Effect of low-level laser therapy (LLLT) on grade of oral mucositis
| RCT | Effect of LLLT on grade of oral mucositis |
| Abramoff et al 14 | For those undergoing prophylactic LLLT, at the third evaluation (between days 6 and 9 after commencing chemotherapy), 73% of the patients in the prophylactic laser group had grade 0 mucositis, compared with 27% in the placebo group (p=0.03). |
| Ahmed et al 15 | Includes some adults. No statistically significant difference on daily evaluation of grade; however, authors report a risk ratio of 2.8 for the occurrence of grade 3 and grade 4 oral mucositis in the sham group compared with the laser group. OR of 0.22 (95% CI of 0.02 to 2.08) of grade 3 or more oral mucositis in the laser group on day 15. |
| Amadori et al 16 | No statistically significant change. Day 4, oral mucositis median grade=2 for both laser and sham groups. Day 7, oral mucositis median grade laser=0, sham=1 (p=0.07). OR of grade 3 or more oral mucositis in laser group is 1.33 (95% CI 0.51 to 3.50) on day 4 and 0.18 (95% CI 0.01 to 3.88) on day 7. |
| Amadori and Bardellini17 | Abstract reports both prophylactic and therapeutic phases to result in a statistically significant reduction of OM in the laser group. Prophylactic phase reported as significant difference at day 4 (p=0.02) and therapeutic phase significant by the end of laser/sham treatment. |
| Cowen et al 18 | Only 2 patients aged 17 out of group of 30 patients. Distribution of daily mucositis index statistically significantly lower in laser group compared with sham group on days 2–7 (inclusive) after bone marrow transplantation. |
| Cruz et al 19 | Oral mucositis severity and prevalence were similar in the laser group and control group (p=0.208). OR of grade 3 or above oral mucositis was lower in the laser group (OR=0.34, 95% CI 0.01 to 8.80) on day 8 and lower in the laser group (OR=0.69, 95% CI of 0.11 to 4.47) on day 15, but not statistically significant. |
| Fani et al 20 | Unable to ascertain how many patients were children and met full inclusion criteria. Based on the WHO scale, there is no significant difference between the groups (p>0.05). However, based on the NCI scale, there is a significant reduction in oral mucositis between the groups (p<0.05). |
| Gobbo et al 21 | On day 7, of those undergoing LLLT, one patient developed grade 4 oral mucositis, and 2 patients developed grade 3. Of those undergoing sham treatment, 8 patients developed grade 4 and 6 patients developed grade 3 oral mucositis (p<0.02). OR of grade 3 or above oral mucositis was lower in the laser group (OR=0.50, 95% CI 0.23 to 1.11) on day 4 but not statistically significant. It was also lower in the laser group (OR=0.17, 95% CI of 0.04 to 0.63) on day 7 and lower in the laser group (OR=0.08, 95% CI of 0.01 to 0.68) on day 11, and this was statistically significant. |
| Hodgson et al 22 | As displayed in the meta-analysis, OR of developing OM of grade 3 or above in laser group was lower at day 3–5 (OR=0.23, 95% CI 0.01 to 6.25) but then higher at days 8–10 (OR=1.25, 95% CI 0.23 to 6.71) and days15–17 (OR=3.29, 95% CI 0.12 to 89.81). None of these were statistically significant. |
| Khouri et al 23 | Unable to ascertain how many patients were children and met full inclusion criteria. Mean grade of oral mucositis in the laser group was 1.75±0.45, compared with 2.45±0.93 in the control group (p<0.01). The laser group had a lower frequency of oral mucositis (p=0.02). |
| Kuhn et al 24 | Statistically significant reduction of oral mucositis in laser group (32% patients grade >0) compared with the placebo group (94% patients grade>0) on day 7 after oral mucositis diagnosis (p=0.001) |
| Salvador et al 25 | Unable to ascertain how many patients were children and met full inclusion criteria. Significant reduction in severity of oral mucositis from day +7 to day +11 (p<0.05). |
| Silva et al 26 | Unable to ascertain how many patients were children and met full inclusion criteria. Statistically significant reduction in grade of oral mucositis between laser and control group (p<0.001). |
| Silva et al 27 | Unable to ascertain how many patients were children and met full inclusion criteria. Less severe oral mucositis in the laser group on day 4, 7 and 8 (p<0.05). No significant difference on all other days of assessment (up to day 21). |
NCI, National Cancer Institute; RCT, randomised controlled trial.