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Recommended intraoral photobiomodulation (laser therapy) protocols for prevention of oral mucositis from the MASCC/ISOO

Recommended intraoral photobiomodulation (laser therapy) protocols for prevention of oral mucositis from the MASCC/ISOO
Cancer treatment modality Protocol Wavelength (nm) Power density (irradiance; mW/cm2) Time per spot (seconds) Energy density (fluence; J/cm2) Spot size (cm2) Number of sites* Distance from the tissue Frequency Duration Based on reference
HSCT #1 632.8 31.25 40 1.0 0.8 18 <1 cm Daily From day after cessation of conditioning for 5 days Barasch et al, 1995[1]
#2 650 1000 2 2.0 0.04 54 to 70 In contact Daily From first day of conditioning until day +2 post-HSCT (for 7 to 13 days) Schubert et al, 2007[2]
RT #1 632.8 24 125 3.0 1 12 <1 cm 5 days/week Entire RT course Gautam et al, 2015[3]
RT-CT #1 660 417 10 4.2 0.24 72 In contact 5 days/week Entire RT course Antunes et al, 2013[4]
#2 660 625 10 6.2 0.04 69 In contact 3 days/week (alternate days) Entire RT course Oton-Leite et al, 2015[5]
MASCC: Multinational Association of Supportive Care in Cancer; ISOO: International Society of Oral Oncology; HSCT: hematopoietic stem cell transplantation; RT: radiotherapy; CT: chemotherapy.
* The number of treated surface areas within the oral mucosa receiving laser therapy. Within these areas, laser therapy was applied using a spot treatment technique to cover the entire surface area; spot size was variable in the trials.
¶ Potential thermal effect. The clinician is advised to pay attention to the combination of specific parameters.
References:
  1. Barasch A, Peterson DE, Tanzer JM, et al. Heliumneon laser effects on conditioning-induced oral mucositis in bone marrow transplantation patients. Cancer 1995; 76:2550.
  2. Schubert MM, Eduardo FP, Guthrie KA, et al. A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Support Care Cancer 2007; 15:1145.
  3. Gautam AP, Fernandes DJ, Vidyasagar MS, et al. Low level laser therapy against radiation induced oral mucositis in elderly head and neck cancer patients-a randomized placebo controlled trial. J Photochem Photobiol B 2015; 144:51.
  4. Antunes HS, Herchenhorn D, Small IA, et al. Phase III trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation. Radiother Oncol 2013; 109:297.
  5. Oton-Leite AF, Silva GB, Morais MO, et al. Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer patients. Lasers Surg Med 2015; 47:296.
Reprinted by permission from: Springer: Supportive Care in Cancer. Zadik Y, Arany P, Rodrigues Fregnani ER, et al. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 2019; 27:3969. Copyright © 2019. https://link.springer.com/journal/520.
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