The Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology now recommend photobiomodulation or low-dose light therapy to prevent oral mucositis caused by radiation therapy for head and neck cancer or stem cell transplantation.
“Many cancer patients can now benefit from this treatment,” said Praveen Arany, DDS, PhD, co-corresponding author of the guidelines, assistant professor or oral biology at the University of Buffalo School of Dental Medicine, and president of the World Association for Photobiomodulation Therapy.
“The staggering breadth of clinical application for photobiomodulation therapy has been both a boon and a bane for the field. Several anecdotal clinical reports have been plagued with inconsistent outcomes and questionable rationales, often relegating this treatment to a pseudoscience,” said Arany, who added that recent advances are enabling rigorous validation of clinical protocols.
“This is a major milestone for the field, and we are confident it will set a clear path for several exciting clinical applications for photobiomodulation therapy, from concussions and wound healing to exciting new work with regenerative medicine and stem cells,” said Arany.
Multiple studies have found that patients report oral mucositis as the worst side effect of their cancer treatment, the researchers report. Pain from the condition can slow or delay cancer treatment and, in severe cases, require hospitalization.
Though light therapies have existed for decades, technology advances have made them more affordable for wider use. At high power, light, often in the form of a laser, can cut or destroy tissue. But at low power, it can relieve pain or inflammation and promote healing.
The new guidelines upgrade previous guidelines published in 2013 that noted the effectiveness of light therapy and recommended, based on relatively limited evidence at the time, the intervention as an optional therapy in specific cancer patient populations and settings.
Sixteen global experts collaborated on the new guidelines, triaging hundreds or research papers published on photobiomodulation therapy for oral mucositis and reviewing dozens of papers in detail.
“These updated guidelines will provide healthcare professionals with better tools to deliver care for cancer patients,” said Yehuda Zadik, DMD, senior lecturer at the Hebrew University-Hadassah School of Dental Medicine and professor at the Eastman Institute for Oral Health at the University of Rochester Medical Center, who led the review.
“But even with the best evidence-based interventions, we don’t yet have an ultimate guideline for mucositis in all clinical settings. We look forward to future research to help shape a more university implementation of photobiomodulation therapy as well as identify additional effective and validated protocols,” Zadik said.
Among other findings, the researchers identified five new protocols recommending light therapy for the prevention of oral mucositis in stem cell transplant patients and in head and neck cancer patients receiving radiation therapy with or without chemotherapy.
No major short-term side effects of light therapy were reported. Also, the therapy could potentially serve as an alternative to opioids, which often are prescribed to alleviate the symptoms of oral mucositis, said Arany.
The researchers further note that future studies are needed to verify its effectiveness in managing oral mucositis in pediatric cancer patients and in adult cancer patients receiving only chemotherapy.
The guidelines, “Systematic Review of Photobiomodulation for the Management of Oral Mucositis in Cancer Patients and Clinical Practice Guidelines,” was published by Supportive Care in Cancer.
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