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

Judith A.E.M. Zecha, Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, Stephen T. Sonis, Sharon Elad, Michael R. Hamblin, Andrei Barasch, Cesar Migliorati, Dan M.J. Milstein, Marie Thérèse Genot, Liset Lansaat, Ron van der Brink, Josep Arnabat-Dominguez, Lisette van der Molen, Irene Jacobi, Judi van Diessen, Jan de Lange, Ludi E. Smeele, Mark M. Schubert & 1 others René Jean Bensadoun

Research output: Contribution to journalReview article

41 Citations (Scopus)

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, 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.

Original languageEnglish (US)
Pages (from-to)2781-2792
Number of pages12
JournalSupportive Care in Cancer
Volume24
Issue number6
DOIs
StatePublished - Jun 1 2016

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Head and Neck Neoplasms
Safety
Neoplasms
Radiotherapy
Therapeutics
Stomatitis
Lymphedema
Therapeutic Uses
Low-Level Light Therapy
Fibrosis
Neck
Inflammation
Technology
Pain
Survival
Wounds and Injuries
Research

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

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

In: Supportive Care in Cancer, Vol. 24, No. 6, 01.06.2016, p. 2781-2792.

Research output: Contribution to journalReview article

Zecha, JAEM, Raber-Durlacher, JE, Nair, RG, Epstein, JB, Sonis, ST, Elad, S, Hamblin, MR, Barasch, A, Migliorati, C, Milstein, DMJ, Genot, MT, Lansaat, L, van der Brink, R, Arnabat-Dominguez, J, van der Molen, L, Jacobi, I, van Diessen, J, de Lange, J, Smeele, LE, Schubert, MM & Bensadoun, RJ 2016, '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', Supportive Care in Cancer, vol. 24, no. 6, pp. 2781-2792. https://doi.org/10.1007/s00520-016-3152-z
Zecha, Judith A.E.M. ; Raber-Durlacher, Judith E. ; Nair, Raj G. ; Epstein, Joel B. ; Sonis, Stephen T. ; Elad, Sharon ; Hamblin, Michael R. ; Barasch, Andrei ; Migliorati, Cesar ; Milstein, Dan M.J. ; Genot, Marie Thérèse ; Lansaat, Liset ; van der Brink, Ron ; Arnabat-Dominguez, Josep ; van der Molen, Lisette ; Jacobi, Irene ; van Diessen, Judi ; de Lange, Jan ; Smeele, Ludi E. ; Schubert, Mark M. ; Bensadoun, René Jean. / 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. In: Supportive Care in Cancer. 2016 ; Vol. 24, No. 6. pp. 2781-2792.
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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, 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.",
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T1 - Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer

T2 - part 1: mechanisms of action, dosimetric, and safety considerations

AU - Zecha, Judith A.E.M.

AU - Raber-Durlacher, Judith E.

AU - Nair, Raj G.

AU - Epstein, Joel B.

AU - Sonis, Stephen T.

AU - Elad, Sharon

AU - Hamblin, Michael R.

AU - Barasch, Andrei

AU - Migliorati, Cesar

AU - Milstein, Dan M.J.

AU - Genot, Marie Thérèse

AU - Lansaat, Liset

AU - van der Brink, Ron

AU - Arnabat-Dominguez, Josep

AU - van der Molen, Lisette

AU - Jacobi, Irene

AU - van Diessen, Judi

AU - de Lange, Jan

AU - Smeele, Ludi E.

AU - Schubert, Mark M.

AU - Bensadoun, René Jean

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

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