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A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis

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Abstract

Purpose

The purpose of this study is to review the effects of low-level laser therapy (LLLT) in the prevention and treatment of cancer therapy-induced oral mucositis (OM).

Methods

A systematic review and meta-analysis of randomised placebo-controlled trials of LLLT performed during chemotherapy or radiation therapy in head and neck cancer patients.

Results

We found 11 randomised placebo-controlled trials with a total of 415 patients; methodological quality was acceptable at 4.10 (SD ± 0.74) on the 5-point Jadad scale. The relative risk (RR) for developing OM was significantly (p = 0.02) reduced after LLLT compared with placebo LLLT (RR = 2.03 (95% CI, 1.11 to 3.69)). This preventive effect of LLLT improved to RR = 2.72 (95% CI, 1.98 to 3.74) when only trials with adequate doses above 1 J were included. For treatment of OM ulcers, the number of days with OM grade 2 or worse was significantly reduced after LLLT to 4.38 (95% CI, 3.35 to 5.40) days less than placebo LLLT. Oral mucositis severity was also reduced after LLLT with a standardised mean difference of 1.33 (95% CI, 0.68 to 1.98) over placebo LLLT. All studies registered possible side-effects, but they were not significantly different from placebo LLLT.

Conclusions

There is consistent evidence from small high-quality studies that red and infrared LLLT can partly prevent development of cancer therapy-induced OM. LLLT also significantly reduced pain, severity and duration of symptoms in patients with cancer therapy-induced OM.

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Acknowledgements

Post-mortem to professor Anne Elisabeth Ljunggren for her encouragement and contribution to the early work on this manuscript. Unfortunately, she was unable to see its completion.

Conflicts of interest

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Authors and Affiliations

  1. Centre for Evidence-Based Practice, Bergen University College-HiB, Moellendalsvn. 6, 5009, Bergen, Norway

    Jan Magnus Bjordal

  2. Service d’Oncologie Radiothérapique, CHU de Poitiers, BP 577, 86021, Poitiers Cedex, France

    Rene-Jean Bensadoun

  3. Grängesberg Dental Clinic, Grängesberg, Sweden

    Jan Tunèr

  4. University of Cruzeiro do Sul, Sao Miguel Paulista, SP, Brazil

    Lucio Frigo

  5. Department of Clinical Odontology, University of Bergen, Bergen, Norway

    Kjersti Gjerde

  6. Institute of Biomedical Sciences, University of São Paulo (USP), São Paulo, Brazil

    Rodrigo AB Lopes-Martins

  7. Centro de Pesquisa Clínica em Biofotônica Aplicada às Ciências da Saúde, Universidade Nove de Julho, São Paulo, Brazil

    Rodrigo AB Lopes-Martins

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  1. Jan Magnus Bjordal
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  2. Rene-Jean Bensadoun
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  6. Rodrigo AB Lopes-Martins
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Correspondence to Jan Magnus Bjordal.

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Bjordal, J.M., Bensadoun, RJ., Tunèr, J. et al. A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis. Support Care Cancer 19, 1069–1077 (2011). https://doi.org/10.1007/s00520-011-1202-0

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  • DOI: https://doi.org/10.1007/s00520-011-1202-0

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