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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 2: proposed applications and treatment protocols

Authors: Judith A. E. M. Zecha, Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, 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

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 and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed.

Methods

Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.

Results

PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780–830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2–3 J (J/cm²), and no more than 6 J/cm² on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations.

Conclusion

PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.

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Title: Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols
Authors: Judith A. E. M. Zecha
Judith E. Raber-Durlacher
Raj G. Nair
Joel B. Epstein
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/s00520-016-3153-y

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