Management of chemo- and radiotherapy induced oral mucositis with low-energy laser: initial results of A.C. Camargo Hospital

Abstract

Luciano Lauria DIBProfessor of Stomatology at UNIP.ackground. Oral mucositis is a common complication of some malignancies treatment, causing therapeutic modifications due to patient's debilitation, which often interferes with the prognosis of the disease. Many attempts have been made to find an optimal treatment or preventive method to minimize the severity of oral mucositis. Several studies have shown good results with the use of low-energy laser, with the aim of accelerating the process of wound healing and promoting pain relief. Methods. Patients (n=18) who developed oral mucositis during chemotherapy and/or radiotherapy were submitted to low-energy laser applications until cessation of symptoms. Mucositis severity was scored by an oral mucositis scale based on clinical features and by an oral toxicity scale from the National Cancer Institute based on the ability to swallow; pain severity was scored by subjects on a visual analogue scale before and after the applications. Results. Immediate pain relief was achieved in 66.6% of the patients after the first application. Based on the functional scale, mucositis grade III (not capable to eat solids) was reduced in 42.85% of the cases. According to the scale based on the clinical features, mucositis grade IV (ulcerative lesions) was reduced in 75% of the patients that presented this grade of mucositis at the beginning of laser therapy. Conclusions. Low-energy laser was well-tolerated and showed beneficial effects on the management of oral mucositis, improving the quality of life during the oncologic treatment.

Mucosite Oral induzida por terapia oncológica – Uma revisão de literatura.

“…Além disso, as ulcerações trazem alto risco de invasão microbiana, acarretando predisposição às infecções locais ou mesmo sistêmicas. 16 …”

“…27 Também, alguns estudos tem documentado o uso do laser de baixa potência como medida preventiva, pelo fato deste possuir mecanismos de ação biológica capaz de interferir nas fases da MO. 16,22,23 A laserterapia possui um efeito fotobiomodulador e é capaz de diminuir a dor, além de controlar a inflamação. A capacidade de modular uma série de eventos metabólicos por meio de processos fotofísicos e bioquímicos explica as vantagens dessa modalidade terapêutica.…”

Treatment of severe oral mucositis in a pediatric patient undergoing chemotherapy

“…The most common drugs used for treating neoplasms in children and adolescents are: vincristine, paclitaxel, cytarabine, doxorubicin, 5-flurouracyl, cyclophosphamide, cisplatin, and methotrexate; the last four are most commonly associated with the development of changes in the oral mucosa [15][16] . Corroborating these findings, the study patient received one of the drugs most commonly associated with stomatotoxicity.…”

Eficácia da laserterapia nas disfunções têmporo-mandibulares: estudo controle

“…It is known that, according to wavelength, the laser light has the capacity to alter cell functions (production of beta-endorphins, increase in protein synthesis, excretion, metabolism, cell division and repair) and, depending on the dose, it can inhibit or stimulate some of these functions [11][12] . Despite the lack of scientific evidence regarding its mechanism of action [10][11] , some theories try to explain its therapeutic effects: greater release of beta-endorphins 11 ; maintaining the nerve cell membrane potential -reducing the transmission of nerve signals 19 and COX inhibition, reducing local pro-inflammatory substances 20 , and these all yield analgesic and anti-inflammatory effects.…”