Kastyro I.V., Reshetov I.V., Korenev S.V., Fatyanova A.S., Babaeva Yu.V., Romanko Yu.S. Photobiomodulation of oral mucositis in chemoradiotherapy for head and neck cancer. Head and neck. Russian Journal. 2023;11(2):65–74 The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, drawings, photographs of patients.
The article presents the results of the most significant studies on the effectiveness of photobiomodulation (PBM) in the treatment of oral mucositis (OM) in patients receiving radiation or chemoradiotherapy for head and neck cancer (HNC). On this issue, we analyzed the Scopus, WoS, MedLine databases and found 55 sources. In the review, we reviewed various experimental and clinical aspects of performing PBM in the prevention and treatment of OM during radiotherapy (RT) or chemoradiation therapy (CRT) HNC, recommended PBM parameters, and directions for future research. The descriptive overview and presentation of the PBM parameters is based on current data and expert opinion.
In experimental studies, it was found that PBM improves and accelerates tissue repair, which is associated with an improvement in intracellular calcium metabolism and an acceleration of ATP synthesis in mitochondria. The effect of laser light with different wavelengths on oxidative stress in vivo in oncological patients suffering from OM and in vitro in two types of cells that are present in large numbers in the inflamed oral mucosa: neutrophil polymorphonuclear granulocytes and keratinocytes was evaluated. It has been established that PBM has a different effect on the redox state of polymorphonuclear granulocytes and keratinocytes depending on the wavelength used, which prompts the verification of the protocol with several wavelengths. Differences in gene expression in oral mucosal keratinocytes in patients treated with PBM were investigated and an attempt was made to link molecular mechanisms to clinical data. It was found that genes that are induced during human epidermal keratinocyte differentiation were upregulated, while genes associated with cytotoxicity and immune response were downregulated in the laser radiation group. Data are presented indicating that the HLA and IRF genes are the main genes regulated by the PBM in the prevention of OM in patients with HNC after CRT. At the same time, the regulation of the immune system with the help of PBM is the main action in the prevention of OM. It has been established that salivary alpha-1 antitrypsin (A1AT) and macrophage migration inhibitory factor (MIF) can be potential predictive biomarkers of severe cancer-induced OM. Recent advances in clinical PBM have increased patient adherence to cancer treatment, improved quality of life and treatment outcomes. PBM may have potential use in the treatment of a wide range of side effects of RT and CRT in patients treated for HNCThe use of PBM in combination with other medical technologies is also promising. Several clinical studies have evaluated PBM in combination with photodynamic therapy (PDT) for the treatment of OM. It was demonstrated that the complex variant of PBM+PDT led to a significantly shorter healing time compared to the use of PBM alone. An analysis of randomized clinical trials of OM PBM in patients treated with HNC, followed by a study of the cost-effectiveness of therapy, showed that the latter was clinically effective and cost-effective. At the same time, the introduction of PBM into the maintenance therapy of patients who underwent RT HNC benefits both the patient and the medical system, reducing the incidence and costs associated with OM.
Conclusion. Suggested exposure parameters and dosimetric parameters for PBM that are potentially effective in OM provide guidance for future research. At the same time, it is necessary that such studies include elucidation of the effect of PBM on the outcomes of treatment with HNC. Thanks to a better understanding of the mechanisms of action and the improvement of dosimetry, PBM has risen to a qualitatively new level of development. Recent advances in PBM demonstrate that in the future this medical technology will contribute to the successful treatment of an increasingly wide range of complications that develop in the treatment of HNC.
Key words: photobiomodulation, PBM, low-level laser therapy, LLLT, low-level light therapy, oral mucositis, orofacial complications, head and neck cancer, chemotherapy, radiation therapy, prevention, supportive care, toxicity, quality of life, cost-effectiveness, ATP, alpha-1- antitrypsin, factors inhibiting macrophage migration, salivary proteins.
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study