Mini Review JOJ Nurse Health Care Volume 9 Issue 5 - November 2018 Copyright © All rights are reserved by Clélea de Oliveira Calvet DOI: 10.19080/JOJNHC.2018.09.555774 Efficacy of Low Level Laser Therapy in Oral Mucositis
Graça Maria Lopes Mattos¹, Cayara Mattos Costa²and Clélea de Oliveira Calvet3* 1CEUMA University, Brazil ²Federal University of Maranhão, Brazil 3Integrated Clinic Hospital, Brazil Submission: November 02, 2018; Published: November 30, 2018 *Corresponding author: Clélea de Oliveira Calvet , Integrated Clinic Hospital, Maranhão, Brazil
Abstract Patients submitted to radiotherapy or chemotherapy induced antineoplastic therapy have as their sequel oral mucositis, which is the main
complication arising from the treatment. Laser therapy is a modality that has grown in recent years, with evidences of significant improvements thein the lesion. prevention A literature and treatment review was of oralconducted mucositis. with This seven study publications aims to show in Portuguese the benefits and of low-level English in laser PubMed therapy and application SciELO databases, in patients from submitted 2008 to to antineoplastic therapy and present oral mucositis by means of an integrative literature review on the use of low-level laser to prevent and treat
effects.2018 and a summary table was prepared. It was observed that low-level laser therapy is an effective tool in the prevention and treatment of oral mucositis in cancer patients, bringing benefits such as: reduction of pain and severity of the lesion and anti-inflammatory, analgesic and healing Keywords: Laser Therapy; Oral Mucositides; Cancer patients
Abbreviations:
OM: Oral Mucositis; LLLT : Low level Laser Therapy Introduction Through radiotherapy or chemotherapy, the antineoplastic etoposide, mitoxantrane and cytarabine are the most common treatment can cause cellular damage to the oral epithelium and And 5-fluorouracil, methotrexate, melafalan, cyclophosphamide, salivary glands, as well as changing its functions and causing methotrexate and cyclophosphamide are the most related to the lesions, such as oral mucositis [1]. chemotherapy drugs [6,7]. Amoung these drugs, 5-fluorouracil, appearance of OM [3,6] in patients undergoing antineoplastic treatment. oral mucosa, which becomes swollen and erythematous and may Oral Mucositis (OM) is an inflammation and ulceration of the The main clinical diagnosis of the severity of the OM is lead to the formation of large ulcers covered by pseudomembrane. indicated by World Health Organization in scales varying from This lesion is extremely painful and causes discomfort, dysphagia and systemic weakness, as well as being the most common cause grade 0 to grade 4, respectively: normal mucosa; erythematous presence of extensive ulcer and feeding of liquid consistency mucosa; ulcer involvement and difficulty in solid feeding; of pain in the mouth in cancer patients [2-4]. [8]. In 2014, the Multinational Association of Support Care in from OM can increase the risk of local and systemic infection and Cancer/International Society of Oral Oncology (MASCC/ISOO) has Due to difficult feeding and speech, the ulcerations resulting can compromise oral function and interfere with antineoplastic treatment. It also may increase hospitalization stays time and form of OM prevention in patients who has received hematopoietic recommended low-level laser therapy because of its benefits as a stem cells [9]. around 7 to 10 days after chemotherapy and generally from the influence the nutritional status of the patients. Lesions appear second week of radiotherapy[3,5,6]. laser therapy (LLLT), has been used in prevention and treatment Some chemotherapy drugs are used alone or associated The photodynamic laser therapy, more specifically low-level with radiotherapy in the hospital scope are responsible for the has biological effects through photophysical and biochemical of OM in recent years [10-12].The application of LLLT on OM appearance of OM lesions, because they act mainly on tumor processes, increasing the cellular metabolism by stimulating cells and affect the tissues of oral mucosa that result from immunosuppression. And due to the great sensitivity of the oral analgesic and cicatrizator effect of lesions in the mucos [13] and mitochondrial activity. The result is an anti-inflammatory, tissues and toxic effects of the chemotherapy drugs, lesions in collagen and elastin production, contraction of the wound and oral cavity are the most common arise from chemotherapy [3]. acceleration of healing, keeping the integrity of the mucosa [1].
JOJ Nurse Health Care 9(5): JOJNHC.MS.ID.555774 (2018) 001 JOJ Nursing & Health Care
an ideal dose, and present as an accessible possibility for the tratment of OM induced by antineoplastic therapy. The authors A systematic review and meta-analysis [14] has showed and infrared laser therapy, which had the potential to partially still revealed that there is a possibility of LLLT become a part of a strong association in the treatment of OM by low-level red suppress the development of the OM induced by antineoplastic the regular oral care in treatment of cancer. Thus, this study aims duration of symptoms. Although laser therapy is demonstrating that present OM, through an integrative review of literature about therapy and significantly reduced pain, severity of the lesion and to show the benefits of the application of LLLT in cancer patients the use of this laser as an preventive measure and OM treatment. patients undergoing antineoplastic therapy [12,15,16] there are a considerable level of efficacy in reducing the grade of OM in still no established protocols for the treatment of OM in cancer Materials and Methods patients [17]. Nevertheless, studies have suggested that laser The integrative review is a descriptive research method therapy could be used as a form of prevention and treatment of where it can search, critically evaluate and synthesize the the OM lesions induced by the treatment of cancer [13,18,19]. available evidences about the theme, in order to show the current knowledge of the subject investigated, to intervene effectively in That way, Bensadoun and Nair [19] proved that there are health care and to reduce costs, to identify gaps directed to the consistent and favourable evidences to LLLT, as long as from development of future research [20]. Table 1: Summary of articles included in this review. No Authors Title Objective Results This study aimed to compare the There was a reduction in frequency and severity of oral Use of therapeutic frequency and the Evolution of oral mucositis with the use of laser. The results suggested Khouri et al. laser for prevention 1 mucositis among patients submitted that the therapeutic laser could be used in both cases [18] and treatment of oral to therapeutic laser and conventional as a new form of prevention and treatment of oral mucositis therapy. mucositis. A systematic review This study aimed to review the and infrared laser therapy may partially inhibit Therethe development are consistent of evidences oral mucositis that low-levelinduced by red 2 Bjordal et al. the prevention and treatment of oral laserand meta-analysistherapy in cancer of mucositiseffects of low-levelinduced by laser antineoplastic therapy in the effect of low-level the pain, severity and duration of the lesion symptoms therapy. mucositis. antineoplasticcaused therapy, by as oral well mucositis. as significantly reduce therapy-induced oral in the prevention and This study aimed to discuss the Low-leveltreatment laser of cancer therapy Bensadoun Nair 3 laser therapy for preventive and [19] Notherapy adverse are effects recommended of low-level to laser prevention therapy and were treatmentpromising of oral state mucositis of low-level induced oftherapy-induced the art based on reported. treatmentThus, low-level of oral red mucositis. and infrared laser antineoplastic therapy. mucositis:literature review 2012 state and
Systematicmeta-analysis. review This study aimed to review the of laser and other Migliorati et al., light therapy for the clinical practices for the use of laser Two new guidelines were created in favor of increasing 4 [19] management of oral andavailable other photodynamicliterature and totherapies define mucositis in cancer for the prevention and treatment of patients. oral mucositis evidences of the efficiency of low-level laser therapy.
This study aimed to conduct a of seven of these concluded that laser therapy in Laser therapy in oral Figueiredo et patientsTwelve undergoing studies were oncotherapy included. The is about meta-analysis nine times 5 of the effectiveness of laser therapy al., [13] more effective in the prevention of oral mucositis insystematic the prevention review of and oral meta-analysis mucositis in grade greater than 3 than in patients without laser mucositis control: a patients undergoing oncotherapy. meta-analysis. treatment. Effect of prophylactic This study aimed to determine Eighteen randomized clinical trials showed risk 6 Oberoi et al. therapy reduces the risk of severe reduction of severe mucositis, as well as reduced low-levelsystematic laser review therapy and whethermucositis prophylactic as compared low-level to placebo laser or outcomes when compared with placebo or no therapy. on oral mucositis: a no therapy.
A systematicmeta-analysis. review This study aims to synthesize the available clinical evidences on the and severe mucositis and decreases the average andlaser meta-analysis therapy (LLLT) of 7 HE et al., 2018 Prophylacticseverity of low-level oral mucositis laser therapy in pediatric reduces and mucositisyoung the effect of low-level in the prevention and treatment patients with cancer, as well as reduces the average induced oral mucositis effects of low-level laser therapy severity of oral mucositis and oral pain. in onpediatric chemotherapy- and young mucositis. patients. of chemotherapy-induced oral
How to cite this article: Graça M L M, Cayara M C, Clélea d O C. Efficacy of Low Level Laser Therapy in Oral Mucositis. JOJ Nurse Health Care. 2018; 002 9(5): 555774. DOI: 10.19080/JOJNHC.2018.09.555774. JOJ Nursing & Health Care
It should be emphasized that the integrative review laser therapy, Bensadoun and Nair [19] reviewed the literature contributes to the process of research and analysis of the results, and conclued that no adverse effects have been reported from aiming to increase of a specif topic based in other social studies the use of LLLT in prevention and treatment of OM induced by already published. This methodology of integrative review of antineoplastic therapy. the literature allows the accomplishment of successful analyzes In addition, Bensadoun and Nair [19] revealed there are on the data collection and information, besides the diagnosis and presentation of the results of the beginning of the study. A literature review of the publications in Portuguese and English moderate to strong evidences in favor of the application of low- OM induced by antineoplastic therapy. The authors also predicted was conducted in PubMed and SciELO databases, from 2010 level laser in ideal doses as an cheap and eficiente alternative for that laser therapy would become a part of the oral care routine in to 2018, using descriptors according to DeCs (Bireme Health cancer.
Migliorati et al. corroborated with Bensadoun and Nair [19] Descriptors) related to: laser, oral mucositis and cancer patients. and conclued that the application of LLLT had the potential to reading of the abstracts was conducted in order to verify if the After the identification of 10 (ten) articles, an exploratory become routine of care practice in combat OM. That way, in 2014 the Multinational Association of Support Care in Cancer/ analysis and subsequent discussion.It was excluded articles article fit the theme. Then, 7 (seven) articles were selected for International Society of Oral Oncology (MASCC/ISOO) has that did not have the inclusion criteria, those that presented recommended LLLT [9] in its guide as an intervention in OM. The duplication amoung databases and articles that after detailed guide is based on strong evidences that supported the treatments reading did not have the objective proposed in this review.
A table was prepared with the purpose of synthesizing and 650nm, power of 40mW and a tissue energy of 2 J/cm²) in the in situations indicated by the guide: LLLT (wavelength up to comparing the obtained data. In relation to the ethical aspects, prevention of OM in patients who transplanted hematopoietic there was the concern to register the necessary information to cells after conditioning with high dose of chemotherapy, with or without total body irradiation. And with reduced evidences, the and the care of changing nothing about the available information guide recommended LLLT (wavelength about 632.8nm) in the the identification of the authorship of the investigated articles in the articles analyzed.In the last decades, due the evolution of prevention of OM in patients submitted to radiotherapy without treatments in cancer patients and with the research for better concomitant chemotherapy for head and neck cancer.
Bensadoun e Nair [19] has recommended the treatment with LLLT emerged as na ally with the prevention and treatment of OM conditions to them, the photodynamic therapy, more specifically LLLT should be repeated every day, every other day or at least three times a week until the wound heals. Nevertheless, although inducedKhouri by antineoplasticet al.[18] conducted treatment a study [10-12]. in Ribeirão Preto, Brazil, the laser therapy is demonstrating a reduction in OM in patients undergoing antineoplastic therapy [12,15,16], a protocol to be laser therapy in prevention and treatment of OM. The laser followed in the treatment of OM in cancer patients has not yet that has showed significant improvements through the use of been established [17]. of the integrity of oral mucosa, tissue repair and patient comfort. therapy provided pain relief, inflammation control, maintenance Finally, a systematic review [21] analyzed the effects of LLLT in OM induced by antineoplastic theray in pediatric and young the information from Khouri study [18]. This systematic review n 2012, a systematic review and meta-analysis [14] confirmed evaluated the interaction between laser therapy and OM and patients. The findings corroborate with other studies in adults relief of symptoms and being na excelente option for prevention and infrared laser therapy in the development of OM induced by [12-14,18] in order to reduce pain and severity of OM, providing found strong evidences regarding the efficacy of low-level red and treatment of OM. antineoplastic therapy. The study also found that the laser therapy Conclusion of the lesions symptoms. would have significantly reduced the pain, severity and duration Several systematic reviews have proved by strong associations Other systematic review [17] compared light and laser therapies in the treatment of OM in cancer patients. They [12,14,17,21]. In addition, all articles consulted have presented the efficacy of laser therapy in treatment and prevention of OM concluded that the evidences were favorable to laser therapy and favorable results for the use of laser therapy in prevention and treatment of OM induced by antineoplastic treatment.Thus, the laser therapy is a promissing and effective tool for prevention and that the studies about the efficacy of laser therapy were raising. effects on OM with a degree greater than three submitted to laser That way, Figueiredo et al.[13] pointed significant prophylatic therapy. treatment of OM in cancer patients and it brings benefits such as analgesic and healing effects.It is believed that soon laser therapy reduction of pain and severity of the lesion and anti-inflammatory, will be a mandatory part of the care protocol for OM prevention revie [12] that revealed LLLT reduced the severity of lesions and Previous studies [13,14,18] were confirmed by a systematic and treatment, although protocols established in the researched pain in cancer patients when laser was applied as a prophylatic literature have not been found. measure. And due the care about possible adverse effects of
How to cite this article: Graça M L M, Cayara M C, Clélea d O C. Efficacy of Low Level Laser Therapy in Oral Mucositis. JOJ Nurse Health Care. 003 2018; 9(5): 555774. DOI: 10.19080/JOJNHC.2018.09.555774. JOJ Nursing & Health Care
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How to cite this article: Graça M L M, Cayara M C, Clélea d O C. Efficacy of Low Level Laser Therapy in Oral Mucositis. JOJ Nurse Health Care. 2018; 004 9(5): 555774. DOI: 10.19080/JOJNHC.2018.09.555774.