Low-level laser therapy: a standard of supportive care for cancer therapy-induced oral mucositis in head and neck cancer patients?

Abstract

Oral mucositis (OM) is still a common and severe acute side-effect of many oncologic treatments, especially in patients treated for head and neck cancer. It may affect quality of life, require supportive care and impact treatment planning and its efficacy. Low-level laser therapy (LLLT) seems to promote pain relief and reduces OM incidence and its severity. It has been recommended for these patients as a treatment option but without any consensus in the LLLT procedure. New recommendations and perspectives for clinical trials will be discussed. Materials (Subjects) and Methods: Step by step, the efficacy of soft laser in the management of iatrogenic oral mucositis has been evaluated during the last two decades. Its effectiveness and level of recommendation got stronger with time. We will report and discuss some major results and the latest recommendations published on this topic. The major clinical results have been reported and analysed last year in a first meta-analysis (1)). 11 randomized placebo-controlled trials were selected with a total of 415 patients treated with chemotherapy and/or radiotherapy for head and neck cancer. The relative risk for developing OM was significantly reduced after LLLT but only for a dose between 1 to 6 Joules per point. Pain, severity and duration of OM grade ≥ 2 were also reduced without difference with placebo for possible side-effects. Nine years after the positive results published for patients treated by radiotherapy alone (2)), a new French randomized, multicentric, phase III trial for patients treated with new standard treatment, using LLLT in accordance to recent recommendations is ongoing. Seven centers are specifically established for this trial which should include a hundred patients. The very encouraging results of LLLT in the prevention and treatment of OM in patients treated by chemotherapy or radiotherapy for advanced head and neck cancer could soon be proposed as a new standard of care, according to the multinational Association of Supportive care in Cancer (MASCC) criteria. Modern lasers are less time consuming and extraoral applicators for a possible use by trained paramedical staff could be helpful to complete clinician practice. A preventive dose of 2 J/cm(2) and a curative dose of 4 J/cm(2) if using a red wavelength lasers are now recommended.