campos L, Brandão TB, Cristófaro M, Eduardo FP, Luiz AC, Marques MM, de Paula Eduardo C, Simões A (2014) Chemotherapy-induced oral mucositis: effect of led and laser phototherapy treatment protocols. Photomed Laser Surg 32(2):81–87

    Article  PubMed  Google Scholar 

  4. Silva GBL, Sacono NT, Othon-Leite AF, Mendonça EF, Arantes AM, Bariani C, Duarte LGL, Abreu MHN, Queiroz-Júnior CM, Silva TA, Batista AC (2014) Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci 30(1):117–126

    Article  PubMed  Google Scholar 

  5. Antunes HS, Ferreira EMS, Matos VD, Pinheiro CT, Ferreira CG (2008) The impact of low power laser in the treatment of conditioning-induced oral mucositis: a report of 11 clinical cases and their review. Med Oral Patol Oral Cir Bucal 13(3):187–192

    Google Scholar 

  6. Alvariño-Martín C, Sarrión-Pérez MG (2014) Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent 6(1):74–80

    Article  Google Scholar 

  7. Cauwels R, Martens L (2011) Low level laser therapy in oral mucositis: a pilot study. Eur Arch Paediatr Dent 12(2):118–123

    Article  CAS  PubMed  Google Scholar 

  8. Legert KG, Remberger M, Ringdén O, Heimdahl A, Dahllöf G (2014) Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Support Care Cancer 22(8):2133–2140

    Article  PubMed  Google Scholar 

  9. Antunes HS, Azevedo AM, Bouzas LFS, Adão CAE, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, Matos VD, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG (2007) Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial. Blood Journal 109(5):2250–2255

    Article  CAS  Google Scholar 

  10. Eduardo FP, Bezinelli LM, Orsi MCE, Rodrigues M, Ribeiro MS, Hamerschlak N, Correa L (2011) The influence of dental care associated with laser therapy on oral mucositis during allogeneic hematopoietic cell transplant: retrospective study. Einstein 9(2):201–206

    Article  Google Scholar 

  11. Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Vadhiraja BM (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 104(3):349–354

    Article  PubMed  Google Scholar 

  12. 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(9):893–897

    Article  PubMed  Google Scholar 

  13. Silva GBL, Mendonça EF, Bariani C, Antunes HS, Silva MAG (2011) The prevention of induced oral mucositis with low-level laser therapy in bone marrow transplantation patients: a randomized clinical trial. Photomed Laser Surg 29(1):27–31

    Article  PubMed  Google Scholar 

  14. Schubert MM, Eduardo FP, Guthrie KA, Franquin JC, Bensadoun RJJ, Migliorati CA, Lloid CME, Eduardo CP, Walter NF, Marques MM, Hamdi M (2007) A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Support Care Cancer 15(10):1145–1154

    Article  PubMed  Google Scholar 

  15. Cowen D, Tardieu C, Schubert M, Peterson D, Resbeut M, Faucher C, Franquin JC (1997) Low energy helium-neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiation Oncology Biol Phys 38(4):697–703

    Article  CAS  Google Scholar 

  16. Jaguar G, Prado J, Nishimoto I, Pinheiro M, Castro D Jr, Perez DC, Alves F (2007) Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation. Oral Dis 13(6):538–543

    Article  CAS  PubMed  Google Scholar 

  17. Whelan HT, Connely JF, Hodgson BD, Barbeau L, Post AC, Bullard G, Buchmann EV, Kane M, Whelan NT, Warwick A, Margolis D (2002) NASA light-emitting diodes for the prevention of oral mucositis in pediatric bone marrow transplant patients. J Clin Laser Med Surg 20(6):319–324

    Article  PubMed  Google Scholar 

  18. Barasch A, Peterson DE, Tamer JM, Brosio JAD, Nuki K, Schubert M, Franquin JC, Clive J, Tutschka P (1995) Helium-neon laser effects on conditioning-induced oral mucositis in bone marrow transplantation patients. Cancer 76(12):2550–2556

    Article  CAS  PubMed  Google Scholar 

  19. Carvalho PAG, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA (2011) Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol 47(12):1176–1181

    Article  CAS  PubMed  Google Scholar 

  20. WHO (1979) WHO handbook for reporting results of cancer treatment. World Health Organization, Geneva

    Google Scholar 

  21. Antunes HS, Herchenhorn D, Small IA, Araujo CM, Viegas CMP, Cabral E, Rampini MP, Rodrigues PC, Silva TG, Ferreira EM, Dias FL, Ferreira CG (2011) Phase iii trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation. Radiother Oncol 109(2):297–302

    Article  Google Scholar 

  22. WHO (2006) Appraising the WHO analgesic ladder on its 20th anniversary. Cancer Pain Release 19(1):1–8

    Google Scholar 

  23. Oberoi S, Netto GZ, Beyene J, Treister NS, Sung L (2014) Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis. PLoS ONE 9(9):1–10

    Article  Google Scholar 

  24. Min CK, Lee W, Min DJ, Lee DG, Kim YJ, Park Y, Kim H, Lee S, Kim D, Lee J, Min W, Kim C (2001) The kinetics of circulating cytokines including IL-6, TNF-α, IL-8 and IL-10 following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 28(10):935–940

    Article  CAS  PubMed  Google Scholar 

  25. Efron PA, Moldawer LL (2004) Cytokines and wound healing: the role of cytokine and anticytokine therapy in the repair response. J Burn Care Res 25(2):149–160

    Article  Google Scholar 

  26. Piva JADAC, Abreu EMDC, Silva VDS, Nicolau RA (2011) Effect of low-level laser therapy on the initial stages of tissue repair: basic principles. An Bras Dermatol 86(5):947–954

    Article  PubMed  Google Scholar 

  27. Hodgson B, Margolis D, Salzman D, Eastwood D, Tarima S, Williams L, Sande J, Vaughan W, Whelan H (2012) Amelioration of oral mucositis pain by NASA near-infrared light-emitting diodes in bone marrow transplant patients. Support Care Cancer 20(7):1405–1415

    Article  PubMed  Google Scholar 

  28. Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RAB (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 Ther 24(2):158–168

    Article  CAS  Google Scholar 

  29. Stolik S, Delgado J, Perez JA, Anasagasti L (2000) Measurement of the penetration depths of red and near infrared light in human ‘ex vivo’ tissues. J Photochem Photobiol B Biol 57(2):90–93

    Article  CAS  Google Scholar 

  30. Enwemeka CS (2001) Attenuation and penetration of visible 632.8 nm and invisible infra-red 904nm light in soft tissues. Laser 13(1):95–101

    Google Scholar 

  31. Bezinelli LM, Eduardo FP, Lopes RMG, Biazevic MGH, Eduardo CP, Correa L, Hamerschlak N, Michel-Crosato E (2014) Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation. Hematol Oncol 32(1):31–39

    Article  PubMed  Google Scholar 

  32. Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, Kanehira T, Yamamoto S, Kondo T, Endo T, Tanaka J, Hashino S, Nishio M, Imamura M, Kitagawa Y, Inoue N (2012) Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer 20(2):367–373

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), the institute in which this study was conducted, and to the hematology team for their support.

Conflict of interest

The authors declare that for all legal effects, there are no conflicts of interest whatsoever associated with this paper. The study received no financial resources, either institutional or private.

Author information

Authors and Affiliations

  1. Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50070-550, Recife, Pernambuco, Brazil

    Betânia Ferreira, Fabiana Moura da Motta Silveira & Flávia Augusta de Orange

Authors
  1. Betânia Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabiana Moura da Motta Silveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Flávia Augusta de Orange
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Flávia Augusta de Orange.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferreira, B., da Motta Silveira, F.M. & de Orange, F.A. Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial. Support Care Cancer 24, 1035–1042 (2016). https://doi.org/10.1007/s00520-015-2881-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2881-8

Keywords

search

Navigation