Source: www.healio.com
Author: Jennifer Southall

Light therapy appeared to be an effective intervention for the prevention of painful oral mucositis associated with cancer treatment, according to results of a systematic review and meta-analysis.

“Many patients [with cancer] can now benefit from this treatment,” Praveen R. Arany, DDS, PhD, assistant professor of oral biology and biomedical engineering at University at Buffalo School of Dental Medicine, said in a press release. “The staggering breadth of clinical application for photobiomodulation therapy, or light therapy, has been both a boon and a bane for the field. Several anecdotal clinical reports have been plagued with questionable rationales and inconsistent outcomes, often relegating this treatment to a pseudoscience.”

Arany and colleagues systematically reviewed published literature in an effort to update the evidence-based clinical practice guidelines on the use of photobiomodulation — including laser and other light therapies — for the prevention and treatment of oral mucositis among patients with cancer. Patients underwent treatment with hematopoietic stem cell transplantation, head and neck radiotherapy, or head and neck radiotherapy plus chemotherapy.

Study findings supported the use of photobiomodulation therapy for the prevention of oral mucositis among certain patients with cancer.

HemOnc Today spoke with Arany about the research and the clinical implications of the findings.

Question: What prompted this research?
Answer: The current forms of cancer treatment are all essential to reduce cancer burden. Unfortunately, complications from these treatments include oral mucositis pain. This not only has a significant impact on quality of life, but also often requires treatment with opioids. The pain and discomfort can be so severe it may even interrupt treatment, which can be lethal. There are no targeted treatments for this condition. We commonly use a mouthwash, which provides relief from symptoms. In contrast to this, there is increasing evidence for the use of light therapy based on precise biological mechanisms.

Q: Can you explain the rationale for this therapy?
A: This treatment has been shown to modulate various biological signaling pathways in cells that results in a positive response, such as alleviation of pain or inflammation. In addition, our lab uncovered a mechanism involving direct activation of a growth factor capable of stimulating wound healing and tissue regeneration. A combination of these responses is responsible for therapeutic benefit in oral mucositis pain.

Q: How did you conduct the study?
A: For the systematic review and meta-analysis, we looked at previously published human clinical studies that focused on how light therapy was used for the prevention of oral mucositis pain. We used the evidence from all studies to establish guidelines, re-analyzing data from each study to develop the final recommendations.

Q: What did you find?
A: There is significant evidence to use photobiomodulation therapy, or light therapy, for the prevention and treatment of oral mucositis pain when patients undergo radiation plus chemotherapy, as well as radiation alone and HSCT. In some instances, photobiomodulation therapy also was used as a preventive measure before and during cancer treatments to reduce the risk for oral mucositis pain.

Q: What will subsequent research entail?
A: The major finding was this treatment is effective. However, most of the studies that we reviewed were performed outside of the United States — including in Brazil, Europe and Asia. It is necessary to conduct studies in the U.S. in a more controlled manner with new devices available. This will be the primary focus of future human clinical research. Preliminary research studies have addressed potential effects of this treatment on tumors and the data are very promising, noting few — if any — deleterious side effects.

Q: Is there anything else that you would like to mention?
A: This is a noninvasive and nonpharmacological approach. This is especially important in the context of opioids in cancer care. Clearly, opioids are effective drugs that have an essential role in pain management. Unfortunately, they have a high threshold for abuse. The use of photobiomodulation therapy can reduce this incidence because patients will not be exposed to opioids. Besides mucositis, photobiomodulation therapy also has been noted to reduce hair loss, depression and fatigue — all key concerns for patients undergoing cancer treatment. Hopefully, we soon will see other published reports that will lead to improved cancer care using this simple but potent new technology. – by Jennifer Southall

Reference:
Zadik Y, et al. “Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines” Support Care Cancer. 2019;doi:10.1007/s00520-019-04890-2.

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