TY - JOUR
T1 - Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer
T2 - part 1: mechanisms of action, dosimetric, and safety considerations
AU - Zecha, Judith A.E.M.
AU - Raber-Durlacher, Judith E.
AU - Nair, Raj G.
AU - Epstein, Joel B.
AU - Sonis, Stephen T.
AU - Elad, Sharon
AU - Hamblin, Michael R.
AU - Barasch, Andrei
AU - Migliorati, Cesar A.
AU - Milstein, Dan M.J.
AU - Genot, Marie Thérèse
AU - Lansaat, Liset
AU - van der Brink, Ron
AU - Arnabat-Dominguez, Josep
AU - van der Molen, Lisette
AU - Jacobi, Irene
AU - van Diessen, Judi
AU - de Lange, Jan
AU - Smeele, Ludi E.
AU - Schubert, Mark M.
AU - Bensadoun, René Jean
N1 - Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Purpose: There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters. Methods: This study is a narrative non-systematic review. Results: We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority. Conclusion: Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.
AB - Purpose: There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters. Methods: This study is a narrative non-systematic review. Results: We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority. Conclusion: Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.
KW - Chemotherapy
KW - Head and neck cancer
KW - LLLT and PBM
KW - Low level laser therapy
KW - Low level light therapy
KW - Mucositis
KW - Orofacial complications
KW - Photobiomodulation
KW - Radiation therapy
KW - Safety
UR - http://www.scopus.com/inward/record.url?scp=84961200173&partnerID=8YFLogxK
U2 - 10.1007/s00520-016-3152-z
DO - 10.1007/s00520-016-3152-z
M3 - Review article
C2 - 26984240
AN - SCOPUS:84961200173
SN - 0941-4355
VL - 24
SP - 2781
EP - 2792
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 6
ER -
