Scottsdale, AZ—Therapeutic, low-level laser therapy (LLLT) reduces pain and accelerates the resolution of oral mucositis (OM) in patients with head and neck cancer receiving chemoradiotherapy (CRT), according to Eric Allan, MD, a radiation oncology medical resident, Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, and colleagues.1
OM is a highly common side effect in patients receiving head and neck radiation therapy (RT) and simultaneous CRT. It can cause severe pain, infection, weight loss, higher hospitalization rates and costs of treatment, and treatment breaks resulting in increased morbidity and reduced treatment efficacy.
The investigators used a laser regimen on patients with head and neck cancer receiving CRT and RT, and presented their preliminary clinical results in a poster at the 2016 Multidisciplinary Head and Neck Cancer Symposium.
Since 2013, 53 patients had been referred for therapeutic LLLT upon developing substantial and troublesome Radiation Therapy Oncology Group grade 2 to 3 OM during RT/CRT, or in cases of OM persisting several weeks following RT/CRT. All patients received treatment on a weekly or biweekly basis—depending on severity —until their ulcerations were completely resolved.
Dr Allan and colleagues used 2 lasers in their therapeutic LLLT regimen: a class 4 Er, Cr: YSGG laser for debridement, and a class 4 diode laser for biostimulation and pain relief. The primary goal of the regimen was pain mitigation for patients still actively undergoing RT/CRT; after completion of RT/CRT, patients were treated with wound-healing intent.
“To assess the efficacy of our LLLT regimen, we controlled for variation in OM due to differences in chemotherapy, RT dose, and surgical management by isolating 13 patients from our laser-treated cohort and retrospectively comparing them to 20 patients from a non−laser-treated cohort,” Dr Allan stated. All 33 patients in the comparison cohort completed a course of RT plus cetuximab for definitive treatment of oropharyngeal carcinoma between 2010 and 2015, and had developed grade 2 or worse OM by the end of therapy.
Full clinical resolutions of oral ulcerations were experienced by all 53 patients in the study. A total of 41 patients initiated LLLT treatment during, or ≤1 month of, RT/CRT completion, and 12 initiated treatment >1 month after therapy completion. Patients received a number of treatments ranging from 2 to 15, with a median of 7.
In the cohort comparison, those treated with LLLT had better pain control at 1 and 3 months after completion of CRT, as well as lower rates of residual OM and opioid analgesia use at 3 months after completing CRT. This was observed despite the LLLT cohort showing higher pain and grade OM scores at the end of CRT when compared to the nonlaser cohort.
At the end of CRT, 92% (n = 12) of patients in the laser cohort had OM grades ≥3 compared with 60% (n = 12) in the nonlaser cohort. However, 3 months after CRT, only 31% (n = 4) of patients treated with LLLT showed OM of grades ≥1 OM versus 80% (n = 16) in the nonlaser group.
Based on these results, the investigators concluded that therapeutic LLLT for the treatment of OM associated with head and neck cancer RT/CRT is indeed feasible, and was delivered safely to a clinically diverse cohort of patients. However, further clinical studies are warranted to validate these preliminary results.
Reference
1. Allan E, Barney C, Baum S, et al. Low-level laser therapy and laser debridement for management of oral mucositis in patients with head and neck cancer receiving chemotherapy and radiation. Presented at: Multidisciplinary Head and Neck Cancer Symposium; February 18-20, 2016; Scottsdale, AZ. www.redjournal.org/article/S0360-3016(15)26904-0/pdf. Accessed April 4, 2016.