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Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols

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Abstract

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 and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed.

Methods

Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.

Results

PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780–830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2–3 J (J/cm2), and no more than 6 J/cm2 on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations.

Conclusion

PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Judith A. E. M. Zecha, Judith E. Raber-Durlacher, Dan M. J. Milstein, Jan de Lange & Ludi E. Smeele

  2. Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam, the Netherlands

    Judith E. Raber-Durlacher

  3. Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland, Australia

    Raj G. Nair

  4. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA

    Joel B. Epstein

  5. Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA

    Joel B. Epstein & Ron van der Brink

  6. Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, 14620, USA

    Sharon Elad

  7. Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA

    Michael R. Hamblin

  8. Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA

    Michael R. Hamblin

  9. Harvard-MIT Division of Health Science and Technology, Cambridge, MA, 02139, USA

    Michael R. Hamblin

  10. Division of Oncology, Weill Cornell Medical Center, New York, NY, USA

    Andrei Barasch

  11. Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN, 38163, USA

    Cesar A. Migliorati

  12. Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium

    Marie-Thérèse Genot

  13. Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands

    Liset Lansaat, Lisette van der Molen, Irene Jacobi & Ludi E. Smeele

  14. Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands

    Judi van Diessen

  15. Department of Oral Surgery, Faculty of Dentistry, University of Barcelona, Barcelona, Spain

    Josep Arnabat-Dominguez

  16. Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA, 98109, USA

    Mark M. Schubert

  17. World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000, Nice, France

    René-Jean Bensadoun

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  1. Judith A. E. M. Zecha
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  2. Judith E. Raber-Durlacher
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  3. Raj G. Nair
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  4. Joel B. Epstein
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  8. Cesar A. Migliorati
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  9. Dan M. J. Milstein
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  10. Marie-Thérèse Genot
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  11. Liset Lansaat
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  14. Lisette van der Molen
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  15. Irene Jacobi
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  17. Jan de Lange
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  18. Ludi E. Smeele
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  20. René-Jean Bensadoun
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Corresponding author

Correspondence to René-Jean Bensadoun.

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Disclaimer

This article is based on a narrative review of existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with the clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and as such does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.

Disclosures

Judith A.E.M. Zecha, Andrei Barasch, Sharon Elad, Steven Sonis, Cesar A. Migliorati, Marie-Thérèse Genot, Dan M.J. Milstein, Liset Lansaat, Irene Jacobi, Judi van Diessen, Jan. de Lange, Ludi E. Smeele and Mark M. Schubert have no disclosures relevant to this work to report.

Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, Ron van der Brink, Josep Arnabat Dominguez, and Rene-Jean Bensadoun have received travel expenses and hotel accommodation for the founding meeting of iGLOB from THOR Photomedicine Ltd., UK. Raj Nair has received an honorarium from THOR, UK. Michael R Hamblin was supported by US NIH grant R01AI050875.

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Zecha, J.A.E.M., Raber-Durlacher, J.E., Nair, R.G. et al. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols. Support Care Cancer 24, 2793–2805 (2016). https://doi.org/10.1007/s00520-016-3153-y

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