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Feasibility of photobiomodulation therapy for the prevention of radiodermatitis: a single-institution pilot study

Abstract

Acute radiodermatitis is one of the major complications when radiation therapy (RT) is delivered to the head and neck region in cases of head and neck cancers or lung cancers with supraclavicular lymph node metastasis. In these cases, high dose of RT is generally used so that acute radiodermatitis is observed in more than 90% of patients, and it negatively affects patients’ quality of life. In this pilot study, we evaluated the clinical feasibility of photobiomodulation (PBM) therapy before conducting a randomized trial based on the hypothesis that PBM therapy may reduce the severity of radiodermatitis in participants receiving 60 Gy or higher dose. Patients who were to receive 60 Gy or higher dose in the neck were included in the study. Thirty-three patients received PBM therapy three times a week during RT. The severity of radiodermatitis was evaluated by two dermatologists and a radiation oncologist using the modified Common Terminology Criteria for Adverse Events (CTCAE). Patients were followed up until a week after RT. In all patients, 90.6% of planned PBM schedule was completed. There was no significant side effect of PBM therapy. Thirteen (39%) patients showed wet desquamation (CTCAE grade 2b or higher). Only three (9%) of them showed grade 3 toxicity, which is a favorable result compared with previous studies. This pilot study showed that PBM therapy is safe and feasible in the clinic, and it might reduce the severity of radiodermatitis. A randomized trial should be warranted to prove the efficacy of PBM therapy.

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Abbreviations

RT:

Radiation therapy

PBM:

PhotoBioModulation

CTCAE:

Common Terminology Criteria for Adverse Events

BMI:

Body mass index

NIR:

Near-infrared

CCRT:

Concurrent chemoradiotherapy

CT:

Chemotherapy

RCT:

Randomized controlled trial

RTOG:

Radiation Treatment Oncology Group

NCI-CTC:

National Cancer Institute- Common Toxicity Criteria

References

  1. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group I (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944

    Article  Google Scholar 

  2. Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP (2003) Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14(3):199–212

    CAS  PubMed  Article  Google Scholar 

  3. Zecha JA, Raber-Durlacher JE, Nair RG, Epstein JB, Elad S, Hamblin MR, Barasch A, Migliorati CA, Milstein DM, Genot MT, Lansaat L, van der Brink R, Arnabat-Dominguez J, van der Molen L, Jacobi I, van Diessen J, de Lange J, Smeele LE, Schubert MM, Bensadoun RJ (2016) Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols. Support Care Cancer 24(6):2793–2805

    PubMed  PubMed Central  Article  Google Scholar 

  4. McQuestion M (2011) Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs 27(2):e1–e17

    PubMed  Article  Google Scholar 

  5. Barkham AM (1993) Radiotherapy skin reactions and treatments. Prof Nurse 8(11):732–736

    CAS  PubMed  Google Scholar 

  6. Liguori V, Guillemin C, Pesce GF, Mirimanoff RO, Bernier J (1997) Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiother Oncol 42(2):155–161

    CAS  PubMed  Article  Google Scholar 

  7. Halperin EC, Gaspar L, George S, Darr D, Pinnell S (1993) A double-blind, randomized, prospective trial to evaluate topical vitamin C solution for the prevention of radiation dermatitis. CNS Cancer consortium. Int J Radiat Oncol Biol Phys 26(3):413–416

    CAS  PubMed  Article  Google Scholar 

  8. Williams MS, Burk M, Loprinzi CL, Hill M, Schomberg PJ, Nearhood K, O’Fallon JR, Laurie JA, Shanahan TG, Moore RL, Urias RE, Kuske RR, Engel RE, Eggleston WD (1996) Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 36(2):345–349

    CAS  PubMed  Article  Google Scholar 

  9. Maiche AG, Grohn P, Maki-Hokkonen H (1991) Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 30(3):395–396

    CAS  PubMed  Article  Google Scholar 

  10. Elliott EA, Wright JR, Swann RS, Nguyen-Tan F, Takita C, Bucci MK, Garden AS, Kim H, Hug EB, Ryu J, Greenberg M, Saxton JP, Ang K, Berk L, Radiation Therapy Oncology Group T (2006) Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of radiation therapy oncology group trial 99-13. J Clin Oncol 24(13):2092–2097

    Article  CAS  Google Scholar 

  11. Wong RK, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB, Eaby-Sandy B, Lacouture ME (2013) Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC skin toxicity study group. Support Care Cancer 21(10):2933–2948

    PubMed  Article  Google Scholar 

  12. Robijns J, Censabella S, Claes S, Pannekoeke L, Busse L, Colson D, Kaminski I, Bulens P, Maes A, Noe L, Brosens M, Timmermans A, Lambrichts I, Somers V, Mebis J (2018) Prevention of acute radiodermatitis by photobiomodulation: a randomized, placebo-controlled trial in breast cancer patients (TRANSDERMIS trial). Lasers Surg Med

  13. Robijns J, Censabella S, Bulens P, Maes A, Mebis J (2017) The use of low-level light therapy in supportive care for patients with breast cancer: review of the literature. Lasers Med Sci 32(1):229–242

    PubMed  Article  Google Scholar 

  14. Costa MM, Silva SB, Quinto AL, Pasquinelli PF, de Queiroz dos Santos V, de Cassia SG, Veiga DF (2014) Phototherapy 660 nm for the prevention of radiodermatitis in breast cancer patients receiving radiation therapy: study protocol for a randomized controlled trial. Trials 15:330

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  15. Robijns J, Censabella S, Claes S, Pannekoeke L, Busse L, Colson D, Kaminski I, Lodewijckx J, Bulens P, Maes A, Noe L, Brosens M, Timmermans A, Lambrichts I, Somers V, Mebis J (2019) Biophysical skin measurements to evaluate the effectiveness of photobiomodulation therapy in the prevention of acute radiation dermatitis in breast cancer patients. Support Care Cancer 27(4):1245–1254

    PubMed  Article  Google Scholar 

  16. CTCAE version 4.03. 2010. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm.

  17. Shah BA, Qureshi MM, Logue JM, Cooley TP, Zaner KS, Jalisi S, Truong MT (2017) Assessing cumulative acute toxicity of chemoradiotherapy in head and neck cancer with or without induction chemotherapy. Am J Otolaryngol 38(4):456–461

    PubMed  Article  Google Scholar 

  18. Chao KS, Ozyigit G, Thorsdad WL (2003) Toxicity profile of intensity-modulated radiation therapy for head and neck carcinoma and potential role of amifostine. Semin Oncol 30(6 Suppl 18):101–108

    CAS  PubMed  Article  Google Scholar 

  19. Singh M, Alavi A, Wong R, Akita S (2016) Radiodermatitis: a review of our current understanding. Am J Clin Dermatol 17(3):277–292

    PubMed  Article  Google Scholar 

  20. Cabezon-Gutierrez L, Khosravi-Shahi P, Escobar-Alvarez Y (2012) Management of dermatitis in patients with locally advanced squamous cell carcinoma of the head and neck receiving cetuximab and radiotherapy. Oral Oncol 48(4):293–297

    PubMed  Article  Google Scholar 

  21. Bjordal JM, Bensadoun RJ, Tuner J, Frigo L, Gjerde K, Lopes-Martins RA (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 19(8):1069–1077

    PubMed  Article  Google Scholar 

  22. Carvalho PA, 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

    CAS  PubMed  Article  Google Scholar 

  23. Gouvea de Lima A, Villar RC, de Castro G, Jr., Antequera R, Gil E, Rosalmeida MC, Federico MH, Snitcovsky IM (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(1):270–275

  24. Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Nigudgi S (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 21(5):1421–1428

    PubMed  Article  Google Scholar 

  25. Saleh J, Figueiredo MA, Cherubini K, Braga-Filho A, Salum FG (2014) Effect of low-level laser therapy on radiotherapy-induced hyposalivation and xerostomia: a pilot study. Photomed Laser Surg 32(10):546–552

    PubMed  Article  Google Scholar 

  26. Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Guddattu V (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

    CAS  PubMed  Article  Google Scholar 

  27. Antunes HS, Schluckebier LF, Herchenhorn D, Small IA, Araujo CM, Viegas CM, Rampini MP, Ferreira EM, Dias FL, Teich V, Teich N, Ferreira CG (2016) Cost-effectiveness of low-level laser therapy (LLLT) in head and neck cancer patients receiving concurrent chemoradiation. Oral Oncol 52:85–90

    PubMed  Article  Google Scholar 

  28. Mallick S, Benson R, Rath GK (2016) Radiation induced oral mucositis: a review of current literature on prevention and management. Eur Arch Otorhinolaryngol 273(9):2285–2293

    PubMed  Article  Google Scholar 

  29. Sonis ST, Hashemi S, Epstein JB, Nair RG, Raber-Durlacher JE (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

    PubMed  Article  Google Scholar 

  30. Ohno Y, Hatabu H, Takenaka D, Van Cauteren M, Fujii M, Sugimura K (2002) Dynamic oxygen-enhanced MRI reflects diffusing capacity of the lung. Magn Reson Med 47(6):1139–1144

    PubMed  Article  Google Scholar 

  31. Bensadoun RJ (2018) Photobiomodulation or low-level laser therapy in the management of cancer therapy-induced mucositis, dermatitis and lymphedema. Curr Opin Oncol 30(4):226–232

    PubMed  Google Scholar 

  32. Strouthos I, Chatzikonstantinou G, Tselis N, Bon D, Karagiannis E, Zoga E, Ferentinos K, Maximenko J, Nikolettou-Fischer V, Zamboglou N (2017) Photobiomodulation therapy for the management of radiation-induced dermatitis : a single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery. Strahlenther Onkol 193(6):491–498

    PubMed  Article  Google Scholar 

  33. Gonzalez-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 20(2):117–122

    PubMed  Article  Google Scholar 

  34. Wang X, Tian F, Soni SS, Gonzalez-Lima F, Liu H (2016) Interplay between up-regulation of cytochrome-c-oxidase and hemoglobin oxygenation induced by near-infrared laser. Sci Rep 6:30540

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  35. Wang X, Tian F, Reddy DD, Nalawade SS, Barrett DW, Gonzalez-Lima F, Liu H (2017) Up-regulation of cerebral cytochrome-c-oxidase and hemodynamics by transcranial infrared laser stimulation: a broadband near-infrared spectroscopy study. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 37(12):3789–3802

    CAS  Article  Google Scholar 

  36. de Freitas LF, Hamblin MR (2016) Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron 22(3)

  37. Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40(2):516–533

    PubMed  Article  Google Scholar 

  38. Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Sanford LE, Woodruff LD (2004) The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg 22(4):323–329

    PubMed  Article  Google Scholar 

  39. Kazemikhoo N, Vaghardoost R, Dahmardehei M, Mokmeli S, Momeni M, Nilforoushzadeh MA, Ansari F, Razagi MR, Razagi Z, Amirkhani MA, Masjedi MR (2018) Evaluation of the effects of low level laser therapy on the healing process after skin graft surgery in burned patients (a randomized clinical trial). J Lasers Med Sci 9(2):139–143

    PubMed  PubMed Central  Article  Google Scholar 

  40. Sperandio FF, Giudice FS, Correa L, Pinto DS Jr, Hamblin MR, de Sousa SC (2013) Low-level laser therapy can produce increased aggressiveness of dysplastic and oral cancer cell lines by modulation of Akt/mTOR signaling pathway. J Biophotonics 6(10):839–847

    CAS  PubMed  PubMed Central  Google Scholar 

  41. 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(2):100–103

    CAS  PubMed  Article  Google Scholar 

  42. Schartinger VH, Galvan O, Riechelmann H, Dudas J (2012) Differential responses of fibroblasts, non-neoplastic epithelial cells, and oral carcinoma cells to low-level laser therapy. Support Care Cancer 20(3):523–529

    PubMed  Article  Google Scholar 

  43. 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 24(6):2497–2501

    PubMed  Article  Google Scholar 

  44. DeLand MM, Weiss RA, McDaniel DH, Geronemus RG (2007) Treatment of radiation-induced dermatitis with light-emitting diode (LED) photomodulation. Lasers Surg Med 39(2):164–168

    PubMed  Article  Google Scholar 

  45. Fife D, Rayhan DJ, Behnam S, Ortiz A, Elkeeb L, Aquino L, Eduardo Roa D, Ramsinghani N, Kuo J, Newcomb R, Zachary CB, Kelly KM (2010) A randomized, controlled, double-blind study of light emitting diode photomodulation for the prevention of radiation dermatitis in patients with breast cancer. Dermatol Surg 36(12):1921–1927

    CAS  PubMed  Article  Google Scholar 

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Funding

This research is funded by the National Research Foundation of Korea (NRF-2017M2A2A7A02018569).

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Authors and Affiliations

Authors

Contributions

Ji-Hye Park contributed to the analysis of data and drafted the manuscript. Hyun Jeong Byun, Jong-Hee Lee, Haeyoung Kim, Jae Myung Noh, Cho Rok Kim, and Dongryul Oh contributed to the data collection and analysis of data. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Dongryul Oh.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The ethical committees of Samsung Medical Center approved this study (approval number: 2017-02-152). The study was registered at the Clinical Research Information Service (trial registration: CRIS, KCT0002706, Registered 23 February 2018- Retrospectively registered, https://cris.nih.go.kr/cris/en/search/search_result_st02.jsp?seq=9480). Only participants who signed the written informed consent form were enrolled in the study.

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Park, JH., Byun, H.J., Lee, J.H. et al. Feasibility of photobiomodulation therapy for the prevention of radiodermatitis: a single-institution pilot study. Lasers Med Sci 35, 1119–1127 (2020). https://doi.org/10.1007/s10103-019-02930-1

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  • DOI: https://doi.org/10.1007/s10103-019-02930-1

Keywords

  • Neck
  • Photobiomodulation therapy
  • Prevention
  • Radiodermatitis