Photobiomodulation for chemotherapy‐induced oral mucositis in leukemic children: A randomized controlled clinical trial

Abstract

Objectives Evaluation of the effectiveness of Photobiomodulation(PBM) for chemotherapy‐induced oral mucositis (OM) in leukemic children. Materials and methods A randomized controlled clinical study including forty‐four leukemic children diagnosed with chemotherapy‐induced OM at the Hematology/Oncology inpatient unit at Alexandria University Children's Hospital, Alexandria, Egypt. Patients were randomly assigned to either the control or test groups with a 1:1 ratio. The control group received conventional symptomatic treatment, while the test group was treated with PBM in addition to the symptomatic treatment. The response to both treatment modalities was evaluated according to the reduction of pain and lesions severity from baseline to 5, 10, and 14 days after treatment. Results A significant reduction of pain was recorded on day 10 in the test group compared to the control group (p < 0.001). There was also a significant decline in the OM grades between the two groups on day14 (p = 0.003). No adverse events were reported. Conclusions The use of PBM along with the conventional treatment was effective in reducing pain and in the recovery of OM lesions in children receiving chemotherapy for the treatment of ALL. It was also safe and applicable to children.

Photobiomodulation for Chemotherapy-Induced Oral Mucositis in Pediatric Patients

“…In total, 4 out of 15 retrieved papers were randomized controlled trials (RCTs) comparing the PBM treatment of OM lesions caused by chemotherapy to no treatment [ 8 , 17 , 18 , 19 ]. Two of them were controlled by a placebo treatment and the patients, along with their parents, were blinded to what kind of therapy they have received [ 17 , 18 ].…”

“…Differences also arose from the frequency of laser therapy sessions, where in some cases they were delivered daily [ 8 , 8 , 17 , 20 , 21 , 22 ], and in other they were delivered every second day [ 13 , 19 , 25 , 26 ]. Additionally, some protocols had a definite number of sessions [ 8 , 13 , 17 , 18 , 19 , 20 ], while others provided PBM treatment until the clinical resolution of the lesion [ 21 , 22 ]. Discrepancies were acknowledged also between the authors’ PBM protocols depending on whether it was used for OM prophylaxis rather than treatment [ 24 ].…”

“…This could be the reason for some controversial study results and an explanation for why it is so difficult to find the optimal PBM protocol parameters. On the other hand, there are multiple clinical trials that observed similar positive effects on OM resolution and pain management despite using different PBM parameters [ 8 , 17 , 18 , 19 , 32 , 46 , 47 , 48 ]. It is therefore sensible to adjust them in a way to make the protocol feasible and child-friendly.…”

“…Only a few systematic reviews have addressed this issue, and large well-controlled studies on the pediatric population exclusively are lacking to determine the exact dose and protocol recommendations [ 5 , 30 ]. With our literature search, we were able to retrieve some high-quality studies that focused on the use of PBM in the treatment of chemotherapy-induced OM in children, which rendered similar clinical outcomes, and further elaborated the importance of laser therapy when it comes to OM healing and pain management [ 8 , 17 , 18 , 19 ]. Unfortunately, studies regarding OM prophylaxis were of a lower quality.…”

“…Due to rapidly dividing cells, oral mucosa is highly sensitive to the damaging effects of cytotoxic drugs or radiotherapy (RT) to the head and neck region. Children and young adults are thus predisposed to develop this condition because they have a higher epithelial mitotic rate [ 5 , 7 , 8 ]. Age, as well as the type of malignancy and treatment regime, are some factors that influence the incidence of chemotherapy-induced OM.…”