Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT)

Abstract

Oral mucositis (OM) is a debilitating and serious side effect in patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Laser therapy is becoming a promising treatment option in these patients, avoiding the necessity of enteral/parenteral nutrition. The aim of this study was to evaluate the efficacy of laser therapy in patients affected by oral mucositis induced by chemotherapy and HSCT. Sixteen onco-hematological pediatric patients receiving chemotherapy and hematopoietic stem cell transplantation, affected by oral mucositis, were enrolled in this study. They were divided in two randomized groups: the laser group and the placebo-control group. Patients in the laser group were treated with HPLT (970 ± 15 nm, 3.2 W (50%), 35-6000 Hz, 240 s) for four consecutive days, once a day; and placebo group underwent sham treatment. The assessment of mucositis was recorded through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through Visual Analogue Scale (VAS). Patients were monitored and evaluated 3, 7, and 11 days after the first day of laser therapy. Once OM was diagnosed, the patients had mucositis grading assessments before laser or sham application at day 3, 7, and 11 after first application. All patients of laser group demonstrated improvement in pain sensation from day 3 after first application of laser (p < 0.05), ulcerations reduced their dimensions and erythema disappeared. The patients of placebo group had improvement from day 7. In laser group, all mucositis were fully resolved from day 7 (p < 0.05). Oral mucositis negatively impacts on nutritional intake, oral hygiene, and quality of life. Laser therapy appears to be a safe and innovative approach in the management of oral mucositis. In this preliminary study, HPLT encourages to consider laser therapy as a part of onco-hematological protocol, providing to decrease pain and duration of OM induced by CT and HSCT. Further researches will be needed, especially randomized, controlled clinical trials with a large number of enrolled patients and a long term of follow-up to confirm the efficacy of laser therapy in prevention and control of OM in onco-hematological pediatric patients.

Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside

“…Oral mucositis (OM) is characterized by erythema, ulceration, pain and, eventually, bleeding; the loss of integrity of the oral mucosa can favor local and systemic infections that can compromise nutrition and fluid intake [3,9,10]. On the other hand, gastrointestinal mucositis (GIM) is sometimes responsible for nausea, vomiting and diarrhea.…”

Evaluation of Oral Mucositis Occurrence in Oncologic Patients under Antineoplastic Therapy Submitted to the Low-Level Laser Coadjuvant Therapy

“…The main forms of treatment for malignant neoplasms are chemotherapy and radiotherapy, which often cause various side effects such as oral mucositis (OM) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. This condition begins asymptomatic and, later, an erythema appears, which may be followed by erosion or ulceration of the oral mucosa, sometimes covered by a fibrinopurulent pseudomembrane and may lead to spontaneous bleeding [ 3 , 11 ].…”

Royal jelly and propolis therapies reduce inflammation and stimulate healing of oral mucositis in rats

“…We observed lower clinical and histopathological OM scores already on day 8, three days after the beginning of treatment, in the RJ and propolis groups compared to the control group. also reported a signi cant decrease in lesion size and the absence or reduction of ulcers and local in ammation [1,20,21,23,25,27,44]. We therefore consider that the use of fresh RJ and 10% propolis was as effective as PBMT by accelerating healing and reducing in ammation in cases of chemically induced OM.…”

“…It is estimated that more than 90% of patients undergoing radiotherapy for head and neck cancers have some degree of OM. This condition is therefore considered one of the most important acute side effects observed in patients with head and neck cancer submitted to radiotherapy and/or chemotherapy [1][2][3][4].…”