Low level laser therapy (LLLT) involves the use of a handheld infrared laser in an attempt to affect cells and physical symptoms often related to inflammation. This therapy has been approved by the U.S. Food and Drug Administration for treatment of post-mastectomy lymphedema. LLLT has also been evaluated for the prevention and treatment of mucositis in patients receiving stem cell transplantation conditioning or radiation therapy to the oral cavity area. For mucositis, LLLT is defined as a wavelength at 650 nm, power of 40 mW, and each square centimeter treated with sufficient time to deliver a tissue energy dose of 2 J/cm2.
Lalla, R.V., Bowen, J., Barasch, A., Elting, L, Epstein, J., Keefe, D.M., . . . Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology. (2014). MASCC/ISOO evidence based clinical practice guidelines for mucositis secondary to cancer therapy. Cancer, 120, 1453–1461. doi:10.1002/cncr.28592
Bjordal, J.M., Bensadoun, R.J., Tuner, J., Frigo, L., Gjerde, K., & Lopes-Martins, R.A. (2011). A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis. Supportive Care in Cancer, 19, 1069–1077.
Review the effects of low level laser therapy (LLLT) in prevention and treatment of oral mucositis induced by cancer therapy. Meta-analysis was done, and all results are provided.
Databases searched were Medline, EMBASE, CINAHL, PedRo, and Cochrane Controlled Trial Register. Hand searching in physiotherapy and medical journals from several countries also were used.
Search keywords were low level laser therapy, low intensity laser therapy, low energy laser therapy, phototherapy, oral mucositis, cancer, chemotherapy, radiation therapy, and specific laser types.
Studies were included if they
A total of 149 papers were initially retrieved. Literature was evaluated using the Jadad checklist and inclusion of study funding sources.
A final sample of 11 trials published from 1997–2009 included 415 patients. Samples ranged from 21–70 subjects and included those receiving chemotherapy, radiation therapy, combined therapy, and transplant cases. One study was done in children.
Moderate to strong evidence was found for effectiveness of LLLT in the prevention of OM, reduced duration and severity of OM, and reduced pain with doses of 1–6 joules per point. Trials aimed at prevention started LLLT seven days before cancer treatment regimens, and effective dosing seen ranged from 1–6 joules. This meta-analysis supported the effectiveness of LLLT in the dosage ranges reported here for the prevention and management of oral mucositis.
The quality of studies was determined to be high; however, substantial variation existed in the actual treatment procedures, number of treatments, timing of treatments, and heterogeneity in the overall findings.
Figueiredo, A.L., Lins, L., Cattony, A.C., & Falcao, A.F. (2013). Laser therapy in the control of oral mucositis: A meta-analysis. [Laser terapia no controle da mucosite oral: um estudo de metanalise]. Revista Da Associacao Medica Brasileira, 59, 467–474.
STUDY PURPOSE: To conduct a meta-analysis and systematic review to determine if laser therapy (LT) is effective in preventing oral mucositis (OM) during oncotherapy
TYPE OF STUDY: Meta-analysis and systematic review
DATABASES USED: LILACS, MEDLINE, Cochrane electronic
KEYWORDS: “laser therapy”, “oral mucositis” used in all databases
INCLUSION CRITERIA: Oncotherapy-induced and diagnosed OM, low-intensity laser was the form of treatment with specific wavelength between 632 and 1,064 nm, randomized trial with control group
EXCLUSION CRITERIA: No specific exclusion criteria referenced; however, OM grade ≥ 3 was used as a cutoff in all the scales to properly evaluate the preventative value of LT.
TOTAL REFERENCES RETRIEVED: 12 prospective, randomized studies met criteria out of 149 initial retrieved studies
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale was used to evaluate the methodology of the studies included. BioEstat 5.0 was used for the meta-analysis. Literature was further evaluated using a standardized form that included study design, country of origin, year of publication, and authors. The patients’ data were analyzed for gender and age, type of cancer treatment, control group treatment, and LT specifics (e.g., wavelength, power, dose, irradiation time, and number of sessions per week).
FINAL NUMBER STUDIES INCLUDED = 12
SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Total sample of 527 patients; 276 of these patients underwent LT, and 251 patients were in the control group. Final meta-analysis resulted in a total sample of 293 patients.
KEY SAMPLE CHARACTERISTICS: 53% of the patients had hematologic malignancy; 47% had head and neck cancer.
PHASE OF CARE: Multiple phases of care
Out of the 12 studies included for review, 7 of them showed (through meta-analysis) that LT is almost 10 times more effective in preventing OM ≥ grade 3 than treatment without the use of LT.
The authors determined that the data supported the effectiveness of LT in the prevention of OM ≥ grade 3. They note that additional studies with larger sample sizes are still required to fully evaluate the total effectiveness of this intervention.
Age range was not listed in this review, nor was prior radiation or chemotherapy exposure. Dental health and evaluation prior to oncotherapy and LT were not referenced in this review. Due to multiple variances in the control group's non-LT prevention measures, the number of studies was much smaller than the number the initial search results returned.
This study, even with the limitations of its size and characteristics, is a good starting point for further investigation into LT to prevent severe OM in patients with cancer undergoing chemotherapy, radiation, or both. LT appears to be a promising intervention. If severe OM can be prevented, then pain and infection, which quickly result from OM, can be prevented, too. Thus, this study has larger implications in overall care and quality of life in patients with cancer. Nurses can begin to address the study and the use of LT in their own institutions.
Oberoi, S., Zamperlini-Netto, G., Beyene, J., Treister, N. S., & Sung, L. (2014). Effect of prophylactic low level laser therapy on oral mucositis: A systematic review and meta-analysis. PloS One, 9, e107418.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Pediatrics, elder care
The primary outcome (overall severity of oral mucositis) of this analysis was that prophylactic LLLT reduced the overall risk of severe mucositis when compared to a placebo or no therapy (RR = .37, 95%, CI = .18–.67, p = .001). The absolute risk reduction was -.35 (95%, CI = -.48– -.2, p < .0001). Secondary outcomes included a decreased risk of severe mucositis at the time of expected worst severity with prophylactic LLLT (RR = .34, 95%, CI = .20–.59, p = .0001). Overall mean grade of mucositis: standardized mean difference = -1.49, 95%, CI = -2– -.95;=, p < .0001. Duration of severe (grade 3 or 4) mucositis: weighted mean difference = -5.32, 95%, CI = -9.45– -1.19, p = .01. Incidence of pain: RR = .89, 95%, CI = .76–1.04, p = .15. Incidence of severe pain: RR = .26, 95%, CI = .18–.37, p < .0001. Overall mean pain score: WMD = -2.46, 95%, CI = -4.4– -.77, p = .004. Number of patients needing opioid analgesia: RR = .47, 95%, CI = .37–.60, p < .0001. Unplanned interruption in radiation (from mucositis in patients with head and neck cancer): RR = .23, 95%, CI = .12–.44, p < .0001.
The overall risk of severe mucositis is decreased by the use of low-level laser therapy. The duration of mucositis, the risk of severe pain, the need for opioid analgesia, and radiation treatment interruption also is positively impacted by LLLT.
There is heterogeneity to the laser schedules, mucositis assessment scales, laser parameters, intervals, and time points for assessment and outcome reporting (per the authors). It is difficult to generalize this study to the pediatric population. The feasibility of using laser therapy continues to be an issue in nursing.
Prophylactic LLLT shows benefit in the prevention of oral mucositis. Additional research to delineate the feasibility of this intervention and define best practice is needed.
Antunes, H.S., Herchenhorn, D., Small, I.A., Araújo, C.M., Viégas, C.M.P., Cabral, E., . . . & Ferreira, C.G. (2013). Phase III trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation. Radiotherapy and Oncology, 109(2), 297–302.
To assess the efficacy of preventive low-laser therapy to reduce grade 3 and 4 oral mucositis (OM) in patients receiving chemoradiation
Both groups received cisplat 100 mg/m2 for three cycles every three weeks, radiation 70.2 Gy (1.8 Gy per day five times per week), and the same oral hygiene. The intervention group received low-level laser therapy five times per week before every fraction of radiation. The energy and energy density were the same for each patient. A dentist applied the laser tip to the mucosa of the lips, the right and left buccal mucosa, the left and right lateral tongue border, the buccal floor, and the ventral tongue. The placebo group had the laser tip touched to the same sites, but there was no laser light.
A significant decrease was seen in the rate of grades 3 and 4 OM in the treatment group. Relative risk ratio (6.4% with laser versus 40.5% control) 0.158 (CI 95%). The treatment group reported better physical, emotional, fatigue, and pain scores and had less pain, fewer problems swallowing, and less trouble with social eating.
Low-level laser light therapy is effective in reducing grades 3 and 4 OM in patients with squamous cell carcinoma of the head and neck undergoing concurrent chemotherapy and radiation.
Nurses who work in facilities with access to low-level laser light therapy should advocate for the use of it for their patients with head and neck cancer undergoing radiation and chemotherapy. There may be a role for nurses in learning to administer low-level laser light therapy.
Arora, H., Pai, K.M., Maiya, A., Vidyasagar, M.S., & Rajeev, A. (2008). Efficacy of he-ne laser in the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 105(2), 180-186, 186.e1.
To evaluate the efficacy of low level laser therapy (LLLT) for the prevention and treatment of radiotherapy-induced oral mucositis in patients with oral cancer
Patients with primary oral cancer were randomized to the laser group or a control group. All patients had oral prophylaxis before starting radiation therapy, and all had the same oral care during treatment. All patients were evaluated daily for pain severity, functional impairment, and oral mucositis. The clinical exams were performed by a single examiner. All the laser treatments were administered by one operator. The treatment consisted of use of a laser scanner for the first eight days followed by treatment to six areas on the right and left sides of the oral cavity for 25 days.
This was a single site, inpatient and outpatient study conducted at Kasturba Medical College of Manipal University in Karnataka, India.
This was a randomized controlled trial.
Pain increased gradually and was the greatest at the end of seven weeks. The laser group had a statistically significant lower level of pain than did the control group (p < 0.03). In week 3, the laser group had grade I functional impairment, while the control group progressed to grade II and III functional impairment, with one individual having grade IV impairment. Overall, the laser group had lower mucositis severity than the control group (p = 0.033).
Prophylactic laser therapy during radiation therapy can reduce the severity of mucositis, as well as the severity of functional impairment and pain.
This form of laser therapy is effective in the prevention of severe mucositis, but it is very high tech and requires special equipment and highly trained personnel.
Carvalho, P.A., Jaguar, G.C., Pellizzon, A.C., Prado, J.D., Lopes, R.N., & Alves, F.A. (2011). Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncology, 47, 1176–1181.
To determine the efficacy of low‐level laser treatment (LLLT) in the prevention and treatment of radioinduced oral mucositis in patients with oral and oropharynx cancer
Patients were randomized into two groups. Group 1 received 660 nm/15 mW/3.8 J/cm² spot size 4 mm² LLLT, and Group 2 received 660 nm/5 mW/1.3 J/cm² spot size 4 mm² LLLT, both beginning on the first day of radiation. In both groups, LLLT application was done daily for five consecutive days per week starting on the first day of radiation therapy. Prior to the study, all patients underwent oral care, including an oral examination, preventive dental treatment, instructions for oral care during radiation therapy, and prescription mouthwashes and fluoride treatment. Randomized sample selection was based on the eligibility criteria that each patient was diagnosed with cancer of the oral cavity or oropharynx and treated with radiation therapy.
This was a single-site study conducted in an inpatient setting at Hospital A.C. Camargo, Sao Paulo Brazil.
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized, double-blind study.
Group 1 had a delay in presentation with oral mucositis compared to Group 2 (13.5 days to 9.8 days, respectively). Group 2 presented with a higher grade of mucositis as compared to Group 1, and Group 2 reported higher overall pain scores.
This study reported a delay in development of mucositis, a decrease in severity of mucositis, and a decrease in pain scores with the group that received the higher dose of LLLT during treatment for oral or oropharynx cancer.
Further studies are necessary to define dose, application time, and number of sessions needed for laser therapy in prevention and management of oral mucositis.
Gautam, A.P., Fernandes, D.J., Vidyasagar, M.S., & Maiya, G.A. (2012). Low level helium neon laser therapy for chemoradiotherapy induced oral mucositis in oral cancer patients: A randomized controlled trial. Oral Oncology, 48, 893–897.
To evaluate the therapeutic effects of a low level He-Ne laser on chemoradiation (CRT) -induced oral mucositis (OM), associated severe pain, and use of total parenteral nutrition (TPN) in patients with oral cancer
Block randomization was done using a computerized program taking primary oral cancer stage as a matching variable of 121 primary patients with oral cancer scheduled to undergo CRT (RT dosage = 66 Gray/33 fractions for five days per week and chemotherapy was three weeks cisplatin). Patients were randomized to either laser (n = 60) or placebo (n = 61). Both groups received standard oral care and hygiene. Patients and outcomes assessor were kept blinded for the laser intervention. OM, its associated pain, and TPN were assessed every week by a blinded assessor. Opioid analgesic use, weight loss, and any CRT breaks were recorded.
Laser treatments used He-Ne 632.8 nm, power output of 24 mW, beam spot diameter of 0.6 mm, noncontact method (Technomed Electronics, Advanced Laser Therapy 1000, Chennai, India). This was applied to the anatomical sites in the oral cavity (buccal mucosa, lateral and ventral tongue, labial mucosa, floor of the mouth and palate), excluding cancer site daily just before radiation session for 6.5 weeks.
The placebo group received sham therapy (the probe was kept off, and there was only a beep sound) just before radiation for 6.5 weeks.
This was a single-site study in a nonspecified setting in India.
This was a prospective double blinded, randomized controlled trial.
During the last weeks of CRT, incidence of mucositis greater than grade 2 was less in the laser group than in the placebo group (p < 0.0001). The mean duration of severe grades of OM was less than in the placebo group.
At the third week of CRT, no statistical difference was found between groups for incidence of OM, severe pain, TPN, and weight loss.
The laser group had less need for opioid use (p < 0.001). None of the patients in the laser group required a break in CRT, but 9% of patients in the placebo group required a break in CRT.
OM progressed at a slower rate in the laser group than in the placebo group. Pain was less severe as rated by pain scores, and TPN was significantly less in the laser group than in the placebo group.
Low level He-Ne laser was found to decrease the incidence of CRT-induced, severe OM and its associated pain; opioid analgesic use; and TPN for patients with oral cancer.
Low level helium neon laser therapy for the reduction of chemotherapy-induced OM in patients with oral cancer appears to be helpful, but the therapy is limited because of the need for the laser and an experienced laser therapist. The laser therapy in this study included standard oral care and hygiene; therefore, laser therapy does not eliminate this need.
Long-term follow-up on the effects of laser on OM is recommended to understand the carryover effects of laser in these patients. Studies explaining the exact mechanisms of action of laser also are recommended.
Gautam, A.P., Fernandes, D.J., Vidyasagar, M.S., Maiya, A.G., & Guddattu, V. (2015). Low level laser therapy against radiation induced oral mucositis in elderly head and neck cancer patients—A randomized placebo controlled trial. Journal of Photochemistry and Photobiology, B: Biology, 144C, 51–56.
To evaluate the effects of low level laser therapy (LLLT) for the prevention and treatment of radiation-induced oral mucositis (OM) in older adult patients with head and neck cancer (HNC)
LLLT seems to be an effective intervention in preventing OM in older adult patients with HNC. Larger, multisite trials are needed for validation.
Nurses are vital in educating patients on good oral hygiene both before and during radiation treatments. Nurses see patients weekly, sometimes daily, and are essential to managing OM while patients undergo treatment, in combination with other methods such as LLLT investigated in this study. Reducing OM allows more patients to finish treatment.
Gautam, A.P., Fernandes, D.J., Vidyasagar, M.S., Maiya, A.G., & Vadhiraja, B.M. (2012). Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients: A triple blinded randomized controlled trial. Radiotherapy and Oncology, 104, 349–354.
To examine the efficacy of low level laser therapy (LLLT) in patients with head and neck cancer receiving chemotherapy and radiation therapy (RT)
Patients were randomly assigned to receive LLLT or sham treatment. Both groups received standard oral care and oral hygiene protocol, including frequent mouth washes with sodium bicarbonate. Patients in the LLLT group were treated with helium neon laser in 15–20 minute sessions, five sessions per week, at six anatomical sites in the oral cavity. Treatment was done daily prior to RT for 45 days. Patients, outcomes assessors, and statisticians were blinded to patient group assignment. Oral mucositis was assessed and graded daily.
This was a single-site, outpatient study conducted in India.
Patients were undergoing the active antitumor treatment phase of care.
The study design was a randomized triple-blind sham-controlled randomized clinical trial.
Prophylactic LLLT in patients with head and neck cancer receiving concomitant radiation and chemotherapy was effective in reducing the incidence of severe oral mucositis.
Without a longer-term follow up, long-term effects of LLT are not known.
Prophylactic use of LLLT was able to prevent and treat severe oral mucositis in this group of patients. This study adds to the growing body of evidence supporting the effectiveness of LLLT in patients with head and neck cancer receiving treatment, particularly in patients receiving chemotherapy with RT. Nurses can advocate for the use of LLLT in this patient population.
Gouvea de Lima, A., Villar, R.C., de Castro, G., Jr., Antequera, R., Gil, E., Rosalmeida, M.C., … Snitcovsky, I.M.L. (2012). Oral mucositis prevention by low-level laser therapy in head-and-neck cancer patients undergoing concurrent chemoradiotherapy: A phase III randomized study. International Journal of Radiation Oncology, Biology, Physics, 82, 270–275.
To evaluate the efficacy of low-level laser therapy (LLLT) to decrease severe oral mucositis and reduce radiation therapy (RT) interruptions
Patients received either gallium aluminum arsenide LLLT 2.5 J/cm2 or placebo laser before each radiation fraction.
This was a single-site, outpatient study conducted in Brazil.
Patients were undergoing the active treatment phase of care.
This was a randomized, double-blind, phase III study.
LLLT benefit was limited to fewer interruptions in RT.
LLLT dosage, schedule, specific laser type, and availability all need to be addressed.
Gouvea de Lima, A., Antequera, R., Peres, M.P., Snitcosky, I.M., Federico, M.H., & Villar, R.C. (2010). Efficacy of low-level laser therapy and aluminum hydroxide in patients with chemotherapy and radiotherapy-induced oral mucositis. Brazilian Dental Journal, 21, 186–192.
To evaluate the use of low level laser therapy (LLLT) and aluminum hydroxide for the prevention of oral mucositis in patients with head and neck cancer, and to evaluate the impact of LLLT on pain scores.
Group 1 was given LLLT at 830 nm daily since first day of radiotherapy (RT) to end of therapy prior to RT (RT days only). It was applied to 12 areas of the oral cavity. Group 2 received aluminum hydroxide (AH) suspension (310 mg/5 mL) starting on first day of RT and continued throughout, including weekends. Patients used 10 mL of AH 4 times a day and swallowed and had to avoid eating during the first hour after treatment.
This was a single-site, outpatient study conducted in Brazil.
Patients were undergoing the active treatment phase of care.
The study was prospective, comparative, and nonrandomized.
Lower oral mucositis (OM) scores were observed in the LLLT group (p = 0.061). More grade III OM was seen in the AH group, and severe OM was delayed in the LLLT group. LLLT pain scores were lower but not statistically significant overall. Quality-of-life (QOL) scores were all higher (i.e., more symptoms) in the AH group.
LLLT was found to be more effective than AH in delaying severe OM; however, more trials are needed.
Although LLLT was found to be more effective than AH in delaying severe OM, questions exist regrding the best protocols and dosing, as well as how this evidence correlates to other disease types. Additionally, availability of equipment may be an issue.
Maiya, G., Sagar, M., & Fernandes, D. (2006). Effect of low level helium-neon (He-Ne) laser therapy in the prevention and treatment of radiation induced mucositis in head and neck cancer patients. Indian Journal of Medical Research, 124(4), 399–402.
He-Ne wavelength 632.8 nm and output of 10 mW was administered for three minutes five days a week until completion of radiation.
Control group received oral analgesics, anesthetics, 0.9% saline, and ovidine wash.
Physician was blinded to the type of treatment.
Patients with cancer of the oral cavity stages 2–4 receiving radiation 66 Gy in 33 fractions over six weeks
Computer randomization; 25 patients receiving laser treatment, 25 patients in the control group
Mean age of study group was 54 years (+/– 1 year); mean age of the control group was 53 years (+/–1 year).
Ratio of men to women was 2:1.
VAS for pain
At the end of week 6 of RT, pain rank in the study group significantly decreased (p < 0.001) as compared to the control group (13 versus 38).
Mean pain score in the study group was 2.6 (+/– 0.64); the control group score was 6.68 (+/– 1.44) (p < 0.001).
At the end of radiation, mucositis grade in the study group was 1.72 (+/– 0.67); the grade was 3.32 (+/–0.09) in the control group (p < 0.001).
18 patients in the study group had grade 1, and 7 had grade 2 mucositis;
14 patients in the control group had grade 3, and 11 had grade 4.
Small sample size, but findings were significant at the end of radiation.
Did not report data during treatment
Simoes, A., Eduardo, F.P., Luiz, A.C., Campos, L., Sa, P.H., Cristofaro, M., … Eduardo, C.P. (2009). Laser phototherapy as topical prophylaxis against head and neck cancer radiotherapy-induced oral mucositis: Comparison between low and high/low power lasers. Lasers in Surgery and Medicine, 41(4), 264–270.
To analyze the effect of different protocols of laser phototherapy (LPT) on the grade of mucositis and the degree of pain in patients undergoing radiation therapy
Patients were divided into three groups. One group was treated with low-dose laser therapy three times per week. Group 2 received combined high and low powered lasers used three times per week. The third group received low-level laser therapy (LLLT) once weekly. Oral mucositis and pain were assessed at the first visit and at each LPT visit.
This was a single-site study conducted at the Cancer Hospital of Mato-Grasso, Brazil.
This was a prospective clinical trial.
No differences were found between groups in overall grades of mucositis. Pain increased in the patients that received LPT weekly (p = 0.01), while pain severity remained about the same over time in other groups. Patients who received combined high and low power laser took significantly more time to heal (p = 0.04).
LPT using low power laser alone or in combination with high powered lasers when applied three times weekly maintained the mucositis grades at levels I and II and prevented increased pain. Combination low and high power laser treatment was associated with a longer time to healing mucositis.
This study provides an initial look at differences in outcomes with LPT based on different dosages and types of LPT treatment. Further research in this area, as well as studies looking at timing differences in the phase of care, are necessary to determine the most effective use of this treatment modality.
Zanin, T., Zanin, F., Carvalhosa, A.A., Castro, P.H., Pacheco, M.T., Zanin, I.C., … Brugnera, Jr., A. (2010). Use of 660-nm diode laser in the prevention and treatment of human oral mucositis induced by radiotherapy and chemotherapy. Photomedicine and Laser Surgery, 28, 233–237.
To evaluate the qualitative and quantitative effects of the 660-nm diode laser in the prevention and treatment of oral mucositis in patients with head and neck cancer being treated with chemotherapy and radiation
Seventy-two patients were divided into two groups. One group was the control, and the other group received low-level laser therapy twice weekly. Teeth were protected using a silicone tray containing neutral fluoride gel. Daily physical intraoral evaluations were performed. Patients were followed for seven weeks during radiation treatment.
This was a single-site study conducted at the Cancer Hospital of Mato-Grasso, Cuiaba, MT, Brazil.
The study was a prospective clinical trial.
This study found that 660-nm diode laser therapy was effective in the prevention and treatment of oral mucositis in patients being treated with chemotherapy and radiation for head and neck carcinoma.
Low level laser therapy may be effective in the prevention of mucositis. However, this treatment is highly technical and requires special equipment and highly trained personnel.
Migliorati, C., Hewson, I., Lalla, R. V., Antunes, H.S., Estilo, C.L., Hodgson, B., … Elad, S. (2013). Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Supportive Care in Cancer, 21(1), 333–341.
To review available literature to develop guidelines for the use of laser and other light therapies in patients with cancer
A total of 692 papers initially were identified, and 24 clinical trials were included in the final review.
Guidelines support use of LLLT for the prevention of oral mucositis in patients undergoing HCT and in patients with head and neck cancer receiving radiotherapy. The research in this area involves a variety of laser devices, protocols, and dosage, making it difficult to identify a specific protocol for clinical application. The most effective wavelengths and dosages are not yet clear. Most protocols examined have involved daily and long treatment times. Based on accumulating evidence, LLLT or other forms of light therapy have the potential to become part of routine treatment.