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

• This review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO).
• Database searched was MEDLINE.
• Search keywords were oral mucositis OR stomatitis AND lasers, laser, low level laser therapy (LLLT), light therapy, phototherapy, light-emitting dioide, visible light, and infrared.

• Patients were in the active antitumor treatment phase of care.
• The study has clinical applicability for pediatric applications.

A total of 692 papers initially were identified, and 24 clinical trials were included in the final review.

• Recommendations were laser therapy in a wavelength around 650 nm, intensity of 40 mW, and treatment of each square cm to tissue energy dose of 2 J/cm³ for prevention of oral mucositis in patients undergoing hematopoietic cell transplantation (HCT). For laser therapy as treatment, no guideline was possible because of insufficient evidence.
• No guidelines for LED and other light sources were provided because of insufficient evidence at the time, but promising findings noted that LED and visible light therapy appeared to interact with human tissue in the same way as LLLT.
• Laser therapy was recommended for prevention of radiation-induced oral mucositis in patients without concomitant chemotherapy with head and neck cancer.
• No guidelines were possible for combination radiation and chemotherapy because of inconsistent findings.
• No guideline were possible for other groups of patients.

• Multiple sources of evidence were relatively flawed studies.
• The authors noted later-breaking evidence that is promising in other groups but not fully included in the review.
• The review included articles through 2010 only.

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.