Low energy Helium-Neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: Results of a double blind randomized trial

This review evaluated the best available evidence concerning the effectiveness of photobiomodulation compared to oral cryotherapy in oral-mucositis prevention among patients with hematological stem cell transplantation (HSCT) receiving chemo-conditioning.

An extensive search for published and unpublished studies was conducted in 11 electronic databases and reference lists. Only randomized controlled trials (RCTs) were included. Two reviewers independently screened relevant studies for eligibility, extracted data using a standardized data collection form, and appraised data using the Cochrane Risk of Bias Tool and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analyses using a random-effect model was performed using Review Manager software. Subgroup analyses were conducted to examine the differential effect of interventions across subgroups and to explore potential sources of heterogeneity. Meta-analyses included 18 RCTs (involving 1,018 patients). Both photobiomodulation and cryotherapy were effective in reducing oral-mucositis severity, severe oral-mucositis incidence, duration, and pain with small to large effect sizes. No significant differences were detected between photobiomodulation and cryotherapy across all outcomes. Subgroup analyses showed significant differences for chemo-conditioning regimens. The overall Grading Recommendations, Assessment, Development and Evaluation quality of evidence was low.

Both photobiomodulation and cryotherapy were effective nonpharmacological oral-mucositis prophylaxis and analgesia, with no significant difference in effectiveness. Chemo-conditioning regimens may influence their effectiveness. Future RCTs may directly compare the effectiveness of photobiomodulation and cryotherapy on the HSCT patients. Rigorous cost-effectiveness studies are also required.

Photobiomodulation and cryotherapy can be offered to HSCT patients in clinical settings. A clinical guideline of both interventions can be also developed.

Our objective was to review the first 20 years of photobiomodulation (PBM) clinical studies for oral mucositis (OM) mitigation.

A scoping review screened controlled clinical studies. The PBM devices, protocols, and clinical outcomes were analyzed.

Seventy-five studies met the inclusion criteria. The first study dated from 1992, and the term “PBM” was first published in 2017. Public services, placebo-controlled randomized trials, and patients with head and neck chemoradiation were predominant among included studies. Prophylactic red intraoral laser protocols were mostly used. Comparing the outcomes of all protocols was unfeasible due to missing treatment parameters and nonhomogeneous measurements.

The main barrier to optimizing clinical protocols of PBM for OM was the lack of standardization in clinical studies. Although PBM use is now globally present in oncology settings and generally marked by good outcomes reported, additional randomized clinical trials with well-described methods are necessary.

Évaluer les indications actuelles et potentielles de la photobiomodulation (PBM) et leur niveau de preuve dans la prévention ou le traitement des effets secondaires liés à la radiothérapie.

Les bases de données Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, et LILACS ont systématiquement été passées en revue afin d’inclure et d’analyser les publications d’études cliniques ayant évaluées la photobiomodulation dans la prévention ou la prise en charge des effets secondaires liées à la radiothérapie. Les mots-clés utilisés étaient « photobiomodulation » ; « low level laser therapy » ; « acute oral mucositis » ; « acute dysphagia » ; « acute radiation dermatitis » ; « lymphedema » ; « xerostomia » ; « hyposalivation » ; « trismus » ; « bone necrosis » ; « osteoradionecrosis » ; « radiation induced fibrosis ». Les études prospectives ont été incluses, alors que les cohortes rétrospectives et les articles non originaux ont été exclus de l’analyse.

La photobiomodulation dans le spectre du rouge ou de l’infrarouge a démontré son efficacité dans des essais contrôlés randomisés dans la prévention et la prise en charge de certaines complications liées à la radiothérapie, en particulier de la mucite aiguë, de l’épithéliite et du lymphœdème du membre supérieur. Le niveau de preuve associé à la photobiomodulation était hétérogène, mais restait globalement modéré. Les principales limites étaient la diversité et la manque de précision des protocoles de traitement qui a pu compromettre l’efficience et la reproductibilité des résultats de la photobiomodulation.

Les données publiées suggèrent que la photobiomodulation pourrait donc être envisagée comme un soin de support à part entière pour les patients traités par irradiation, au moins dans le cadre d’essai clinique thérapeutique. Toutefois, tant que des données solides n’auront pas été publiées sur son innocuité à long terme, l’utilisation de la photobiomodulation doit être envisagée avec prudence, particulièrement lorsqu’elle est pratiquée proche des zones avec des tumeurs connues ou possibles. Le patient doit être informé des avantages et des risques théoriques de la photobiomodulation afin d’obtenir son consentement éclairé avant le traitement.

To evaluate the current and potential indications of photobiomodulation (PBM) and their level of evidence in the prevention or management of radiation therapy-related side effects.

The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that have assessed PBM in the prevention or management of radiotherapy-related side effects. The keywords used were “photobiomodulation”; “low level laser therapy”; “acute oral mucositis”; “acute dysphagia”; “acute radiation dermatitis”; “lymphedema”; “xerostomia”; “hyposalivation”; “trismus”; “bone necrosis”; “osteoradionecrosis”; and “radiation induced fibrosis”. Prospective studies were included, whereas retrospective cohorts and non-original articles were excluded from the analysis.

PBM in the red or infrared spectrum has demonstrated efficacy in randomized controlled trials in the prevention and management of radiotherapy-related side effects, especially acute oral mucositis, acute radiation dermatitis, and upper extremity lymphedema. The level of evidence associated with PBM was heterogeneous, but overall was still moderate. The main shortcomings were the diversity and lack of detail in treatment protocols, which could have compromised efficiency and reproducibility of PBM results.

The published data suggest that PBM may be considered as a full-fledged supportive care for patients treated with radiotherapy, or at least in the setting of a therapeutic clinical trial. However, until strong evidence has been published on its long-term safety, the use of PBM should be considered with caution, specifically when applied near areas with proven or potential tumors. The patient should be informed of the theoretical benefits and risks of PBM in order to obtain his informed consent before treatment.

Among noble gases, Helium and Neon have smaller size, high ionization potential and low polarizability due to which these two gases exhibit weak binding affinities toward any surface. Bartlet’s discovery and subsequent similar successful discoveries of stable complexes of noble gases opened new avenues for the storage of noble gases particularly on the new surfaces and their interactions for the storage of these gases. Here, we report the adsorption of light noble gases on polycationic clusters. Our current work not only investigates the interaction behavior of He and Ne with (Sb7Te8)⁵⁺ cluster but also explores the saturation limit of the cluster for He and Ne. Stability of various complexes of He and Ne with cationic surfaces is determined by the calculation of their interaction energies which reveal that the adsorption of single and multiple atoms of noble gases at faces of double cubic cluster is comparatively more favorable than at the bond lengths. Electronic properties such as HOMO-LUMO gaps show that complexes of He and Ne are more stable electronically than that of pure cluster, because HOMO-LUMO gap of complexes are higher than the bare polycationic cluster. NCI analysis of iso-surfaces and RDG maps confirms the presence of van der Waals forces between light noble gases and polycationic clusters. Saturation studies reveal that cluster can adsorb eleven He and/or ten Ne atoms with no or minimum distortion in the geometry of cluster. The results showed that Ne has greater tendency to interact with polycationic clusters due to the large electronic cloud and polarizability value than He.

The aim of this study was to evaluate the adherence of patients with head and neck cancer who underwent radiotherapy or radio-chemotherapy combined to the preventive laser photobiomodulation protocol in a public health service.

This was a cross-sectional study, whose population sample included patients with malignant head and neck neoplasms. Thirty head and neck cancer patients undergoing cancer treatment, were examined and interviewed through a record of signs and symptoms of oral mucositis (OM) and adherence to the preventive laser photobiomodulation protocol, that began in the first session of radiotherapy, and included the laser application three times a week during the 3-week period. The collected data were documented, and the descriptive and inferential statistics were performed with a significance level of p < 0.05.

It was observed that 66.6% of patients developed OM. There was a predominance of degrees I and II, with 36.8% and 31.6%, respectively. A total of fifteen patients (50%) missed one or more laser photobiomodulation sessions. A positive association was found between patients who missed at least two laser photobiomodulation sessions with the development of OM degrees III (p < 0.05).

There was moderate adherence of patients with head and neck cancer to the laser photobiomodulation protocol and the development of more severe degrees of OM was related to individuals that didn’t attend scheduled sessions.

The aim of this study was to determine whether prophylactic and therapeutic low-level laser therapy (LLLT), compared with placebo or no therapy, reduced the risk of severe oral mucositis (OM) in patients receiving chemotherapy or radiotherapy.

We searched for articles published on randomized controlled trials (RCTs) in the databases MEDLINE, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials, Web of Science, and Clinical Trials, until December 2018. RCTs were filtered on the basis of eligibility criteria, and data were analyzed by using R software 3.5.2.

Overall, 30 studies were included in the meta-analysis. Prophylactic LLLT reduced the overall risk of severe OM (relative risk [RR] = 0.40; 95% confidence interval [CI]: 0.28–0.57; P < .01). Therapeutic LLLT substantially reduced the duration of severe OM (P < .01). LLLT also reduced the overall mean grade of OM, overall incidence of severe pain, mean score of pain, and incidence of severe OM, at the most anticipated time.

Prophylactic and therapeutic LLLT can reduce the risk of severe OM in patients receiving chemotherapy or radiotherapy.