PREVENTIVE LASER PHOTOBIOMODULATION EVALUATION IN PATIENTS WITH HEAD AND NECK CANCER UNDERGOING RADIOCHEMOTHERAPY
Description
Oral mucositis (OM) is one of the most frequent lesions in patients undergoing cancer treatment. This study aimed to evaluate the effect of laser photobiomodulation in the development of OM in patients with head and neck cancer. This randomized clinical study divided patients into two groups: the laser group (LG, n = 30) and the control group (CG, n = 24). The LG (InGaALP, 660 nm, 86.7 mW, 2 J/cm2) participated in the preventive protocol, while the CG underwent a simulated procedure without light emission. The degrees of OM, salivary flow, and referred pain were evaluated at five different periods of radiotherapy. Both groups showed a significant increase in the degree of OM (p < 0.01). Regarding OM, salivary flow, and oral pain, there was no significant difference between the groups. The laser photobiomodulation protocol used in this study was not effective in preventing radiochemotherapy-induced OM.
Files
Steps to reproduce
This randomized clinical trial included patients with solid malignant neoplasms who had not yet started RT and/or CT through a free demand. The collected data included the type and location of the neoplasm, staging, proposed treatment (radiation or radiochemotherapy combined), dose, and number of sessions that the patients underwent. Additionally, a physical examination was performed to identify possible intraoral lesions. Before starting treatment, all patients underwent physical examinations and intraoral panoramic radiography. Patients who required oral care underwent tooth extractions, scaling and root planning, and endodontic services, in addition to undergoing a rigorous orientation regarding oral hygiene. Follow-up and the preventive treatment began on the first day of radiation and was performed every 48 hours between completed RT sessions. The evaluations were performed at baseline and at the 6th, 12th, 18th, and 24th RT in which intraoral examinations were performed included stimulated saliva collection and recording of painful symptoms using a visual analog scale (VAS). For the LG, a low-power laser device composed of InGaALP diode, Twin Flex® (MM Optics, São Carlos, Brazil), with a maximum output power of 86.7 mW, active tip area of 0.1256 cm², and continuous wavelength of 660 nm, was used at specific points in the oral cavity. The dosimetry used in each application was of 2 J for 3 seconds, totaling to 56 J. A total of 28 equidistant points of laser application were delineated, excluding the location of the tumor. The stimulated salivary flow determination was performed with the patient initially kept a portion of the film of paraffin (Parafilm M®, São Paulo, Brazil), measuring 4 cm2, for 1 minute, in the dorsal lingual vein, and after swallowing this, the saliva began to chew it for 5 minutes. The pain related to the oral cavity was measured using a VAS with 11 scores in ascending order, where 0 indicated less pain and 10 indicated maximum pain, just after stimulated saliva collection. At the end of each of the six RT sessions until the 24th session, the participants in both groups were evaluated every day. Tissue repair was compared through physical examination of the oral cavity by five experienced and calibrated evaluators, taking as reference the scouting scale of mucositis according to the World Health Organization (WHO), 1979. The database was analyzed using R software (version 3.3.3). A descriptive analysis was performed. To verify the associations between the study groups and variables of interest, we used chi-squared or Fisher’s exact test for the qualitative analysis and Student’s t-test for the quantitative analysis of variables. To identify the significant differences in the degree of OM, salivary flow, and referred pain between the times assessed per group, we used Friedman test and Mann-Whitney U test, followed by Dunn’s posteriori tests . The significance level was 95%.