Efficacy of Photobiomodulation in the Treatment of Cancer Chemotherapy-Induced Oral Mucositis: A Meta-Analysis with Trial Sequential Analysis

Abstract

Oral mucositis is a debilitating complication of chemotherapy, characterized by erythema, ulcers and oedema of the oral mucosa. This review aimed to evaluate the efficacy of Photobiomodulation in the treatment of oral mucositis using meta-analysis and trial sequential analysis, and also to assess the quality of the results by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A comprehensive search of three databases, including Embase, Medline and Central, was performed to identify randomized controlled trials studying the efficacy of Photobiomodulation in the treatment of cancer chemotherapy-induced oral mucositis. The primary outcome was reduction in the severity of oral mucositis. Secondary outcomes were pain relief, duration of oral mucositis and adverse effects. The meta-analysis was performed using the random-effects model, and random errors of the meta-analyses were detected by trial sequential analysis. A total of 6 randomized controlled trials with 398 participants were included in our analysis. Photobiomodulation significantly reduced the severity of oral mucositis when compared to sham radiation (RR 0.43, 95% CI 0.20 to 0.93; p < 0.05). Sensitivity analysis by excluding trials with high risk of bias reiterated the robustness of our results (RR 0.28, 95% CI 0.16 to 0.48). Trial sequential analysis illustrated that the evidence from the meta-analysis was conclusive. The result of the meta-analyses with trial sequential analysis illustrated that Photobiomodulation is an effective therapeutic intervention for the treatment of oral mucositis, and the evidence gathered can be considered conclusive with a moderate level of certainty according to GRADE. Further trials are recommended to standardize the laser parameters required for the optimal effect.

Clinical and Histopathologic Evaluation of the Effect of Laser Photobiomodulation And Epicatechin in the Treatment of Radiation Induced Oral Mucositis in Rat Model

“…(35) The target area was covered with total ED of 5.4 J/cm 2 that was used based on the recommendations of similar trials using energy densities ranging from 2 to 8 J/cm 2 . (35,36) Results of the current study revealed clinically that there was no statistically significant difference among the four groups up to day 7, that revealed the highest MD score, which was in agreement with similar studies. (37) The mean MD score did not exceed 3 in the three therapeutic groups, in contrast to CG with the mean MD score reaching 3.5 on days 8 and 9, reflecting the positive role of the therapeutic agents in managing the condition.…”

Prevention, Evaluation, and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis

“…With a strong base of evidence, the MASCC/ISOO guidelines advise using PBM to avoid oral mucositis brought on by chemotherapy and radiotherapy. http://dx.doi.org/10.52533/JOHS.2022.21210 A recent meta-analysis published after the latest update of MASCC/ISOO included recently emerging evidence to support the efficacy of photobiomodulation in the management of cancer chemotherapy-induced oral mucositis (50). Their findings illustrated that photobiomodulation is an effective therapeutic intervention for reducing oral mucositis severity, so it is advised for the treatment (50).…”

“…http://dx.doi.org/10.52533/JOHS.2022.21210 A recent meta-analysis published after the latest update of MASCC/ISOO included recently emerging evidence to support the efficacy of photobiomodulation in the management of cancer chemotherapy-induced oral mucositis (50). Their findings illustrated that photobiomodulation is an effective therapeutic intervention for reducing oral mucositis severity, so it is advised for the treatment (50). The use of extra-and intra-oral lasers on patients receiving RT for head and neck cancer resulted in improved clinical outcomes and a decrease in oral mucositis (51).…”

“…To assess the patient's risk of relapse and overall survival, long-term follow-up is needed. Additionally, the expensive laser equipment, the requirement for ongoing maintenance, and the requirement for staff training are the drawbacks of PBM (50).…”

Salivary inflammatory mediators as biomarkers for oral mucositis and oral mucosal dryness in cancer patients: A pilot study

“…Oral mucositis (OM) is an inflammatory condition of the oral mucosa characterized by painful erythematous and ulcerative lesions in the oral cavity [ 1 ]. OM occurs as a common side effect in patients with cancer receiving chemotherapy (CTx) and radiotherapy (RT), which can be severe and impede the quality of life [ 2 – 4 ].…”