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Supportive Care in Cancer
Published in: Supportive Care in Cancer 6/2016

01-06-2016 | Review Article

Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety considerations

Authors: Judith A. E. M. Zecha, Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, Stephen T. Sonis, Sharon Elad, Michael R. Hamblin, Andrei Barasch, Cesar A. Migliorati, Dan M. J. Milstein, Marie-Thérèse Genot, Liset Lansaat, Ron van der Brink, Josep Arnabat-Dominguez, Lisette van der Molen, Irene Jacobi, Judi van Diessen, Jan de Lange, Ludi E. Smeele, Mark M. Schubert, René-Jean Bensadoun

Published in: Supportive Care in Cancer | Issue 6/2016

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Abstract

Purpose

There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters.

Methods

This study is a narrative non-systematic review.

Results

We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority.

Conclusion

Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.
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Metadata
Title
Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety considerations
Authors
Judith A. E. M. Zecha
Judith E. Raber-Durlacher
Raj G. Nair
Joel B. Epstein
Stephen T. Sonis
Sharon Elad
Michael R. Hamblin
Andrei Barasch
Cesar A. Migliorati
Dan M. J. Milstein
Marie-Thérèse Genot
Liset Lansaat
Ron van der Brink
Josep Arnabat-Dominguez
Lisette van der Molen
Irene Jacobi
Judi van Diessen
Jan de Lange
Ludi E. Smeele
Mark M. Schubert
René-Jean Bensadoun
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-016-3152-z

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