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Low-level laser therapy for oral mucositis in children with cancer
  1. Melody Grace Redman1,2,
  2. Katherine Harris3,
  3. Bob S Phillips4
  1. 1Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
  2. 2Yorkshire Regional Genetics Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Department of Medical Education, University of Liverpool, Liverpool, UK
  4. 4Centre for Reviews and Dissemination, University of York, York, UK
  1. Correspondence to Dr Melody Grace Redman, Yorkshire Regional Genetics Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK; meloredman{at}gmail.com

Abstract

Objective To assess the efficacy of oral low-level laser therapy (LLLT) – also known as photobiomodulation – in the reduction of oral mucositis experienced by children and young people with cancer undergoing chemotherapy.

Design A systematic review to evaluate the efficacy of oral LLLT for oral mucositis in children with cancer and the safety of oral LLLT in any age with cancer (International Prospective Register of Systematic Reviews/PROSPERO registration: CRD42018099772). Multiple databases and grey literature were screened. Randomised controlled trials were considered for assessing efficacy, and all studies were considered for assessing safety. Primary outcomes included severity of oral mucositis, oral pain and adverse events. Where results were compatible, meta-analysis was performed using a random-effects model. A narrative synthesis considered other outcome measures.

Results 14 studies (n>416 children) were included in the narrative synthesis of LLLT efficacy. 5 studies (n=380 children and young people) were included in the meta-analyses. Results demonstrate that LLLT may reduce the severity of oral mucositis and the level of oral pain, but further randomised controlled trials are needed to confirm or deny this. There is vast variation in different trial protocols. Insufficient blinding between LLLT or sham therapy/control led to a strong risk of performance bias. 75 studies (encompassing 2712 patients of all ages who had undergone LLLT) demonstrated minor and infrequent adverse reactions, but most studies had significant areas of weakness in quality.

Conclusion LLLT appears to be a safe therapy, but further evidence is needed to assess its efficacy as a prevention or treatment tool for oral mucositis in children with cancer.

  • pain
  • technology

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @MelodyRedman, @drbobphillips

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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