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Efetividade profil??tica e terap?autica do laser de baixa intensidade na mucosite bucal em pacientes submetidos ao tratamento do c?￠ncer
摘要： Objective: the purpose of this review is to present the different randomized clinical protocols using low level laser in the management of oral mucositis, in the last eighteen years of study. Literature review: oral mucositis remains a major problem to be solved in clinical oncology. This cytotoxic effect limits food intake by mouth due to the pain and discomfort in chewing and/or swallowing. Nutritional status may be aggravated contributing to increased morbidity and hospital stay, and providing negative impact on the quality of life of cancer patients, and on their treatment. Disturbances in the integrity and function of the oral cavity are due to the fact that radiotherapy and chemotherapy are not able to destroy tumor cells without damaging normal cells. Numerous treatments are described in literature and there are several methodologies for the treatment of oral mucositis, yet there is no consensus on the best strategy for prevention and therapy. Final considerations: several studies have shown good results with the use of low level laser, which main indications include anti-inflammatory and analgesic effects, and inducing tissue repair. However, there is no definition of a single protocol for this promising resource so far to be applied in the therapy of this pathology.
关键词： Low level,Laser therapy,Oral mucositis,Chemotherapy,Radiotherapy
更新于2025-09-23 15:19:57
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Retrospective evaluation of the safety of low-level laser therapy/photobiomodulation in patients with head/neck cancer
摘要： Background The standard therapeutic approach for locally advanced head and neck cancer is optimal use of radiation therapy with or without concomitant chemotherapy. The most common and distressing acute complication of such therapies is oral/pharyngeal mucositis that may be associated with severe morbidity and can interfere with the planned administration of therapy. Methods We have identified all patients diagnosed with head/neck cancer between 2005 and 2009, having received radiotherapy with or without cisplatin-based chemotherapy. Radiotherapy consisted of intensity-modulated radiation therapy (IMRT) in all patients. In patients with grade > 2 mucositis, photobiomodulation (PBM) consisted of three sessions of low-level laser irradiation weekly, in accordance with recently published recommendations for PBM. Patients who did not receive PBM were those for whom that approach was not requested by the radiotherapists and those who declined it. Results Two hundred twenty-two patients (62%) received PBM and 139 did not (39%). The patient’s characteristics were equally distributed between the two groups. For overall survival, time to local recurrence, and progression-free survival, there was no statistical evidence for a difference in prognosis between patients with and without PBM. In a multivariate analysis, after adjusting for known prognostic factors, we found no statistical evidence that PBM was related to overall survival, progression-free survival, or local recurrence. Conclusions Our results show evidence of no effect of PBM upon overall survival, time to local recurrences, and disease-free survival of patients with head and neck cancer treated with radiotherapy with/without chemotherapy.
关键词： Head/neck cancer,Oral mucositis,Radiotherapy,Prevention,Photobiomodulation,Laser therapy
更新于2025-09-11 14:15:04
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Photobiomodulation at Multiple Wavelengths Differentially Modulates Oxidative Stress <i>In Vitro</i> and <i>In Vivo</i>
摘要： Photobiomodulation (PBM) is emerging as an effective strategy for the management of multiple inflammatory conditions, including oral mucositis (OM) in cancer patients who receive chemotherapy or radiotherapy. Still, the poor understanding of the mechanisms by which the light interacts with biological tissues and the heterogeneity of light sources and protocols employed worldwide significantly limits its applicability. Reactive oxygen species (ROS) are massively generated during the early phases of OM and play a major role in the pathogenesis of inflammation in general. Here, we report the results of a clinical and experimental study, aimed at evaluating the effect of laser light at different wavelengths on oxidative stress in vivo in oncologic patients suffering from OM and in vitro in two cell types abundantly present within the inflamed oral mucosa, neutrophil polymorphonuclear (PMN) granulocytes, and keratinocytes. In addition to standard ROS detection methods, we exploited a roGFP2-Orp1 genetically encoded sensor, allowing specific, quantitative, and dynamic imaging of redox events in living cells in response to oxidative stress and PBM. We found that the various wavelengths differentially modulate ROS production. In particular, the 660 nm laser light increases ROS production when applied either before or after an oxidative stimulus. In contrast, the 970 nm laser light exerted a moderate antioxidant activity both in the saliva of OM patients and in both cell types. The most marked reduction in the levels of ROS was detected in cells exposed either to the 800 nm laser light or to the combination of the three wavelengths. Overall, our study demonstrates that PBM exerts different effects on the redox state of both PMNs and keratinocytes depending on the used wavelength and prompts the validation of a multiwavelength protocol in the clinical settings.
关键词： Reactive oxygen species,Laser therapy,Photobiomodulation,Oxidative stress,Oral mucositis
更新于2025-09-04 15:30:14