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
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Author(s)
Elad, Sharon
Barasch, Andrei
Genot, Marie-Thérèse
Lansaat, Liset
van der Brink, Ron
Arnabat-Dominguez, Josep
van der Molen, Lisette
Jacobi, Irene
van Diessen, Judi
de Lange, Jan
Date Issued
March 2016
Journal
Supportive Care in Cancer
Publisher
Springer-Verlag
Citation
Zecha, Judith A. E. M., Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, Sharon Elad, Michael R. Hamblin, Andrei Barasch, et al. “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.” Supportive Care in Cancer, vol. 24, no. 6 (March 2016), pp. 2793–2805.
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Author's final manuscript
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.
MIT Department
Harvard University--MIT Division of Health Sciences and Technology
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DOI of Published Version
https://doi.org/10.1007/s00520-016-3153-y
