Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation

Abstract

Background Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient's quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. Material and Methods A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019. Results The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF> 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment. Conclusions Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures. Key words: Photobiomodulation, head and neck neoplasms, radiotherapy, xerostomia, saliva.

Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2

“…They demonstrated unchanged unstimulated salivary flow during RT but decreased saliva quantity 1 month after the end of cancer treatment. Despite not corroborating the role of PBM in modulating hyposalivation and salivary gland damage, a concomitant intraoral, lower dose protocol was used for OM that was not the main objective of the study confounding the interpretations of their results [35]. Interestingly, the control of hyposalivation induced by RT seems to be positively affected by PBM treatment strategies [47].…”

Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello

“…Cuando la capacidad secretora residual de las glándulas salivales aún está presente, puede ser apropiada la estimulación de la secreción salival 46 . Entre las opciones reportadas en la literatura están los fármacos parasimpaticomiméticos, la acupuntura, la fitoterapia, la estimulación nerviosa y la PBMT 38,[45][46][47][48][49][50][51][52][53][54][55][56][57][58] .…”

“…Es bien sabido el papel de la PBMT en el tratamiento de la RIOM; además, debido a su bajo costo y fácil aplicación, se espera que tenga la misma eficacia en reducir la queja de xerostomía reportada por los pacientes con CCC. Ribeiro et al 57 concluyeron que la PBMT no interfirió significativamente en la incidencia de xerostomía, pero sí parece evitar que esta complicación se agrave. Otra investigación no encontró diferencias significativas en la xerostomía entre el grupo que recibió la PBMT y el grupo control 58 .…”

Prognostic role of the prognostic nutritional index (PNI) in patients with head and neck neoplasms undergoing radiotherapy: A meta-analysis

“…The inclusion criteria were as follows: (1) patients were diagnosed with HNNs histopathologically; (2) patients were treated with radiotherapy; (3) the association between pretreatment PNI and OS, PFS, and/or DMFS was recorded.…”

“…A relatively worse and uncertain 5-year survival rate for HNN patients, varying from 30% to 70% based on the stage and location of the tumor, has been reported by Hoesseini et al [ 2 ]. The standard therapies for initial and locally advanced malignant HNNs have long been considered radiotherapy and surgery with or without chemotherapy [ 3 ]. Although the recent two decades have seen the rapid development of radiotherapy technology, some inevitably severe side effects profoundly impact patient survival outcomes after treatment, such as oral mucositis, dysgeusia, and dysphagia [ 4 ].…”