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Published in: Supportive Care in Cancer 3/2016

01-03-2016 | Original Article

Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial

Authors: Betânia Ferreira, Fabiana Moura da Motta Silveira, Flávia Augusta de Orange

Published in: Supportive Care in Cancer | Issue 3/2016

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Abstract

Purpose

The purpose of this study is to evaluate the effectiveness of low-level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic stem cell transplantation.

Methods

This is a randomized, parallel, superiority trial including 35 patients divided into the following: laser (n = 17) and sham (n = 18). The variables assessed were oral mucositis (grade 2 of the World Health Organization oral toxicity scale), severe oral mucositis (grade 3 or 4), and pain (according to a visual analogue scale). In the laser group, a InGaAlP laser, wavelength of 650 nm, power 100 mW, energy per point of 2 J, time 20 s by point, extremity fiber optic 0.028 cm2, and energy density 70 J/cm2, was used, applied the first day of conditioning until D + 5, while the sham group received simulated laser over the same period.

Results

No statistically significant difference was found in the incidence of oral mucositis (p = 0.146). Severe mucositis was found in 40 % of the patients (14/35), 3 in the intervention group (17.65 %) and 11 in the sham group (61.11 %) (p = 0.015). The cumulative probability of survival with respect to the development of severe oral mucositis was >0.6 for the intervention group and 0 for the control group (p = 0.0397). On the day on which pain was considered the worst, patients in the sham group were more likely to classify their pain as severe compared to those in the laser group (p = 0.041).

Conclusion

Low-level laser therapy proved effective for the prevention of severe oral mucositis and intense oral pain in patients submitted to hematopoietic stem cell transplantation.
Literature
1.
go back to reference Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan R, Potting CJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB (2014) Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 23(1):223–236PubMedCentralCrossRefPubMed Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan R, Potting CJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB (2014) Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 23(1):223–236PubMedCentralCrossRefPubMed
2.
go back to reference Djavid GE, Emami A, Ataie-Fashtami L, Safaeinodehi SR, Merikh-Baiat F, Fateh M, Zand N (2011) Low level laser therapy in management of chemotherapy- induced oral mucositis: prophylaxis or treatment? J Lasers Med Sci 2(1):12–17 Djavid GE, Emami A, Ataie-Fashtami L, Safaeinodehi SR, Merikh-Baiat F, Fateh M, Zand N (2011) Low level laser therapy in management of chemotherapy- induced oral mucositis: prophylaxis or treatment? J Lasers Med Sci 2(1):12–17
3.
go back to reference Freitas ACC, Campos L, Brandão TB, Cristófaro M, Eduardo FP, Luiz AC, Marques MM, de Paula Eduardo C, Simões A (2014) Chemotherapy-induced oral mucositis: effect of led and laser phototherapy treatment protocols. Photomed Laser Surg 32(2):81–87CrossRefPubMed Freitas ACC, Campos L, Brandão TB, Cristófaro M, Eduardo FP, Luiz AC, Marques MM, de Paula Eduardo C, Simões A (2014) Chemotherapy-induced oral mucositis: effect of led and laser phototherapy treatment protocols. Photomed Laser Surg 32(2):81–87CrossRefPubMed
4.
go back to reference Silva GBL, Sacono NT, Othon-Leite AF, Mendonça EF, Arantes AM, Bariani C, Duarte LGL, Abreu MHN, Queiroz-Júnior CM, Silva TA, Batista AC (2014) Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci 30(1):117–126CrossRefPubMed Silva GBL, Sacono NT, Othon-Leite AF, Mendonça EF, Arantes AM, Bariani C, Duarte LGL, Abreu MHN, Queiroz-Júnior CM, Silva TA, Batista AC (2014) Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci 30(1):117–126CrossRefPubMed
5.
go back to reference Antunes HS, Ferreira EMS, Matos VD, Pinheiro CT, Ferreira CG (2008) The impact of low power laser in the treatment of conditioning-induced oral mucositis: a report of 11 clinical cases and their review. Med Oral Patol Oral Cir Bucal 13(3):187–192 Antunes HS, Ferreira EMS, Matos VD, Pinheiro CT, Ferreira CG (2008) The impact of low power laser in the treatment of conditioning-induced oral mucositis: a report of 11 clinical cases and their review. Med Oral Patol Oral Cir Bucal 13(3):187–192
6.
go back to reference Alvariño-Martín C, Sarrión-Pérez MG (2014) Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent 6(1):74–80CrossRef Alvariño-Martín C, Sarrión-Pérez MG (2014) Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent 6(1):74–80CrossRef
7.
go back to reference Cauwels R, Martens L (2011) Low level laser therapy in oral mucositis: a pilot study. Eur Arch Paediatr Dent 12(2):118–123CrossRefPubMed Cauwels R, Martens L (2011) Low level laser therapy in oral mucositis: a pilot study. Eur Arch Paediatr Dent 12(2):118–123CrossRefPubMed
8.
go back to reference Legert KG, Remberger M, Ringdén O, Heimdahl A, Dahllöf G (2014) Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Support Care Cancer 22(8):2133–2140CrossRefPubMed Legert KG, Remberger M, Ringdén O, Heimdahl A, Dahllöf G (2014) Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Support Care Cancer 22(8):2133–2140CrossRefPubMed
9.
go back to reference Antunes HS, Azevedo AM, Bouzas LFS, Adão CAE, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, Matos VD, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG (2007) Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial. Blood Journal 109(5):2250–2255CrossRef Antunes HS, Azevedo AM, Bouzas LFS, Adão CAE, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, Matos VD, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG (2007) Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial. Blood Journal 109(5):2250–2255CrossRef
10.
go back to reference Eduardo FP, Bezinelli LM, Orsi MCE, Rodrigues M, Ribeiro MS, Hamerschlak N, Correa L (2011) The influence of dental care associated with laser therapy on oral mucositis during allogeneic hematopoietic cell transplant: retrospective study. Einstein 9(2):201–206CrossRef Eduardo FP, Bezinelli LM, Orsi MCE, Rodrigues M, Ribeiro MS, Hamerschlak N, Correa L (2011) The influence of dental care associated with laser therapy on oral mucositis during allogeneic hematopoietic cell transplant: retrospective study. Einstein 9(2):201–206CrossRef
11.
go back to reference Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Vadhiraja BM (2012) Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients: a triple blinded randomized controlled trial. Radiother Oncol 104(3):349–354CrossRefPubMed Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Vadhiraja BM (2012) Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients: a triple blinded randomized controlled trial. Radiother Oncol 104(3):349–354CrossRefPubMed
12.
go back to reference Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya GA (2012) Low level helium neon laser therapy for chemoradiotherapy induced oral mucositis in oral cancer patients: a randomized controlled trial. Oral Oncol 48(9):893–897CrossRefPubMed Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya GA (2012) Low level helium neon laser therapy for chemoradiotherapy induced oral mucositis in oral cancer patients: a randomized controlled trial. Oral Oncol 48(9):893–897CrossRefPubMed
13.
go back to reference Silva GBL, Mendonça EF, Bariani C, Antunes HS, Silva MAG (2011) The prevention of induced oral mucositis with low-level laser therapy in bone marrow transplantation patients: a randomized clinical trial. Photomed Laser Surg 29(1):27–31CrossRefPubMed Silva GBL, Mendonça EF, Bariani C, Antunes HS, Silva MAG (2011) The prevention of induced oral mucositis with low-level laser therapy in bone marrow transplantation patients: a randomized clinical trial. Photomed Laser Surg 29(1):27–31CrossRefPubMed
14.
go back to reference Schubert MM, Eduardo FP, Guthrie KA, Franquin JC, Bensadoun RJJ, Migliorati CA, Lloid CME, Eduardo CP, Walter NF, Marques MM, Hamdi M (2007) A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Support Care Cancer 15(10):1145–1154CrossRefPubMed Schubert MM, Eduardo FP, Guthrie KA, Franquin JC, Bensadoun RJJ, Migliorati CA, Lloid CME, Eduardo CP, Walter NF, Marques MM, Hamdi M (2007) A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Support Care Cancer 15(10):1145–1154CrossRefPubMed
15.
go back to reference Cowen D, Tardieu C, Schubert M, Peterson D, Resbeut M, Faucher C, Franquin JC (1997) Low energy helium-neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiation Oncology Biol Phys 38(4):697–703CrossRef Cowen D, Tardieu C, Schubert M, Peterson D, Resbeut M, Faucher C, Franquin JC (1997) Low energy helium-neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiation Oncology Biol Phys 38(4):697–703CrossRef
16.
go back to reference Jaguar G, Prado J, Nishimoto I, Pinheiro M, Castro D Jr, Perez DC, Alves F (2007) Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation. Oral Dis 13(6):538–543CrossRefPubMed Jaguar G, Prado J, Nishimoto I, Pinheiro M, Castro D Jr, Perez DC, Alves F (2007) Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation. Oral Dis 13(6):538–543CrossRefPubMed
17.
go back to reference Whelan HT, Connely JF, Hodgson BD, Barbeau L, Post AC, Bullard G, Buchmann EV, Kane M, Whelan NT, Warwick A, Margolis D (2002) NASA light-emitting diodes for the prevention of oral mucositis in pediatric bone marrow transplant patients. J Clin Laser Med Surg 20(6):319–324CrossRefPubMed Whelan HT, Connely JF, Hodgson BD, Barbeau L, Post AC, Bullard G, Buchmann EV, Kane M, Whelan NT, Warwick A, Margolis D (2002) NASA light-emitting diodes for the prevention of oral mucositis in pediatric bone marrow transplant patients. J Clin Laser Med Surg 20(6):319–324CrossRefPubMed
18.
go back to reference Barasch A, Peterson DE, Tamer JM, Brosio JAD, Nuki K, Schubert M, Franquin JC, Clive J, Tutschka P (1995) Helium-neon laser effects on conditioning-induced oral mucositis in bone marrow transplantation patients. Cancer 76(12):2550–2556CrossRefPubMed Barasch A, Peterson DE, Tamer JM, Brosio JAD, Nuki K, Schubert M, Franquin JC, Clive J, Tutschka P (1995) Helium-neon laser effects on conditioning-induced oral mucositis in bone marrow transplantation patients. Cancer 76(12):2550–2556CrossRefPubMed
19.
go back to reference Carvalho PAG, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA (2011) Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol 47(12):1176–1181CrossRefPubMed Carvalho PAG, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA (2011) Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol 47(12):1176–1181CrossRefPubMed
20.
go back to reference WHO (1979) WHO handbook for reporting results of cancer treatment. World Health Organization, Geneva WHO (1979) WHO handbook for reporting results of cancer treatment. World Health Organization, Geneva
21.
go back to reference Antunes HS, Herchenhorn D, Small IA, Araujo CM, Viegas CMP, Cabral E, Rampini MP, Rodrigues PC, Silva TG, Ferreira EM, Dias FL, Ferreira CG (2011) Phase iii trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation. Radiother Oncol 109(2):297–302CrossRef Antunes HS, Herchenhorn D, Small IA, Araujo CM, Viegas CMP, Cabral E, Rampini MP, Rodrigues PC, Silva TG, Ferreira EM, Dias FL, Ferreira CG (2011) Phase iii trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation. Radiother Oncol 109(2):297–302CrossRef
22.
go back to reference WHO (2006) Appraising the WHO analgesic ladder on its 20th anniversary. Cancer Pain Release 19(1):1–8 WHO (2006) Appraising the WHO analgesic ladder on its 20th anniversary. Cancer Pain Release 19(1):1–8
23.
go back to reference Oberoi S, Netto GZ, Beyene J, Treister NS, Sung L (2014) Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis. PLoS ONE 9(9):1–10CrossRef Oberoi S, Netto GZ, Beyene J, Treister NS, Sung L (2014) Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis. PLoS ONE 9(9):1–10CrossRef
24.
go back to reference Min CK, Lee W, Min DJ, Lee DG, Kim YJ, Park Y, Kim H, Lee S, Kim D, Lee J, Min W, Kim C (2001) The kinetics of circulating cytokines including IL-6, TNF-α, IL-8 and IL-10 following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 28(10):935–940CrossRefPubMed Min CK, Lee W, Min DJ, Lee DG, Kim YJ, Park Y, Kim H, Lee S, Kim D, Lee J, Min W, Kim C (2001) The kinetics of circulating cytokines including IL-6, TNF-α, IL-8 and IL-10 following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 28(10):935–940CrossRefPubMed
25.
go back to reference Efron PA, Moldawer LL (2004) Cytokines and wound healing: the role of cytokine and anticytokine therapy in the repair response. J Burn Care Res 25(2):149–160CrossRef Efron PA, Moldawer LL (2004) Cytokines and wound healing: the role of cytokine and anticytokine therapy in the repair response. J Burn Care Res 25(2):149–160CrossRef
26.
go back to reference Piva JADAC, Abreu EMDC, Silva VDS, Nicolau RA (2011) Effect of low-level laser therapy on the initial stages of tissue repair: basic principles. An Bras Dermatol 86(5):947–954CrossRefPubMed Piva JADAC, Abreu EMDC, Silva VDS, Nicolau RA (2011) Effect of low-level laser therapy on the initial stages of tissue repair: basic principles. An Bras Dermatol 86(5):947–954CrossRefPubMed
27.
go back to reference Hodgson B, Margolis D, Salzman D, Eastwood D, Tarima S, Williams L, Sande J, Vaughan W, Whelan H (2012) Amelioration of oral mucositis pain by NASA near-infrared light-emitting diodes in bone marrow transplant patients. Support Care Cancer 20(7):1405–1415CrossRefPubMed Hodgson B, Margolis D, Salzman D, Eastwood D, Tarima S, Williams L, Sande J, Vaughan W, Whelan H (2012) Amelioration of oral mucositis pain by NASA near-infrared light-emitting diodes in bone marrow transplant patients. Support Care Cancer 20(7):1405–1415CrossRefPubMed
28.
go back to reference Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RAB (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Ther 24(2):158–168CrossRef Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RAB (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Ther 24(2):158–168CrossRef
29.
go back to reference Stolik S, Delgado J, Perez JA, Anasagasti L (2000) Measurement of the penetration depths of red and near infrared light in human ‘ex vivo’ tissues. J Photochem Photobiol B Biol 57(2):90–93CrossRef Stolik S, Delgado J, Perez JA, Anasagasti L (2000) Measurement of the penetration depths of red and near infrared light in human ‘ex vivo’ tissues. J Photochem Photobiol B Biol 57(2):90–93CrossRef
30.
go back to reference Enwemeka CS (2001) Attenuation and penetration of visible 632.8 nm and invisible infra-red 904nm light in soft tissues. Laser 13(1):95–101 Enwemeka CS (2001) Attenuation and penetration of visible 632.8 nm and invisible infra-red 904nm light in soft tissues. Laser 13(1):95–101
31.
go back to reference Bezinelli LM, Eduardo FP, Lopes RMG, Biazevic MGH, Eduardo CP, Correa L, Hamerschlak N, Michel-Crosato E (2014) Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation. Hematol Oncol 32(1):31–39CrossRefPubMed Bezinelli LM, Eduardo FP, Lopes RMG, Biazevic MGH, Eduardo CP, Correa L, Hamerschlak N, Michel-Crosato E (2014) Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation. Hematol Oncol 32(1):31–39CrossRefPubMed
32.
go back to reference Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, Kanehira T, Yamamoto S, Kondo T, Endo T, Tanaka J, Hashino S, Nishio M, Imamura M, Kitagawa Y, Inoue N (2012) Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer 20(2):367–373CrossRefPubMed Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, Kanehira T, Yamamoto S, Kondo T, Endo T, Tanaka J, Hashino S, Nishio M, Imamura M, Kitagawa Y, Inoue N (2012) Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer 20(2):367–373CrossRefPubMed
Metadata
Title
Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial
Authors
Betânia Ferreira
Fabiana Moura da Motta Silveira
Flávia Augusta de Orange
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 3/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2881-8

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