Article

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: 2.36). 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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    • "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.
    Full-text · Article · Feb 2014 · Mediators of Inflammation
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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.
    Full-text · Article · Feb 2014 · International Journal of Clinical Dentistry
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    • "The frequency of mucositis and its severity are fundamentally dependent upon the type, duration and dose of chemotherapy used (5). In this sense, bone marrow-suppressing (myeloablative) chemotherapy is associated with a mucositis risk of 60-100% (4,6,7), while the combination of chemotherapy and radiotherapy implies a risk of almost 100% (3). "
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    ABSTRACT: Oral mucositis is one of the most common side effects of cancer treatment (chemotherapy and/or radiotherapy). It is an inflammatory process that affects the mucosa of the oral cavity, giving rise to erythematous areas in combination with ulcers that can reach a large size. The true importance of oral mucositis is the complications it causes – fundamentally intense pain associated to the oral ulcers, and the risk of overinfection. This in turn may require reduction or even suspension of the antineoplastic treatment, with the risk of seriously worsening the patient prognosis. This points to the importance of establishing therapeutic tools of use in the prevention and/or treatment of mucositis. The present study offers a literature review of all the articles published over the last 10 years referred to the prevention and/or treatment of oral mucositis associated to chemotherapy. Key words:Oral mucositis, management, prevention, treatment, chemotherapy.
    Full-text · Article · Feb 2014 · Journal of Clinical and Experimental Dentistry
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Questions & Answers about this publication

  • Ratan Khuman added an answer in Muscle Metabolism:
    Does the laser used in physical therapy entails changes in skeletal muscle in patients with cancer?

    We are putting together a research project that aims to trace the muscle metabolic profile of the laser effects in mice with cancer. Can anyone suggests some article?

    Ratan Khuman

    Dear Vitor, Very important question as clinician point of view. Below is the link which may be helpful to you...

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      [Show abstract] [Hide abstract]
      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.
      Full-text · Article · Jun 2011 · Supportive Care in Cancer