A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis

Centre for Evidence-Based Practice, Bergen University College-HiB, Moellendalsvn. 6, 5009, Bergen, Norway.
Supportive Care in Cancer (Impact Factor: 2.5). 06/2011; 19(8):1069-77. DOI: 10.1007/s00520-011-1202-0
Source: PubMed

ABSTRACT The purpose of this study is to review the effects of low-level laser therapy (LLLT) in the prevention and treatment of cancer therapy-induced oral mucositis (OM).
A systematic review and meta-analysis of randomised placebo-controlled trials of LLLT performed during chemotherapy or radiation therapy in head and neck cancer patients.
We found 11 randomised placebo-controlled trials with a total of 415 patients; methodological quality was acceptable at 4.10 (SD ± 0.74) on the 5-point Jadad scale. The relative risk (RR) for developing OM was significantly (p = 0.02) reduced after LLLT compared with placebo LLLT (RR = 2.03 (95% CI, 1.11 to 3.69)). This preventive effect of LLLT improved to RR = 2.72 (95% CI, 1.98 to 3.74) when only trials with adequate doses above 1 J were included. For treatment of OM ulcers, the number of days with OM grade 2 or worse was significantly reduced after LLLT to 4.38 (95% CI, 3.35 to 5.40) days less than placebo LLLT. Oral mucositis severity was also reduced after LLLT with a standardised mean difference of 1.33 (95% CI, 0.68 to 1.98) over placebo LLLT. All studies registered possible side-effects, but they were not significantly different from placebo LLLT.
There is consistent evidence from small high-quality studies that red and infrared LLLT can partly prevent development of cancer therapy-induced OM. LLLT also significantly reduced pain, severity and duration of symptoms in patients with cancer therapy-induced OM.

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Available from: Jan Magnus Bjordal, Aug 13, 2015
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    • "This would affect the biological regulation of nitric oxide and adenosine triphosphate and would further affect the inflammatory process or cytokine release. LLLT is prevalent in the prevention and treatment of cancer therapy-induced oral mucositis [9] [10] and may alter human immunity. LLLT has also been shown to have several biological effects that favor the healing process [11]. "
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    ABSTRACT: Low-level laser therapy (LLLT) has been used in the treatment of radiotherapy-induced oral mucositis and allergic rhinitis. However, the effects of LLLT on human monocyte polarization into M1 macrophages are unknown. To evaluate the effects of LLLT on M1-related cytokine and chemokine production and elucidate the mechanism, the human monocyte cell line THP-1 was treated with different doses of LLLT. The expression of M1-related cytokines and chemokines (CCL2, CXCL10, and TNF- α ) was determined by ELISA and real-time PCR. LLLT-associated histone modifications were examined by chromatin immunoprecipitation (ChIP) assays. Mitochondrial involvement in the LLLT-induced M1-related cytokine expression was evaluated by quantitative real-time PCR. Flow cytometry was used to detect the cell surface markers for monocyte polarization. The results showed that LLLT (660 nm) significantly enhanced M1-related cytokine and chemokine expression in mRNA and protein levels. Mitochondrial copy number and mRNA levels of complex I-V protein were increased by LLLT (1 J/cm(2)). Activation of M1 polarization was concomitant with histone modification at TNF- α gene locus and IP-10 gene promoter area. This study indicates that LLLT (660 nm) enhanced M1-related cytokine and chemokine expression via mitochondrial biogenesis and histone modification, which may be a potent immune-enhancing agent for the treatment of allergic diseases.
    Mediators of Inflammation 02/2014; 2014:625048. DOI:10.1155/2014/625048 · 3.24 Impact Factor
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    • "Antunes et al [7], used 4J/cm² from D -7 to neutrophil recovery and obtained an average of 63.2% from the transplanted patients with grade 0-1 OM and 31.5% with grade 2 OM, with only 5.3% of the patients remaining presenting grade 3 OM and Silva et al [29], used 4J/cm² from D -4 to D +4 and obtained an average of 66.7% of the transplanted patients with grade 0-1 OM and 33.3% with grade 2 OM, not having observed grade 3 OM in this study. Recently, two systematic reviews showed an increasing evidence in favor of LLLT for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation [30] [31]. Once installed, the treatment of mucositis is of its symptoms and it will depend on the degree of severity. "
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    ABSTRACT: Oral Mucositis (OM) is one of the main complications of patients submitted to the oncologic treatment. The incidence of oral mucositis varies, and is intimately related to the toxicity of chemotherapy and radiotherapy protocol. Prolonged or profound oral mucositis leads to significant pain and morbidity and depending on its progression, it may be necessary to interrupt the treatment followed or not by hospitalization. OM occurs approximately in seven to ten days after chemotherapy and from the second week of radiotherapy. Although it is a toxic reaction and inflammation that is studied for a long time, the molecular and cell mechanisms described recently may contribute for the appearance of new protocols of prevention. In the context of options studied in the prevention of OM, there are efficient alternatives as cryotherapy, growth factor of keratinocytes and the low-level lasers that promote a reduction in the incidence of OM and pain during the period of the oncologic treatment. The aim of this chapter was to investigate the available literature regarding OM, searching relevant articles and eligible clinical trials in order to obtain additional information about prevention and treatment interventions to OM.
    International Journal of Clinical Dentistry 02/2014; 7(1):8-15.
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    • "There are some differences between analgesic effects of NACLT and the other classical low power lasers. The analgesic effect in LLLT is usually gradual, cumulative, and multi-session (Pinheiro, Cavalcanti et al. 1998; Gur, Karakoc et al. 2002; Gur, Sarac et al. 2004; Nes and Posso 2005; Chow, Heller et al. 2006; Djavid, Mehrdad et al. 2007; Bjordal, Bensadoun et al. 2011; Iwatsuki, Yoshimine et al. 2011; Ribeiro, de Aguiar et al. 2011). In contrast, the pain relieving effect of NACLT is immediate, dramatic and more sustained than conventional phototherapeutic lasers, so that immediately after NACLT, the patients of the studies have been able to eat and drink easily (Zand, Ataie-Fashtami et al. 2009; Zand, Mansouri et al. 2009; Zand, Najafi et al. 2010). "
    CO2 Laser - Optimisation and Application, 03/2012; , ISBN: 978-953-51-0351-6
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