The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 23 , ISSUE 1 ( January, 2022 ) > List of Articles


Low-level Laser Therapy in the Management of Oral Mucositis Induced by Radiotherapy: A Randomized Double-blind Clinical Trial

Alessandra Kuhn-Dall'Magro, Eduardo Zamboni, Tobias Fontana, Letícia C Dogenski, João P de Carli, Fernado Fornari

Keywords : Laser therapy, Oral mucositis, Radiotherapy

Citation Information : Kuhn-Dall'Magro A, Zamboni E, Fontana T, Dogenski LC, Carli JP, Fornari F. Low-level Laser Therapy in the Management of Oral Mucositis Induced by Radiotherapy: A Randomized Double-blind Clinical Trial. J Contemp Dent Pract 2022; 23 (1):31-36.

DOI: 10.5005/jp-journals-10024-3277

License: CC BY-NC 4.0

Published Online: 21-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: The present study evaluated the effect of LLLT at red and infrared wavelengths associated with therapeutic measures from the Mucositis Study Group of the Multinational Association of Supportive Care of Cancer and International Society of Oral Oncology (MASCC/ISOO) for preventing and treating RT-induced oral mucositis (OM). Materials and methods: For the study, 80 subjects diagnosed with head and neck cancer (HNC) undergoing treatment were randomized into three groups to apply different photobiomodulation protocols for 42 days, as follows: Group I—LLLT of 660 nm; Group II—LLLT of 810 nm; and Group III—association of wavelengths of 660 and 810 nm. The treatments were performed by properly trained professionals and with equipment calibrated for the intervention. Results: Different OM scores were noted for the groups studied, and the third group had lower scores than Groups I and II (p = 0.012). No difference was noted in the pain score analyzing the groups (p = 0.49). Conclusion: The LLLT was effective for OM lesions in individuals treated with radiotherapy associated or not with chemotherapy. When combined, the red and infrared lasers reduce OM scores. Clinical significance: OM is one of the main adverse effects of antineoplastic therapy in head and neck cancer patients. The evidence supporting the validity of LLLT for OM can improve patients’ quality of life.

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394–424. DOI: 10.3322/caac.21492.
  2. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol 2017;3(4):524–548. DOI: 10.1001/jamaoncol.2016.5688.
  3. Chow LQM. Head and neck cancer. N Engl J Med 2020;382(1):60–72. DOI: 10.1056/NEJMra1715715.
  4. Boras VV, Fučić A, Baranović S, et al. Environmental and behavioural head and neck cancer risk factors. Cent Eur J Public Health 2019;27(2):106–109. DOI: 10.21101/cejph.a5565.
  5. Allen C, Her S, Jaffray DA. Radiotherapy for cancer: present and future. Adv Drug Deliv Rev 2017;109:1–2. DOI: 10.1016/j.addr.2017.01.004.
  6. Semrau R. The role of radiotherapy in the definitive and postoperative treatment of advanced head and neck cancer. Oncol Res Treat 2017;40(6):347–352. DOI: 10.1159/000477128.
  7. Marín-Conde F, Castellanos-Cosano L, Pachón-Ibañez J, et al. Photobiomodulation with low-level laser therapy reduces oral mucositis caused by head and neck radio-chemotherapy: prospective randomized controlled trial. Int J Oral Maxillofac Surg 2019;48(7): 917–923. DOI: 10.1016/j.ijom.2018.12.006.
  8. Alterio D, Marvaso G, Ferrari A, et al. Modern radiotherapy for head and neck cancer. Semin Oncol 2019;46(3):233–245. DOI: 10.1053/j.seminoncol.2019.07.002.
  9. Curra M, Soares Junior LAV, Martins MD, et al. Chemotherapy protocols and incidence of oral mucositis. An integrative review. Einstein (Sao Paulo) 2018;16(1):eRW4007. DOI: 10.1590/s1679-45082018rw4007.
  10. Cidon EU. Chemotherapy induced oral mucositis: prevention is possible. Chin Clin Oncol 2018;7(1):6. DOI: 10.21037/cco.2017.10.01.
  11. Blakaj A, Bonomi M, Gamez ME, et al. Oral mucositis in head and neck cancer: evidence-based management and review of clinical trial data. Oral Oncol 2019;95:29–34. DOI: 10.1016/j.oraloncology.2019.05.013.
  12. Al-Dasooqi N, Sonis ST, Bowen JM, et al. Mucositis Study Group of Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Emerging evidence on the pathobiology of mucositis. Support Care Cancer 2013;21(7): 2075–2083. DOI: 10.1007/s00520-013-1810-y.
  13. Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, et al. Prevention and treatment of chemotherapy and radiotherapy induced oral mucositis. Medicina (Kaunas) 2019;55(2):25. DOI: 10.3390/medicina55020025.
  14. Mallick S, Benson R, Rath GK. Radiation induced oral mucositis: a review of current literature on prevention and management. Eur Arch Otorhinolaryngol 2015;273(9):2285–2293. DOI: 10.1007/s00405-015-3694-6.
  15. Zadik Y, Arany PR, Fregnani ER, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 2019;27(10):3969–3983. DOI: 10.1007/s00520-019-04890-2.
  16. He M, Zhang B, Shen N, et al. A systematic review and meta-analysis of the effect of low-level laser therapy (LLLT) on chemotherapy-induced oral mucositis in pediatric and young patients. Eur J Pediatr 2017;177(1):7–17. DOI: 10.1007/s00431-017-3043-4.
  17. Lalla RV, Bowen J, Barasch A, et al. Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014;120(10):1453–1461. DOI: 10.1002/cncr.28592.
  18. Zecha JA, Raber-Durlacher JE, Nair RG, et al. Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: Part 1: Mechanisms of action, dosimetric, and safety considerations. Support Care Cancer 2016a;24(6):2781–2792. DOI: 10.1007/s00520-016-3152-z.
  19. Hamblin MR, Nelson ST, Strahan JR. Photobiomodulation and cancer: What is the truth? Photomed Laser Surg 2018;36(5):241–245. DOI: 10.1089/pho.2017.4401.
  20. Bensadoun RJ. Photobiomodulation or low-level laser therapy in the management of cancer therapy-induced mucositis, dermatitis and lymphedema. Curr Opin Oncol 2018;30(4):226–232. DOI: 10.1097/CCO.0000000000000452.
  21. World Health Organization. WHO handbook for reporting results of cancer treatment. vol. 48. Genebra: Offset Publication; 1979. p. 15–22.
  22. Kuhn A, Heinzmann G, Silva CA, et al. Low-level infrared laser therapy to prevent radiotherapy-induced oral mucositis: A randomized placebo-controlled study. J Oral Laser Appl 2008; 8(4):219–224. Available at: Accessed: April 19, 2022.
  23. Chan S, Rowbottom L, McDonald R, et al. Does the time of radiotherapy affect treatment outcomes? A review of the literature. Clin Oncol (R Coll Radiol) 2016;29(4):231–238. DOI: 10.1016/j.clon.2016.12.005.
  24. Noirrit-Esclassan E, Valera MC, Vignes E, et al. Photobiomodulation with a combination of two wavelengths in the treatment of oral mucositis in children: the PEDIALASE feasibility study. Arch Pediatr 2019;26(5):268–274. DOI: 10.1016/j.arcped.2019.05.012.
  25. Hamblin MR. Photobiomodulation or low-level laser therapy. J Biophotonics 2016;9(11–12):1122–1124. DOI: 10.1002/jbio.201670113.
  26. Antunes HS, Herchenhorn D, Small IA, et al. Long-term survival of a randomized phase III trial of head and neck cancer patients receiving concurrent chemoradiation therapy with or without low-level laser therapy (LLLT) to prevent oral mucositis. Oral Oncol 2017;71:11–15. DOI: 10.1016/j.oraloncology.2017.05.018.
  27. Migliorati C, Hewson I, Lalla RV, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Support Care Cancer 2013;21(1):333–341. DOI: 10.1007/s00520-012-1605-6.
  28. Kuhn A, Porto FA, Miraglia P, et al. Low-level infrared laser therapy in chemotherapy-induced oral mucositis: a randomized placebo-controlled trial in children. J Pediatr Hematol Oncol 2009;31(1):33–37. DOI: 10.1097/MPH.0b013e318192cb8e.
  29. Mosca RC, Ong AA, Albasha O, et al. Photobiomodulation therapy for wound care: a potent, noninvasive, photoceutical approach. Adv Skin Wound Care 2019;32(4):157–167. DOI: 10.1097/01.ASW.0000553600.97572.d2.
  30. Pandeshwar P, Roa MD, Das R, et al. Photobiomodulation in oral medicine: a review. J Investig Clin Dent 2016;7(2):114–126. DOI: 10.1111/jicd.12148.
  31. Lima AMCT, Silva SLP, Fonseca AS. Photobiomodulation via multiple-wavelength radiations. Lasers Med Sci 2019;35(2):307–316. DOI: 10.1007/s10103-019-02879-1.
  32. Campos L, Cruz ÉP, Pereira FS, et al. Comparative study among three different phototherapy protocols to treat chemotherapy-induced oral mucositis in hamsters. J Biophotonics 2016;9(11–12):1236–1245. DOI: 10.1002/jbio.201600014.
  33. Zecha JA, Raber-Durlacher JE, Nair RG, et al. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: Part 2: Proposed applications and treatment protocols. Support Care Cancer 2016b;24(6):2793–2805. DOI: 10.1007/s00520-016-3153-y.
  34. Brandão TB, Morais-Faria K, Ribeiro ACP, et al. Locally advanced oral squamous cell carcinoma patients treated with photobiomodulation for prevention of oral mucositis: retrospective outcomes and safety analyses. Support Care Cancer 2018;26(7):2417–2423. DOI: 10.1007/s00520-018-4046-z.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.