Journal Article

Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety considerations

Schubert, Mark M., van Diessen, Judi, de Lange, Jan, Genot, Marie-Thérèse, Barasch, Andrei, Epstein, Joel B., Arnabat-Dominguez, Josep, Nair, Raj G., Sonis, Stephen T., Hamblin, Michael R., Lansaat, Liset, Elad, Sharon, van der Brink, Ron, Raber-Durlacher, Judith E., Jacobi, Irene, Bensadoun, René-Jean, Migliorati, Cesar A., Milstein, Dan M. J., Zecha, Judith A. E. M., van der Molen, Lisette, Smeele, Ludi E.

2016

Overview

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, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters. Methods This study is a narrative non-systematic review. Results We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority. Conclusion Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Action / Analysis / Ascription / Cancer / Chemoradiotherapy - adverse effects / Chemotherapy / Clinical outcomes / Complications / Complications and side effects / Drug effects / Drug-Related Side Effects and Adverse Reactions - etiology / Drug-Related Side Effects and Adverse Reactions - therapy / Efficacy / Head & neck cancer / Head and neck cancer / Head and Neck Neoplasms - drug therapy / Head and Neck Neoplasms - radiotherapy / Head and Neck Neoplasms - therapy / Humans / Inflammation / Laser surgery / Laser therapy / Lasers / Low-Level Light Therapy - adverse effects / Low-Level Light Therapy - methods / Low-Level Light Therapy - standards / Lymphedema / Management / Medical lasers / Medical treatment / Medicine / Medicine & Public Health / Neutrality / Nursing / Nursing Research / Oncology / Oral diseases / Pain Medicine / Patients / Radiation / Radiation (Physics) / Radiation therapy / Radiotherapy / Rehabilitation Medicine / Responsiveness / Review Article / Safety / Side effects / Systematic review / Therapy / Treatment outcomes / Tumors / Vigilance