High Dose Laser Therapy (HDLT)

High Dose Laser Therapy (HDLT)

PEP Topic 
Mucositis
Description 

High-dose laser therapy (HDLT) is a non-invasive use of laser energy that attempts to affect cells and physical symptoms often related to inflammation. HDLT is produced by Class IV lasers and uses a higher wavelength and energy power than low-level laser therapy. HDLT has been investigated in patients with cancer as a treatment for mucositis.

Effectiveness Not Established

Research Evidence Summaries

Chermetz, M., Gobbo, M., Ronfani, L., Ottaviani, G., Zanazzo, G.A., Verzegnassi, F., . . . Zacchigna, S. (2013). Class IV laser therapy as treatment for chemotherapy-induced oral mucositis in onco-haematological paediatric patients: A prospective study. International Journal of Paediatric Dentistry.

doi: 10.1111/ipd.12090
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Study Purpose:

To evaluate the efficacy of class IV laser therapy in pediatric patients affected by severe oral mucositis (OM)

Intervention Characteristics/Basic Study Process:

Laser treatments were performed twice daily for four consecutive days, all over the oral cavity in ulcerated and erythematous areas. Treatment was started on average 7.5 days after the end of chemotherapy.

Sample Characteristics:

  • N = 18     
  • AGE: 10–17 years 
  • MEDIAN AGE: 13 years
  • MALES: 12 (67%); FEMALES: 6 (33%)
  • KEY DISEASE CHARACTERISTICS: 10 patients (55.4%) were affected by acute lymphoblastic leukaemia, 4 patients (22.2%) by non-Hodgkin lymphoma, 1 patient (5.6%) by Ewing’s sarcoma, 1 patient (5.6%) by acute myeloid leukaemia, one patient (5.6%) by aplastic anaemia, and one patient (5.6%) by osteosarcoma. All patients underwent chemotherapy with various drugs depending on their neoplasia, whereas six patients also had been subdued to hematopoietic stem cell transplantation prior to total body irradiation.

Setting:

  • SITE: Single site 
  • SETTING TYPE: Inpatient  
  • LOCATION: Pediatric Hemato-Oncology Department at the Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Italy

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Pediatrics

Study Design:

  • Single-blind, quasi-experimental

Measurement Instruments/Methods:

  • World Health Organization (WHO) Oral Mucositis Grading Objective Scale
  • Visual analog scale to assess pain  
  • A validated questionnaire 
  • Photographs of lesions were taken during each session.
  • Patients were re-evaluated 11 days after the first day of laser therapy.

Results:

The use of class IV laser therapy (high-power laser therapy [HPLT]) was effective and induced better healing, reduced inflammation, and limited thermal damage along with maintained tissue integrity as compared to traditional low-power laser therapy (LPLT). All patients experienced a statistically significant decrease in pain sensation the day after the first laser application, with lesions healing by day 11.

Conclusions:

The innovative protocol used, HPLT, employs high power and high wavelength as compared to traditional protocols and was effective, safe, and non-invasive for the treatment of OM. It accelerates healing time and causes reduction of pain and inflammation of OM. The efficacy of LPLT in pediatric patients with cancer has been established. Thus, laser light therapy has proved to be successful in the prevention and treatment of chemotherapy-induced OM. In the present study, all patients perceived a great improvement in all lesions and functional capacity.

Limitations:

  • Small sample (< 30)
  • Risk of bias (no random assignment)
  • Findings not generalizable
  • Subject withdrawals ≥ 10%

Nursing Implications:

A gap indicates a lack of knowledge regarding dosing levels of laser therapy (low versus high, adult versus pediatric), so additional research is needed. More double-blind, randomized, controlled studies are needed, as well as laser protocols.


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