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Laser Therapy Research for Mucositis

Low Level Energy Laser in Oral Mucositis: A Pilot Study Using the Microlight ML830 Laser

Katherine Anderson, ND FABNO, Larry Altshuler, MD, Katrina Bogdon, ND FABNO, Stacy Dunn, ND FABNO, Judith Boice, ND LAc, Shana Deneen, ND LAc, Lucas Tims, ND, Samantha Hoang, ND, Aisha Chilcoat, ND
Cancer Treatment Centers of America (CTCA) at Southwestern Regional Medical Center, Tulsa, OK

Purpose: The goal of this pilot study is to investigate the capacity of pain relief and wound healing of the low level energy laser therapy (LLEL) in chemotherapy induced oral mucositis (OM) in an adult oncology population group.

Methods: 50 patients were recruited from Southwestern Regional Medical Center, suffering from chemotherapy induced oral mucositis. OM grade was assessed using the WHO classification. All patients were treated with an 830 nm wavelength laser multiple times per week. Energy delivered (joules) was determined based on severity and number of lesions (3 joules per 33 sec cycle). Treatment time estimates ranged from 3-15 minutes. Side effects of treatment and concomitant medications and therapies were recorded at each visit. Subjective pain was recorded immediately prior and following treatment using a visual analogue scale (VAS). Functional impairment was recorded and all data was charted in an electronic healthcare record.

Results: After 12 months, medical records were evaluated. In many patients, pain relief was noted immediately after receiving treatment. LLEL contributed to healing of mucositis lesion, with the number and duration of treatments corresponding to the severity of the lesions.

Conclusions: Low level energy laser is an exciting new tool that significantly improves quality of life for many cancer patients. It is beneficial in treating chemotherapy induced oral mucositis and was shown to provide immediate pain relief for some patients. No side effects were noted with LLEL therapy. This is a therapy that should be made available to oncology patients experiencing mucositis. More research needs to be done in understanding how LLEL may affect cancerous lesions.

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Low level laser therapy in oral mucositis: a pilot study.

Cauwels RG, Martens LC.
Dept of Paediatric Dentistry, University Hospital, De Pintelaan 158, B 9000 Ghent, Belgium.

Eur Arch Paediatr Dent. 2011 Apr;12(2):118-23. [PMID: 21473845]

Aim: The goal of this pilot study was to investigate the capacity of pain relief and wound healing of low level laser therapy (LLLT) in chemotherapy-induced oral mucositis (OM) in a paediatric oncology population group.

STUDY DESIGN AND METHODS: 16 children (mean age 9.4 years) from the Gent University Hospital - Department Paediatric Oncology/haematology, suffering from chemotherapy-induced OM were selected. During clinical investigations, the OM grade was assessed using the WHO classification. All children were treated using a GaAlAs diode laser with 830 nm wavelength and a potency of 150 mW. The energy released was adapted according to the severity of the OM lesions. The same protocol was repeated every 48 hrs until healing of each lesion occurred. Subjective pain was monitored before and immediately after treatment by an appropriate pain scale and functional impairment was recorded. At each visit, related blood cell counts were recorded.

Results: After 12 mths, records were evaluated and information about treatment sequence, treatment sessions and frequencies related to the pain sensation and comfort were registered. Immediately after beaming the OM, pain relief was noticed. Depending on the severity of OM, on average, 2.5 treatments per lesion in a period of 1 week were sufficient to heal a mucositis lesion.

Conclusions: LLLT, one of the most recent and promising treatment therapies, has been shown to reduce the severity and duration of mucositis and to relieve pain significantly. In the present study similar effects were obtained with the GaAlAs 830nm diode laser. It became clear that using the latter diode device, new guidelines could be developed as a function of the WHO-OM grades i.e. the lower the grade, the less energy needed. Immediate pain relief and improved wound healing resolved functional impairment that was obtained in all cases.

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Patients with moderate chemotherapy-induced mucositis: pain therapy using low intensity lasers.

Nes AG, Posso MB.
Buskerud University, Drammen, Norway.

Int Nurs Rev. 2005 Mar;52(1):68-72.[PMID: 15725279]

Background: Intensive cancer therapy normally affects malignant and normal cells with high replication rates. Cells in the gastrointestinal tract are therefore commonly affected by cytotoxins. This often results in the development of chemotherapy-induced oral mucositis (COM). COM is the inflammatory response of the oral mucous membrane to the chemotherapy drugs. Low level laser therapy (LLLT) has proved to be effective in treating and repairing biologically damaged tissue and to reduce pain. LLLT has also proven to be an efficient method for the prevention of oral mucositis.

Objective: To investigate the effect of LLLT on pain relief among patients who have developed COM.

Method: The study was performed as a clinical test with a sample consisting of 13 adult patients receiving oncology treatment. The patients were treated during a 5-day period, and the pain was measured before and after each laser application. The laser used was an AsGaAl, with a wavelength of 830 nm and a potency of 250 mW. The energy given was 35 J cm(-2).

Analysis: The results were analysed using the Wilcoxon test.

Results: There was a significant (P = 0.007) 67% decrease in the daily average experience of pain felt before and after each treatment, confirming that LLLT can relieve pain among patients who have developed COM.

Study Limitations: The low number of COM patients at the hospital did not allow a control group to be included in the study, and therefore the results contain a potential placebo effect. IMPLICATIONS FOR NURSING CARE: The most important benefit the authors consider to be the value for the patients of better and quicker treatment with a drastic reduction in painful mucositis.

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Efficacy of low-level laser therapy and aluminum hydroxide in patients with chemotherapy and radiotherapy-induced oral mucositis.

Lima AG, Antequera R, Peres MP, Snitcosky IM, Federico MH, Villar RC.
Clinics Hospital, University of São Paulo, SP, Brazil.

Braz Dent J. 2010;21(3):186-92 [PMID: 21203698]

Abstract:This study evaluated the efficacy of low-level laser therapy (LLLT) and aluminum hydroxide (AH) in the prevention of oral mucositis (OM). A prospective, comparative and non-randomized study was conducted with 25 patients with head and neck cancer subjected to radiotherapy (RT) or radiochemotherapy (RCT). Twelve patients received LLLT (830 nm, 15 mW, 12 J/cm²) daily from the 1st day until the end of RT before each sessions during 5 consecutive days, and the other 13 patients received AH 310 mg/5 mL, 4 times/day, also throughout the duration of RT, including weekends. OM was measured using an oral toxicity scale (OTS) and pain was measured using the visual analogue scale (VAS). EORTC questionnaires were administered to the evaluate impact of OM on quality of life. The LLLT group showed lower mean OTS and VAS scores during the course of RT. A significant difference was observed in pain evaluation in the 13th RT session (p=0.036). In both groups, no interruption of RT was needed. The prophylactic use of both treatments proposed in this study seems to reduce the incidence of severe OM lesions. However, the LLLT was more effective in delaying the appearance of severe OM.

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Low-Intensity Laser Therapy in the Treatment of Mucositis induced by Chemotherapy and Radiotherapy

Alessandra Kuhn, Joao Carlos B. Wagner, Algemir Lunardi Brunetto, Mauricio R. Volkweis, Eduardo Dall'Magro

Purpose: The aim of this article was to develop a protocol for the treatment of oral mucositis induced by chemotherapy and radiotherapy. A pilot trial was conducted with low-intensity laser therapy (GaAIAs/InGaAIP laser) to decrease the lesions' manifestation time and to promote pain control.

Materials and Methods: Fifty patients for whom chemotherapy or chemoradiotherapy was indicated were evaluated in this study. Fifteen patients developed mucositis (30%) and were divided into 3 groups of 5, receiving low-intensity laser therapy 3 times a week, with a specific dosage in each group. Group A: GaAIAs laser, wavelength 830 nm (infrared), power 70 mW, dose 5 J/cm2; Group B: InGaAIP Laser, wavelength 685 nm (red), power 35 mW, dose 5 J/cm2; Group C: Placebo. The presence and severity of mucositis was clinically evaluated using the WHO scale, and pain was measured by using a visual analogue scale (VAS). The Kruskal-Wallis test was used to test differences among groups. Results were considered statically significant when p <0.05.

Results: The infrared laser 830 nm (Group A) showed therapeutic superiority when compared with the red laser 685 nm (Group B) and the Group C (Placebo). Group B showed intermediate results between groups A and C in terms of mucositis duration and the decrease of the lesion grade at 7 and 15 days. However, the pain level at 7 days of the treatment continued to be high compared to Group C (placebo)

Conclusions: Low-intensity laser therapy with a 830-nm (infrared) wavelength can be indicated for oral mucositis induced by chemoradiotherapy, due to its better therapy results compared to the red laser (685 nm) and the placebo group in the same application periods.

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The Effect of Low Level Laser Therapy in Different Wavelengths in the Treatment of Oral Mucositis—Proposal for ExtraOral Implementation

J. J. C. Moraesa, A. S. Queiroga, R. C. C. G. De Biase, E. P. Leite, C. R. Cabral Júnior, and F. A. Limeira Júnior

Abstract:The oral mucositis is the most frequent acute oral complication resulting from antineoplastic treatment and may worsen the clinical condition of the patient and interfere with his/her quality of life. This study aimed to comparatively evaluate, from a clinical point of view, the effect of Laser Therapy λ660 nm (wavelength of the red Laser) and λ830 nm (wavelength of the infrared Laser), at extraoral points, in remission of severity of oral mucositis and pain associated with it in pediatric oncological patients undergoing chemotherapy with the anticancer drug methotrexate, noting which of the two wavelength is the most appropriate to this new technique. The sample consisted of 13 patients placed at random in each group and subjected to sessions of Low Level Laser Therapy, at predetermined extraoral points for five consecutive days, starting at the beginning of the observation of mucositis injuries. It became possible to note that from the group of patients in the group of Laser λ830 nm (n = 6; 46.15%), four (n = 4; 66.67%) of these patients had remission of injuries to grade 0 (WHO), and as for pain, five patients (n = 5; 83.33%) showed no painful symptoms for mucositis injuries. In the Laser λ660 nm group (n = 7; 53.85%), only two patients (n = 2; 28.57%) achieved a regression of lesions to grade 0 (WHO), while four patients (n = 4; 57.14%) had no pain. So, the extraoral application of Laser Therapy was effective in treating injuries of oral mucositis in the patients treated; and Laser Therapy in the infrared spectrum (λ830 nm) was more effective in the treatment of oral mucositis injuries compared to the red spectrum (λ660 nm), which can be explained by the greater power of penetration of infrared rays, acting in a more expressive way in deeper places.

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